What is Bipolar Disorder?

By Carol Mirones, LCSW

Many times we have clients that are coming to our psychotherapists for help with behaviors that they don’t understand. They’re confused and scared because they don’t recognize themselves. Their thought processes are off, their behaviors are off, and they’re either really up or really down.

Talking to a psychotherapist can help someone not feel so alone. We can help to normalize what you’re going through and give you tools to help you start to feel better.

First, let’s talk about what bipolar disorder is for those of you wondering if you may have this mental health condition. There are three main types of bipolar disorder:

• Bipolar I
• Bipolar II
• Cyclothymia

Let’s break them down.

Bipolar I

Bipolar I can only be diagnosed when a person has experienced at least one full manic episode. What’s a manic episode? The book mental health professionals use to diagnose mental health disorders is called the Diagnostic and Statistical Manual of Mental Disorders, we’re in the 5th edition so it’s abbreviated to the DSM-5. This book clearly outlines what the symptoms of mania are: 

Manic Episode:

1. A distinct period of time when your mood is persistently elevated, expansive, or irritable, combined with having increased activity and energy. This lasts for at least a week and is present for most of the day, everyday that the person is manic
2. During the manic episode three or more of the following symptoms have to be present and represent a noticeable change from your usual behaviors:
   1. Inflated self-esteem and grandiosity, or heightened irritability
   2. Getting very little sleep (but feels rested after minimal sleep), decreased need for sleep
   3. More talkative than normal or feeling pressured to keep talking
   4. Having tons of ideas popping into your head or feeling like your thoughts are racing
   5. Easily distracted (usually observed by others)
   6. Increase in goal-directed behaviors (may get fixated on something and spend all your time focused on that); or feel restless, edgy, and purposeless combined with a feeling that you’ve got to move your body (fidgets, shakes leg, pacing)
   7. Partaking in more risky behaviors that are outside your norm (e.g., excessive spending, gambling, sexual indiscretions, foolish business investments).
3. The mood disturbance is causing you impaired functioning in your life; either in your work or school, your relationships, or your physical well-being; or there are psychotic features (delusional thoughts, paranoia, hallucinations, lack of awareness of reality).
4. We can’t diagnose mania if the client has been abusing drugs, or using a medication that may have contributed to the manic episode, or if they have a medical condition that mania may be a symptom of. 

The name Bipolar kind of says it all, a manic episode is on one side of the pole and on the other is a depressive episode. You don’t have to have had a depressive episode in order for your mental health practitioner to diagnose bipolar I, but it is very common for people to swing back and forth along the poles. 

In order for psychotherapists to diagnose a depressive episode for bipolar we look to the DSM-5 and see if the client meets the following criteria:

1. Five (or more) of the following symptoms have to have been present during the same 2 week period and represent a change from how the client had been previously functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure in things that used to bring you pleasure

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: in children and adolescents, can appear as an irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% body weight in a month), or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia (oversleeping) nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others) – when you’re pacing, fidgeting, shaking your leg, can’t sit down; or the opposite – you can barely move
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for commiting suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or    important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition. 

Bipolar II

When you’re watching movies or TV shows they’re often showing people with bipolar I, but bipolar II can be very disruptive to a person’s life as well. The difference is the type of mania a person experiences. With bipolar II a person has hypomania. The DSM-5 classifies hypomania as:

Hypomania:

1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.
2. During the period of mood disturbance and increased energy and activity, there (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from the usual behavior, and have been present to a significant degree:
   1. Inflated self-esteem or grandiosity
   2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
   3. More talkative than usual or pressure to keep talking
   4. Flight of ideas or subjective experience that thoughts are racing
   5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli(, as reported or observed
   6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscrimination, or foolish business investments)
3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
4. The disturbance in mood and the change in functioning are observable by others.
5. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
6. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.

In order to diagnose Bipolar II, a person has to have experienced at least one hypomanic episode combined with a depressive episode (the depressive episode symptoms are the same as the Bipolar I depressive symptoms). The person has to have NEVER had a full manic episode, and the person’s depressive symptoms are causing them clinical distress and impairment in their functioning, but their hypomanic symptoms do not cause them impairment or distress in functioning.

Cyclothymic Disorder

This one is pretty rare, but falls under the bipolar umbrella of mental health disorders. People with Cyclothymia symptoms alternate between vast emotional highs and lows. They don’t meet all the criteria for hypomania or major depression (and never have); but they have been having mood swings for at least two years and their symptoms have been present for at least half that time period. And, they have not gone without symptoms for more than 2 months in those two years. 

Symptoms are similar to Bipolar I and Bipolar II, but they’re less severe. People with cyclothymic disorder can usually function in their daily life, though it’s certainly not easy. Having unpredictable mood swings is never fun for the person having them or the people around them. 

What do I do if I think I might have bipolar?

First, the fact that you’re here reading about bipolar is amazing. The next step is to reach out to a mental health professional. A psychotherapist will do a thorough assessment of your history, we’ll ask you a series of questions that help us in formulating a diagnosis. We will help you to come up with treatment goals and objectives that are unique to you and match how you want to manage this disorder.

One of the things we stress to our clients at Seasons Psychotherapy Associates is that you may have a mental health disorder like bipolar, but you are not ‘Bipolar.’ You’re still you, with all the amazingly unique things about you that make you special and awesome. Getting diagnosed with a mental health disorder is no different than getting diagnosed with diabetes or multiple sclerosis. 

There are ways to manage the disorder, and we help you do that. Having an unbiased, trained professional evaluating your mood each week (or once you’re stable – maybe only once per month) is very helpful. Your psychotherapist will also either refer you to a medical doctor or consult with any doctors you already see about the possibility of adding medication to your treatment. Medication is usually a helpful and necessary component to bipolar disorder treatment. 

Studies show that patients using a combination of psychotherapy and drug therapy have fewer recurrences and fewer symptoms over 12 months versus those using medication alone. We understand that taking medication may be scary, and that’s why having someone to talk through your fears is useful. 

We encourage you to reach out to make an appointment with one of our clinicians if you feel that you or a loved one is experiencing symptoms of bipolar disorder. We’re here to help. 

Resources: 

BP Hope: https://www.bphope.com/

NAMI Connection Recovery Support Group is a free, peer-led support group for any adult who has experienced symptoms of a mental health condition. https://namibroward.org/support-and-education/support-groups/nami-connection/

https://ibpf.org/

Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner by Julie A. Fast (Author), John D. Preston (Author)

The Bipolar Disorder Survival Guide: What You and Your Family Need to Know Third Edition by David J. Miklowitz (Author)