The Many *EvIL* Faces of Bipolar Disorder
Bipolar Disorder's Bi-Polarity
The Statistics of Bipolar disorder
Approximately 3-4% of the population of the United States over the age of 18 is affected by Bipolar Disorder at any given time. That may not sound like a very big number, but what about this one: an estimated 5.7 million people in the U.S. is living with this often-times debilitating disorder, and of the 35,000 people who commit suicide every year in the United States, over 90% of them were suffering with (either diagnosed or undetected but suspected) a major mental disorder, and Bipolar Disorder tops that list as one of the most prevalent disorders amongst suicide victims. The National Institute of Mental Health reports that of the 5.7 million bipolar sufferers in the United States, over 82% are considered severe cases. 48% of the people who suffer from bipolar disorder are receiving treatment; of those receiving treatment, a disturbingly low 39.2% are receiving minimally adequate care (21.8% of the total sufferers). In other words, the majority of bipolar disorder (BD) sufferers are walking around every day of their lives without any sort of medical treatment, and if left untreated, bipolar disorder continues to get worse. The median age of onset of BD is 25 years old, although it can start as early as five years old and as late as over 50 years old. An equal number of men and women suffer from BD and it is prevalent in all races, ethnic groups, and socioeconomic statuses. Bipolar disorder is known to have a high hereditary factor; more than 2/3 of people with a diagnosis of Bipolar disorder have a close family member with the same diagnosis or a major depressive disorder. Furthermore, women are three times more likely to experience rapid cycling (going from mania to depression and back) whereas men are more likely to be manic rather than depressed, and their mania lasts longer.
According to the American Journal of Psychiatry, Bipolar disorder is a psychiatric disorder referred to as a mood disorder, though some publications and journals describe it as more of a personality disorder. Some believe they are the same thing; however, a mood disorder, such as bipolar disorder, is a different diagnosis out of the DSM-IV (Diagnostics and Statistics Manual) of mental disorders than a personality disorder. The most informative of all the educational resources that I found and read while attending Sonoma State University, is the American Journal of Psychiatry. The AJP described bipolar disorder as a mood disorder characterized by two distinct "mood swings" of sorts--the person is either in an extremely "manic" state--mania is an abnormally elevated or irritable mood, arousal and/or energy levels, or the opposite extreme is severe depression. Mania is the opposite of depression. I want to clarify something that many people make a mistake in thinking with bipolar disorder. Because mania is described as an elevated mood and is referred to as the opposite of depression, it's easy to make the mistake--and many people do--in thinking mania is always a positive state of mind. Some people think "euphoria" and they're thinking "oh my, euphoria...like the euphoria I get when I take opiates"? Mania can be, at times, a euphoric state, however the euphoria is not the same as a drug-induced euphoria but can be described as more of an onset of intense happiness and excitement...here's what wikipedia.com says about the euphoria of bipolar disorder: "...While most people would consider euphoria to be purely benevolent, it can be problematic in individuals with bipolar disorder who experience phases of depression and mania. In a manic episode the patient acquires a state of euphoria, sometimes causing potentially dangerous actions to occur...." Mania has a small instance of being positive, but it can also be expressed with someone flying off the deep end and running around in a panicking state of mind or extremely irritable with everyone around them. The word mania comes from the Greek "μανία" which means "madness, frenzy"; and the Greek verb "μαίνομαι" which means "to be mad, to rage, or to be furious". The depression, on the other hand, is more of a withdrawn state of being; the bipolar sufferer who is in a depressed state will lock themselves in their room for days and cry uncontrollably and want to be left alone. There are times that each state--mania or depression--can last for weeks or even months at a time. The important thing to remember about bipolar disorder is the fact that the sufferer is rarely in a normal, even-tempered state of mind, or rather, what you or I would consider an even-tempered state of mind; they spend the highest amount of time in either a manic or depressed state of mind. Many BD sufferers don't even know what a normal, even-tempered state of being is.
Personality disorder, on the other hand, refers to a class of "personality types and permanent behaviors" associated with powerful distress or defect, which cause the person to have great difficulty comforming to social expectations, particularly in their relationships with other people. Personality disorders have a separate diagnosis in the DSM-IV and include such disorders as Borderline Personality Disorder, Narcississtic Personality Disorder, and Antisocial Personality Disorder. People with personality disorders do things in life differently than most people; for example, someone with an antisocial personality is likely to behave in a way that completely disregards and even violates the rights of others. Children with early signs of antisocial personality disorder are the ones killing animals or putting a live-bird in the microwave and turning it on. Wikipedia puts it most clearly in stating that individuals with antisocial personality disorder have an "impoverished moral sense or conscience" and typically have a history of legal problems, aggressive behavior and impulsivity that often dates back to adolescence or even childhood. On the other hand, someone with Borderline Personality disorder has the impulsive behavior like BD (Bipolar disorder) but also has intense and unstable interpersonal relationships, is fearful of abandonment, has an unstable sense of self--alternating between having an overly positive self-regard and being heavily disappointed in and not liking oneself to the point they harm themselves by cutting and often attempt suicide. People report feeling like they are constantly "walking on eggshells" with someone who suffers from Borderline Personality, because you just never really know what to expect from one moment to the next with someone who has borderline personality. Based on the description of each of the two disorders, it is easy to see the difference in the two; one is more "behavior" based and one is more "mentally" based.
Bipolar Disorder SpectrumClick thumbnail to view full-size
Personal Experience and Education in Abnormal Behaviors
I have personal experience dealing with adolescents who have been diagnosed with a variety of abnormal behaviors, as I have an extensive education in Psychology and worked in group homes for several years. The group homes I worked in were Level 6, meaning moderate security in a regular secluded home, not in a hospital or school-type of setting. Every girl in the three separate but linked homes I worked in had a minimum of one mood disorder or personality disorder, some had multiple mental issues. Working with children and adolescents who were the "problem kids" or who had been in and out of foster home after foster home and felt abandoned and given up on, was what I wanted to do after college and for a career the rest of my life. I care very much for these children, they have more things happen to them as children than most people do their whole lives. After receiving my Bachelor of Art in Psychology in 1999, I planned to complete my Master's and then eventually, open a group home of my own and dedicated my life to ehlping those youth. I have a year left, still--yes, 14 years later, before graduating with my Master of Arts in Psychology, so I have spent years studying these disorders. But my life has gone so much differently than I had originally planned due to marriage and starting my own family, but I absolutely did not want to make those precious angels feel no one would stick with them, so passed them off to someone else. I would still very much love to follow through on my dream to open my own group home for children and adolescents with abnormal behaviors, such as bipolar disorder. My purpose in sharing a snippet of my background is to point out the amount of study I have done in Psychology and specifically, on bipolar disorder in order to gain a little bit of credibility because, as I researched for this, I was alarmed at the amount of websites--including Wikipedia--which had information about bipolar disorder that was completely inaccurate, and bipolar disorder is a serious mental disorder and it's highly important that the information people get be accurate.
Having BiPoLaR Disorder is VERY FRUSTRATING!
I know this poll seemed a little confusing, but it wasn't flexible in its format, it only let me do straight questions and answers, and it only allows the reader to select one answer. Please read each symptom, then once you've read them all count the number of symptoms you have (if any) and choose the letter that has the total number of symptoms you have. For example, if you have a total of 8 symptoms, choose the selection which says (+7). I did this mainly to give you an idea how, #1--Bipolar Disorder can be misdiagnosed since there are other mental illnesses which cause some of the same symptoms as Bipolar Disorder, and #2, to get you really thinking about each and every symptom and to force you to decide (honestly, I hope!) if you have any of these symptoms and/or if you possibly could be suffering from Bipolar Disorder or know someone who is...
In order to get a diagnosis of Bipolar Disorder, you would have to show unmistakeable and obvious signs of having both mania and depression (number 1 & 2), both which must have been present for more than six months; both have to be significantly impairing your ability to function in day-to-day life; it has to be affecting your interpersonal relationships and/or preventing you from having relationships at all; in order to have mania, and you have to have at least six of the major symptoms of mania in order for a firm diagnosis of Bipolar to be made. Furthermore, you must have at least one of the symptoms of Psychosis (the last one, I lumped all three symptoms together). Also, for a diagnosis of mania, there has to have been a prolonged period of a mood that is very unusual for the individual person. Bipolar disorder is very confusing!
****Please participate in this poll before continuing...****
Have you ever had any of the following symptoms? (Make one selection by looking over the list of symptoms, and selecting the number that corresponds to the total # of symptoms) **SEE NEXT PARAGRAPH**
++Altman Self-Rating Mania Scale++
- Altman Self-Rating Mania Scale - Wikipedia, the free encyclopedia
This is a widely used method for Psychiatrists and other Health Practitioners to find out how patients rate themselves in the mania department. It's very important to be completely honest throughout...
++ BiPoLaR ArT ++Click thumbnail to view full-size
The DiFFeReNT Types of Bipolar Disorder
There are two main, distinct forms of Bipolar Disorder; Bipolar II, a less severe form of bipolar, and Bipolar I, which is the form of bipolar disorder being predominantly discussed in this article. The DSM-IV was the first time there was evidence of the two different forms of BD but even such, there are a lot of contradictions in the information within the DSM-IV and therefore, when the DSM-V comes out in just a few weeks, which is a highly anticipated resource in the mental health field, there will be a much better distinguishing between BD I & II. However, until the DSM-V actually comes out, the differences between Bipolar disorder I&II is as follows:
Bipolar I: A person with bipolar I has manic episodes, while with bipolar II there are hypomanic episodes. In mania, the elevated mood is abnormally different and also, and this is important, the elevated mood interferes with the person's daily functioning, and the increased activity or energy that accompanies it is also abnormal. The symptoms which were listed in the above Bipolar Disorder Poll are all applicable to Bipolar disorder I.
Bipolar II: The hypomanic episodes, as opposed to the manic episodes of Bipolar I, are the difference between the two diagnoses. In the hypomania of bipolar 2, a person has a constant, uninterrupted mood that is elevated (heightened), expansive (grand, superior--even possibly euphoric) or irritable. This mood has to be noticeably different from his or her normal mood when not depressed. For example, Mikayla is exceptionally cheerful, needs only a few hours of sleep rather than the eight hours she normally needs and makes sure to get; she spends more money than she should and speaks far more rapidly than usual, along with other symptoms of hypomania. This behavior is noticeably different from her own usual mood, yet there are cheerful people who normally function very well on little sleep, spend a lot and talk fast who don't have bipolar disorder, so it's not considered abnormal in all cases. It's important to make the distinction between what is normal for that person, because their own usual behavior is the only one it's important to make the comparison with. On the other hand, Wayne, who has manic episodes, is over-the-top happy, even during serious events (he burst out laughing disruptively during a funeral). He ran around outside in the middle of the night shouting how much he loves his wife, and he also displayed several other symptoms of mania. That is behavior is abnormal for anyone.
Other differences between Bipolar I and II: One or more of the following symptoms must be present in mania but cannot be present in hypomania:
- Feelings of grandiosity (believing that one's self is more important than actually is, such as believing oneself to be the King of an entire country or one of the members of one's favorite rock band
The above symptoms are all ones of psychosis. Psychosis is never present in Bipolar Disorder II. Furthermore, the level of mania versus hypomania is such that mania significantly interferes in daily life. For example, Wayne, from the previous example, wants to go skydiving, so decides to miss work in order to take a 4-hour, $550 skydiving lesson with extra dive-time and buys a super-expensive parachute even though the lesson came with a loaner-parachute. Mikayla, however, also wants to go skydiving, but unlike Wayne, she decides to set it up on a weekend when she doesn't have to work and has no other obligations which are more important. A couple more distinct differences between mania and hypomania:
- Someone with mania has to be hospitalized due to the severity of symptoms
- Extreme impulsivity
- Hypomania doesn't last as long as mania and isn't as severe
- More time is spent in depressed mood than hypomania with Bipolar II
- There can be symptoms such as hallucinations and delusions in Bipolar II only when in a depressed mood, rather than during a manic episode with Bipolar I, and it does not change the diagnosis from Bipolar II to I.
In addition to the two main types of Bipolar Disorder, Bipolar I and Bipolar II, there are two less severe, much more mild forms of Bipolar Disorder. **Wikipedia states that there are three main types as well as one which is considered "unspecified". I contacted Wikipedia and am attempting to change that, Wikipedia does not claim to be 100% accurate with their information but in this case it's most definitely wrong. Bipolar I and II are the main types of Bipolar disorder; the other two types are not as common nor are they even completely acknowledged by some health practitioners, they are sometimes just lumped together with Bipolar Disorders I and II.
Cyclothymia: A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. There is a low-grade cycling between moods which seems to family, friends, acquaintances, or anyone who talks at length to the individual as though he or she has a personality flaw, and interferes with functioning.
Bipolar Disorder NOS (Not Otherwise Specified): This is a form of bipolar which is very difficult to diagnose and place in one of the other groups, but there are symptoms, just the others, of both mania and depression, just not as severethe symptoms are milder but still interfere with normal functioning.
The Rapid Cycling (Mania to Depression) in Bipolar Disorder
Bipolar and Me...
There is more than one reason why Bipolar Disorder is such an interesting, important disorder for me and in my life. It is natural for someone with an education such as mine, in Psychology and Abnormal Behavior, to be completely fascinated by disorders like bipolar because it's very multi-faceted and there is such an enormous variety of different major and severe symptoms, some of which can differ from person to person (like halluncinations, delusions, and clang associations ) making each case of BD very unique to each person. And each person has unique, personal coping skills and abilities which definitely impact how they get through each day and what their attitude is. There are so many factors involved that it's very intriguing to hear each individual person's journey through the disorder, before being diagnosed and after. Bipolar disorder is also very personal to me because I have a few good friends (casual and close) as well as family members either who have BD or who have strong symptoms of it (there are also a handful to which I have expressed my suspicions, and not one of them will trust that I know a great deal about this disorder and feel comfortable in my insight into it, though I don't blame them, most people view BD in a very negative and harsh way. Plus, having a relationship with someone who has Bipolar Disorder is challenging, frustrating, and tiring but as long as you can keep reminding yourself that the person doesn't choose to be difficult, it makes it easier.
I'm no longer embarrassed to say this and for most of my life I was, but I believe and have for years, that I have bipolar disorder, I have symptoms which I believe show I have it but I have had two different Psychiatrists tell me that I DO NOT HAVE BIPOLAR DISORDER; I completed an online bipolar disorder test one time and printed it and took it to my Psychiatrist and he stated that "You do not have Bipolar Disorder, Jennifer". I don't know why they are adamant about me not having it while I feel I do, but to be quite honest, after conducting research for this article and typing it up and piecing everything together, I just can't believe how many symptoms I seem to have, but maybe for me it's difficult to self-diagnose. Maybe I'm being like I was in college when I first took an abnormal behavior class, every single disorder and condition I learned about I swore I had. Perhaps I just get so involved in my research of these things that are of great importance to me and in preparing my report and findings I start to feel like it's hitting home when really, I'm just doing a thorough job in conducting research and doing my reporting. There's certainly no shame in that.
Some Self-Help Books for Bipolar Disorder: I highly recommend and believe in self-help books for any disorder or condition, it can make a huge difference in you
**There is such a social stigma associated with Bipolar Disorder, and this book has some awesome questions and discussions, I loved this book...
**I included this one because I very much believe in and advocate taking a Cognitive-Behavioral Approach for all mental illnesses and it truly does help. I have a lot of experience with dealing with this disorder and I believe a Cognitive-Behavioral Approach is priceless--even if it's only for the attitude change it helps a person to make.
Just be There for Your Friend or Family Member Suffering with Bipolar...They Need You!
Everything I presented thus far shows the complexity of bipolar disorder and anyone going through it should have a large, trustworthy and reliable support network. You'll notice I didn't include treatment options in this article. The focus is on the disorder itself and anyone suffering should not suffer alone. Anyone with BD should be highly encouraged, for as long as it takes until they realize that a support group would be an amazing and positive coping resource. There are many, many BD available, find them...use them....make them your friend. Don't suffer alone, get into a group. This disorder is manageable, you just have to have a positive attitude and not give up....every day is a new opportunity to have a better attitude than yesterday. When you wake up tomorrow, tell yourself that LIFE IS GOOD! Don't give up, keep smiling and remember that each person with bipolar disorder is unique, special, and important... you are loved!