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What exactly is Bipolar Disorder?

Updated on May 15, 2013
Source

Bipolar disorder

Bipolar disorder, by definition, is a mood disorder involving manic episodes, possibly alternating with major depressive episodes.

Although everybody cycles through mood swings, they are much more extreme for people with bipolar disorder. A person with bipolar disorder alternates between periods of mania where they become very agitated, along with being hyper-energetic, rarely getting any sleep, and have periods of depression.

In order to be diagnosed with bipolar disorder, an individual must experience at least one manic episode. A manic episode, by definition, is a period of euphoric mood with symptoms involving abnormally heightened levels of thinking, behavior, and emotionality.

This flow chart shows the characteristics of a manic episode, a depressive episode, and psychotic and cognitive symptoms.
This flow chart shows the characteristics of a manic episode, a depressive episode, and psychotic and cognitive symptoms. | Source

Criteria for a manic episode

There must be a distinct period of abnormally and persistently elevated or irritable mood and abnormally and persistently increased activity or energy that lasts 1 week and is present every day.

During the period of the mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a degree.

  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual or pressure to keep talking
  • flight of ideas or subjective experience that thoughts are racing
  • distractibility
  • increase in goal-directed activity or psychomotor agitation
  • excessive involvement in activities that have a high potential for painful consequences (ex: shopping sprees, sexual indiscretions, or foolish business investments)

During all this, the individual may experience a euphoric mood, which is a feeling state that is more cheerful and elated than average.

Hypomanic - a period of elated mood not as extreme as a manic episode.

Criteria for major depressive episodes

The symptoms have to be continuous for at least 2 weeks. At least one of the two symptoms below must be present.

  • Depressed mood, almost every day, during the minimum 2-week period. Feelings of sadness, emptiness, hopelessness or depression, or crying for no apparent reason
  • Loss of interest in most or all normally enjoyable activities, continuing for most of the day nearly every day

Now, 3 - 4 of the symptoms below must also be present. Altogether should be around 5 total symptoms.

  • Increase or decrease in appetite most days, or a significant increase or decrease in weight over a month (5%)
  • Insomnia or hypersomnia almost every day
  • Psychomotor agitation or psychomotor retardation
  • Fatigue or loss of energy almost every day
  • Feelings of worthlessness and/or feelings of guilt that are excessive or not related to anything a person who isn't depressed would feel guilty about -- must occur almost every day during a 2-week period
  • Trouble concentrating and/or making decisions nearly every day
  • Recurring thoughts of death or of being dead


Bipolar I and Bipolar II

Bipolar I Disorder causes the individual to experience one or more manic episodes that last for about a week. The manic episode cannot be better explained by another medical condition. Major depressive episodes can occur but aren’t necessary for the diagnosis of the disorder.

Bipolar II Disorder on the contrary causes the individual to experience one or more major depressive episodes. The individual may also experience at least one hypomanic episode but there has never been a full manic episode for this type of disorder.

Is bipolar disorder biological or environmental?

The current thinking is that bipolar disorder is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain).

Genetic Factors

  • It seems that bipolar disorder "runs in families". About half of the people who have bipolar disorder have a family member with some type of mood disorder.
  • A person with 1 parent with bipolar disorder has a 15 - 25% chance of having the condition.

Environmental Factors

  • A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder
  • Hormonal problems can also trigger an episode
  • Substance abuse can worsen the illness by interfering with recovery

Sources

  • "Abnormal Psychology: Clinical Perspectives on Psychological Disorders" 7th Edition by Susan Krauss Whitbourne
  • DSM-IV
  • "What Is a Major Depressive Episode?: The Low Side of Bipolar Disorder" by Marcia Purse
  • "The Causes of Bipolar Disorder (Manic Depression)" by Steve Bressert, PH.D

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