- Mental Health
Things You May Not Know About Bipolar Disorder
• The information in this article is not meant to assist you in diagnosing yourself, or a loved one. Please see your physician if you have symptoms you believe might be bipolar disorder.
Madness is to think too many things in succession too fast, or of one thing too exclusively."— Voltaire
The basic facts of bipolar disorder
The basic information about mental disorders, specifically this disorder, given on a great many medical websites and literature, are often generalized. There are so many variables that people may not be aware of - even people who have this diagnosis. This article offers information about bipolar disorder that goes outside the general information and rigid rules of diagnosis from the American Psychiatric Association (2013) text. 1
Bipolar is a brain disorder, formerly known as manic depressive illness. As you might guess, the word bipolar indicates two opposite poles - the high moods (mania) on one pole, and the low mood (depression) on the other pole. Approximately 5.5 million adults (2.6%) have this mood disorder in the United States. 2
Bipolar is characterized by intense mood swings. It is cyclical in nature, although not necessarily in a regular pattern. This disorder is no respecter of persons - it can occur in anyone, at any age, and at any stage of life. It tends to run in families. Some research studies have suggested that people with certain genes are more likely to develop the disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness compared with children who do not have a family history of it .3 Doctors and scientists are still trying to determine the exact cause of this disorder. It is believed that in addition to the biochemical brain side, environmental factors can also be at play. Following are the basic symptoms of bipolar disorder. You can note that a few of the symptoms are evident in both mania and depression.
- Feelings of euphoria, invincibility, and grandiosity.
- Continuous high energy.
- An abnormal, increased level of irritability.
- A flight of ideas.
- Rapid speech (also known as pressured speech), and jumping from one topic to another.
- Decreased amount of sleep.
- Pleasure-seeking and increased risk taking behavior (spending sprees, risky sex etc.).
- Racing thoughts or jumping from one idea to another.
- Easily distracted.
- Feeling agitated or jumpy.
- Extended period of sadness, hopelessness, helplessness, and low self-esteem.
- Decreased energy and fatigue.
- Lack of interest in things that once brought pleasure.
- Inability to make decisions.
- Inability to concentrate.
- Being agitated.
- Slow movement, speech and thought.
Thoughts of suicide and/or attempts at suicide.
Types of bipolar
Some doctors and scientists believe there are only three types of Bipolar - Types l and ll, and Cyclothymia. Following are the traditional forms of thought on bipolar types. 4
Bipolar l is the most severe form. The mania is the most intense out of all the other types. With type l, the symptoms can be more extreme than all other types and is said to lead to hospitalization more often; however, due to personal experience and talking with my clinicians, I believe this to be far from reality. People with type ll have to deal with more serious depression at times.
Many people are under the impression that mania is only a positive experience (euphoria, high energy). The fact is, mania can be a very negative experience. Irritability, agitation, psychosis can all be symptoms of mania. In an agitated, irritable state, one may become angry and enraged; thus behavior can be threatening sometimes. However, many people with bipolar do not display aggression at all.
Type l mania is also characterized by risky behaviors. Hypersexuality is one symptom that might lead to careless, impulsive sexual encounters. Or during mania one might go on spending sprees or make poor business decisions.
Bipolar ll has milder mania called hypomania - hypo meaning a lower (or under) mania. Literature often tells us that hypomania is less likely to cause marked impairment, that one is less likely to have difficulty functioning in their work, social situations, and day to day living. It's a case by case situation. Without the right treatment, people with type ll can progress to full blown mania.Type ll tends to be more on the depressive side, the depression is much more severe, and there is a higher rate of suicide with this type.
Cyclothymia is the mildest form. Milder hypomania and depressions than types l and ll. This diagnosis is seldom used because the symptoms are so mild many doctors don't want to characterize it as a bipolar illness.
These are the most commonly known types of bipolar in the DSM IV and DSM V and other medical texts and publications. The research in recent years has brought a lot more to the table - type lll, soft bipolar, and NOS (not otherwise specified) and the spectrum theory, to name a few. 5
Rapid Cycling Moods
Rapid cycling is something many are not aware of; however, it is discussed frequently in medical and mental health educational literature now, and most all psychiatrists are very well informed on it and recognize it in their patients. Rapid cycling is a pattern of frequent, severe mood swings. It is most often seen in type ll and in women, but it can happen anywhere on the spectrum. Statistics show that rapid cycling occurs in ten to twenty percent of people with this disorder. 6
Author and journalist Gloria Hochman describes rapid cycling this way,
"...rapid cyclers, with mood changes colliding with each other, from month to month, day to day, or sometimes even within the same day. These men and women zigzag between highs and lows so rapidly they often feel as though they are about to die. They bounce from euphoria to despair and back again within hours. They are in exquisite pain, out of control, like a race car gone berserk, and sometimes say that they are afraid of being alone with their episodes because they don't know what they will be doing next." 7
I find Ms. Hochman's explanation spot on in my personal experience. It is scary living with moods so powerful, wild, and unpredictable. Suicidal thoughts can arise and become very intense. I think the person who created the phrase 'Stop the world I want to get off' might experiencing rapid cycling."
In the last century, we didn't hear about rapid cycling. Now doctors, mental health professionals, and researchers have taken due note of this phenomenon in people who struggle with bipolar of any type; perhaps because overall, scientists and doctors are more observant as they research it. They believe that the use of antidepressants and stimulants (for people with ADD and ADHD) could be one of the major reasons. Certainly though, other factors could be at play - lack of sleep, more stress, trauma, etc. 8
Patty Duke on her diagnosis
The dangerous phenomenon of a mixed mood state
A mixed mood, also known as a mixed state, can take someone by storm. It can be one of the most frightening experiences for someone with bipolar disorder ever. Often it is combined with rapid cycling. One clinician told me a mixed state was mania and depression simultaneously. Huh? That seems impossible. Gloria Hochman describes it as "...a smorgasboard of symptoms that are at odds with each other."
My experiences with mixed state were not euphoria and depression simultaneously, but severe depression, severe irritability and agitation, and racing (frenzied) thoughts. Dr. James R. Phelps, author of Why Am I Still Depressed: Recognizing and Managing the Ups and Downs of Bipolar ll and Soft Bipolar Disorder, doesn't beat around the bush when he states, "This combination is one of the most dangerous mood states known." The combination of self-loathing, agitation, terror, and despair is indescribable. The risk for suicide is at it's highest in this state. This too is very accurate from my life.
The mixed state can be one of the most terrifying and dangerous mood states to occur in mental illness.
The symptom of psychosis
Many professionals will say that psychosis can be one of many symptoms of bipolar l. The fact is, it is possible with any form of the disorder, as well as schizophrenia, and severe depression, (including postpartum depression). Brain diseases or conditions, medications, illegal substances like cocaine, meth, and crack, can also cause psychosis. Many of these causes can actually be a result of sleep deprivation. When one is up for days with only a few hours of sleep here and there, or none at all, psychosis can set in.
Psychosis is when a person loses touch with reality. One can have visual or auditory hallucinations, or have irrational, false beliefs or ideas that can't be corrected by reason or confrontation, including paranoia (known clinically as delusions).
I figured I must have this for a reason and I'm supposed to tell people about it."— Patty Duke
Do you believe a person with bipolar can live a relatively stable, rich and meaningful life?
The importance of quality and quantity of sleep
Quality sleep is of the utmost importance for most mental disorders. With bipolar it is probably the most important necessity for stability. Exercise is a close second. For years it was thought that the decreased need for sleep, or decreased sleep, is a symptom of mania. Not necessarily. Experts once grappled with the question 'Is sleeplessness a symptom of mania, leading to depression, or is lack of sleep during depression causing mania?' They have discovered it can be both - either/or. It could be that someone is in a normal state but not sleeping well due to stress or some other non-related issue, and after a prolonged period, end up in a manic or depressed state. Inability to sleep can both be a symptom of depression. Not sleeping can be a symptom of mania or depression.
A rich and meaningful life is possible
People with bipolar and similar brain disorders can live meaningful lives. This is not something new. How many people do you know with a serious medical condition that is managed successfully, either by medication, other regular treatments, or just practicing good self-care daily? Think diabetes, for example. It's a very serious disease. For most people, if they practice good self-care with eating, exercise, and whatever else the doctor orders, along with medication, they still can live happy, fulfilled lives.
This might be simplifying things a bit, and there are some who have severe cases, but most can live quality lives even as they manage symptoms and all that involves.
For so many years, decades even, people with mental health challenges have been told they will never get better, that treatment is maintenance and they will have to make do the best they can. Not so. People can do much more than make due. They can do more than survive - they can thrive. Being proactive in other forms of self-care, and having an attitude that living a life as meaningful as everyone else is possible, and establishing and utilizing a healthy support system, one can and will succeed and do so. It takes work, willingness, and healthy support people. This is a fairly new concept for people.
If you struggle with bipolar or some other disorder, or perhaps more than one, don't think that without hard work you can't do anything to make your life better. You most certainly can! It may not be easy (whose life is), but it will be good quality. It takes willingness to do whatever is necessary.
1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2Treatment Advocacy Center. Bipolar Fact Sheet (2011), from http://www.treatmentadvocacycenter.org/resources/briefing-papers-and-fact-sheets/159/463
3 National Institute of Mental Health (n.d.). Bipolar Disorder in Adults (NIMH publication No. 12-3679) Revised 2012. Retrieved July 25, 2014 from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml
4 Phelps, J. (2006). Why Am I Still Depressed?: recognizing and managing the ups and downs of bipolar ll and soft bipolar disorder. New York, NY: McGraw Hill Publishers.
6 Web M.D. Medical Reference. Reviewed by Joseph Goldberg MD (2014, May 11). Rapid Cycling in Bipolar Disorder http://www.webmd.com/bipolar-disorder/guide/rapid-cycling-bipolar-disorder
7 Duke, P. and Hochman, G.(1992). A Brilliant Madness: Living with manic depressive illness. New York, NY: Bantam Books.
8 Phelps, J. (2006). Why Am I Still Depressed?: Recognizing and managing the ups and downs of bipolar ll and soft bipolar disorder. New York, NY: McGraw Hill Publishers. p. 170-171
© 2014 Lori Colbo