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.
The basic facts of bipolar disorder
Information about Bipolar Disorder given on a great many medical websites and literature is often pretty basic, although things are changing and more detailed information is being written. There are 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 criteria of diagnosis from the Diagnostic and Statistical Manual (5th edition).1
Bipolar is a brain disorder characterized by intense mood swings. It is formerly known as manic depressive illnes. 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 a spectrum disorder. People have different severities and symptoms within their classification. 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 condition 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 more intense out of all the other types. Type l is said to lead to hospitalization more often; however, due to personal experience and talking with my clinicians and other people who have it , I believe this is not completely accurate. 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, frenzied and irrational, and may act out in some way. The high mania can be characterized sometimes 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 a phenomenom many are not aware of; however, it is discussed frequently in medical and mental health educational literature now. 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. For me it feels like an out of control locomotive rather than a race car. It is scary living with moods so powerful, wild, and unpredictable. Suicidal thoughts can arise and become very intense. I think the person who coined the phrase 'Stop the world I want to get off' might have been 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
I know for me lack of sleep and severe stress can catapult me into a rapid cycling episde.
Patty Duke on her diagnosis
The dangerous experience 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. That sounds impossible but 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. I liken it to being caught up into tornado. 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.
This combination is one of the most dangerous mood states known."— Dr. James R. Phelps
The symptom of psychosis
Psychosis is loosing touch with reality. During psychosis one can have visual or auditory hallucinations, or have irrational, false beliefs or ideas that can't be corrected by someone confronting them with conclusive reality, including paranoia (known clinically as delusions). During psychosis someone may believe they're being followed or plotted against, they may hear voices, or see something that isn't there.
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. There are medications to help with psychosis. If caused by sleep deprivation, finding ways to get enough and quality sleep will help a great deal. It can be a challenge.
I figured I must have this for a reason and I'm supposed to tell people about it."— Patty Duke
The importance of quality and quantity of sleep
Quality sleep is of the utmost importance for most mental disorders. With bipolar it is probably one of the most important necessities for stability. I can say emphatically it is true for me. For years it was thought that the decreased need for sleep, or decreased sleep, is a symptom of mania. Not necessarily. Experts 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 and too much sleep can both be a symptom of depression.
People with bipolar can have a quality, meaningful life
People with bipolar and similar brain disorders can live meaningful lives. This is not something new. Many people with serious medical conditions manage them successfully by taking medication, other regular treatments, and practicing good self-care daily. Take diabetes, for example. It's a very serious disease. For most people, if they practice good self-care by monitoring their blood sugar, eating the right foods and avoiding the harmful foods, exercising, and taking their medication as prescribed, they still can live happy, fulfilled lives. Symptoms may arise still, some may have more challenges, more severity than others and have to work harder.
This is not to say people with bipolar will never have symptoms if they are enjoying a quality life. It means their treatment and self-care is working significantly enough to allow them more stability. When symptoms arise they see their providers to make adjustments and continue good self-care. Flare ups and setbacks come up, I've had them, but we can learn and develop resiliency, the ability to bounce back and recover more quickly. Setbacks can be overcome, or smoothed out. It may take time and require a lot of hard work between the person and their providers.
We can learn and develop resiliency, the ability to bounce back and recover more quickly.
My experience finding a quality life
I think the best way to drive home to people with bipolar being able to acquire and enjoy a quality, meaningful life is to share what I've discovered and put into practice in the last two years. My purpose is not to imply I have arrived. But I have found more stability and meaningfulness in my life than I have ever experienced since my diagnosis almost two decades ago. It's actually very simple, but not always easy. In fact it's been hard work.
One of the first and biggest steps I've taken is to make attitude adjustments. I've discarded my pessimism and stopped interacting with pessimistic professionals and non-professionals. I have sought clinicians who are encouraging cheer leaders and are willing to listen and respect me when I voice a concern. I, in turn, have done the same toward them. I had to learn this the hard way. I also avoid people with judgemental attitudes, or don't talk about this part of my life.
I've also become willing to participate in my recovery. It's not my clinician's responsibility to make me well. They guide and direct, give me tools, but I'm the one that has to heed and use them. I discovered the hard way again by being unwilling, lazy, or passive. I got tired of suffering the consequences.
I've taken a holistic approach in my journey. Spiritually, physically, mentally (attitude, thinking), and emotionally (laughter, realizing feelings won't kill me and I'm not going to be a slave to them).
I have a daily maintenance plan I try to be faithful to. I listen to my body and mind to appreciate feeling well and recognizing when things are slipping south. I pay attention to stressors and triggers and have a plan for those times.
I also reach out to help others, to practice more kindness and compassion, to try to bless instead of drain my friends and acquaintances. Many times I've been given the privileged opportunity to share my experiences and knowledge with people who cross my path with people struggling with mental health issues.
I still have more to learn. We all do.
Do you believe a person with bipolar can live a relatively stable, rich and meaningful life?
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