Bipolar disorder, which was formerly known as manic depression, is a serious mood disorder that is characterized by an alternating pattern of emotional highs, or mania, and lows, or depression. And while the mania and depression usually occur separately, bipolar disorder occasionally involves mixed state episodes in which both symptoms are present.
The mood swings that are associated with bipolar disorder can occur very quickly and seemingly without cause, and the intensity of both the mania and depression can vary from mild to severe. Both the highs and lows of bipolar disorder represent significant differences from the afflicted individual’s usual personality.
There are three primary types of bipolar disorder:
Bipolar I: When an individual suffers from bipolar I, he or she will experience extreme manic and depressive episodes of varying lengths and severity.
Bipolar II: Individuals with this type of bipolar disorder will experience depressive episodes similar to those that characterize bipolar I, but their manic episodes will not be as severe. The manic episodes of bipolar II are often referred to as hypomanic episodes.
Cyclothymia (also referred to as cyclothymic disorder): This is a less severe form of bipolar disorder, in which both the manic and depressive episodes are milder than are those experienced by individuals with bipolar I or II, but have occurred for at least two years.
It is important to understand that the manic and depressive episodes that are symptomatic of bipolar disorder are much more severe and problematic than are the simple ups and downs that most people experience in the course of their lives. However, the good news is that, with proper treatment, individuals who are afflicted with bipolar disorder are able to deal with their symptoms in a healthy manner and are capable of pursuing productive and successful futures.
Bipolar disorder can affect both men and women, and symptoms usually begin to manifest in late adolescence or early adulthood. Research indicates that about 50% of bipolar cases occur before the resident has reached age 25.
According to the National Institute of Mental Health (NIMH), about 2.6% of adults in the United States (or about 5.7 million adults) are diagnosed with bipolar disorder each year. The Depression and Bipolar Support Alliance (DBSA) reports that bipolar disorder affects equal numbers of men and women and that this disorder is found in all ethnic groups and socioeconomic classes. Yet, while bipolar disorder occurs with equal prevalence among men and women, the nature and severity of the disease does appear to be influenced by gender. Multiple studies conducted in the 1990s revealed that women who have bipolar disorder are more likely to experience increased numbers of depressive episodes and more rapid cycling between episodes than do men with bipolar disorder.
Because of the high prevalence of suicide among individuals who have bipolar disorder, the disease results in 9.2-year reduction in expected lifespan.
Causes and Risk Factors for Bipolar Disorder
As with other mood disorders and psychological conditions, the single identifiable cause of bipolar disorder has yet to be discovered. However, experts have identified a number of risk factors that can place an individual at an increased risk for developing the disorder.
Genetic: Research has revealed that genetics may play a significant role in determining who will develop bipolar disorder. The NIMH reports that as many as two-thirds of all bipolar disorder residents have at least one close relative who has also struggled with either bipolar or major depressive disorder. Additionally, scientists have identified 266 genes that may influence a person’s likelihood for developing bipolar disorder. Noting that these 266 genes may interact in more than 35,000 combinations, the results of this finding emphasize the extreme complexity of determining clear genetic causes for bipolar.
Environmental: In addition to indicating an increased genetic risk, the presence of bipolar disorder in a close family member (especially a parent) can also be an environmental factor in the development of the disorder. For example, children who have a bipolar parent or parents may be exposed to mood swings, drug/alcohol abuse, physical/verbal abuse, and other inappropriate behaviors that can add significant stress to their lives.
Beyond the stresses of living with a bipolar parent, other environmental risk factors can include a traumatic life event and the abuse of alcohol or other drugs. However, researchers have not established a cause-effect relationship between substance abuse and bipolar disorder, but they have noted the ability of substance abuse to magnify or exacerbate bipolar symptoms.
- Family history (especially having a close family member with bipolar or major depressive disorder)
- Age (at least 50% of bipolar cases occur between ages 15 and 30)
- Gender (women are at increased risk for rapid cycling and mixed-state bipolar, while men are more likely to develop early-onset bipolar)
Signs and Symptoms of Bipolar Disorder
Bipolar disorder is characterized by drastic and sudden changes in mood, from unnatural highs (the manic phase) to devastating lows (the depressive phase). While mood changes are a natural part of life, the mood swings experienced by bipolar individuals are exaggerated and debilitating.
Bipolar episodes may be triggered by external stimuli, or can occur with no apparent cause. If you are concerned that you or a loved one is battling bipolar disorder, consider the presence of the following symptoms:
Behavioral symptoms (manic episodes):
- Rapid speech
- Impulsive actions
- Heightened energy, including no apparent need for sleep
- Engaging in risky or reckless activities (e.g., spending sprees, heightened sexual activity, gambling binges, etc.)
Behavioral symptoms (depressive episodes):
- Expressions of despair or extreme pessimism
- Hypersomnia (excessive sleeping)
- No interest in activities that the person usually finds important or pleasurable
- Withdrawal from family, friends, and other associates
Physical symptoms (manic episodes):
- Heightened state of alertness and energy
- Voracious appetite
- High sex drive
Physical symptoms (depressive episodes):
- Low energy and/or extreme fatigue
- Sleep problems (either insomnia or excessive sleepiness)
- Loss of appetite
- Little to no interest in sex
Cognitive symptoms (manic episodes):
- Feelings of extreme creativity
- Racing mind, jumping from thought to thought
- Delusions of grandeur
- Supreme self-confidence and optimism
- Unrealistically positive expectations for the future
- Inability to concentrate or focus on one task or issue
Cognitive symptoms (depressive episodes):
- Inability to concentrate
- Memory problems
- Thoughts of suicide or other forms of self-harm
Psychosocial symptoms (manic episodes):
- Expressions of unrealistic plans or goals
- Lashing out at others who fail to show expected enthusiasm or support
- Acting with little to no consideration for consequences
- High levels of enthusiasm and excitement
Psychosocial symptoms (depressive episodes):
- Expressions of anger, disgust, or disdain with self and world
- Obsession with death, especially talking about or attempting suicide
- Feelings of inadequacy, hopelessness, and despair
Effects of Bipolar Disorder
Clearly, individuals who experience symptoms such as those enumerated in the previous section are likely to experience significant negative consequences and, when the afflicted individual is in a position of personal or professional power, those consequences can also be felt by loved ones, children, co-workers, and employees.
Common effects of bipolar disorder include the following:
- Strained, damaged, or ruined interpersonal relationships
- Career setbacks, work-related failures, and potential loss of employment
- Legal and financial problems due to reckless behaviors
- Physical problems and diseases as a result of substance abuse and unsafe sexual practices
- Inability to care for oneself
- Self-harm to the point of suicide
The instability and psychological extremes that are associated with bipolar disorder put afflicted individuals at elevated risk for experiencing a host of co-occurring disorders.
The following are among the disorders that are commonly experienced by people who are also dealing with bipolar disorder:
- Substance use disorders
- Obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Attention-deficit/hyperactivity disorder (ADHD)
- Eating disorders
- Anxiety disorders