Bipolar disorder, once known as manic depression, is a serious mental illness which includes exaggerated mood states. Bipolar disorder involves shifts in moods between mania and depression. Bipolar disorder includes both the highs and lows of moods resulting in risky behaviors, loss of relationships and thoughts of suicide. At times there may be neutral states between these extremes though some individuals switch back and forth between the extremes without experiencing a return to neutral.
Part of the difficulty in diagnosing bipolar disorder is there is no defining pattern for mood states and each individual can display a different pattern or change patterns over time. The mania phase involves a highly energetic, euphoric state during which individuals have a decreased need for sleep, talk excessively and make grandiose plans which are often delusional. The depressed phase is characterized by the opposite symptoms including excessive sadness, lack of energy, decreased speech production and lack of motivation. While most adults don’t cycle very frequently, the periods between the cycles are often characterized by extreme anxiety caused by anticipation of the next extreme mood state.
There are three primary types of Bipolar disorder.
- Bipolar I which is manic symptoms and at least one major depressive episode.
- Bipolar II has hypomanic symptoms which are predominantly the same as manic symptoms though at a lower intensity and severity level and at least one major depressive episode.
- Cyclothymic Disorder involves hypomanic-like symptoms which don’t meet criteria for a hypomanic episode or a major depressive episode.
Bipolar Disorder has historically been difficult to diagnose in children and adolescents as the diagnostic criteria are not developmentally sensitive. The symptoms based upon how the disorder manifests in adults have been applied to children in order to obtain a diagnosis. However, it has been recognized the presentation of bipolar disorder in childhood is quite different from what is seen in adulthood. Diagnosing children is made even more difficult because the presentation of bipolar disorder is very different between children and adolescents as well.
The 12-month prevalence rate for bipolar I in adults in the U.S. is estimated at 0.6%. The lifetime male to female prevalence ratio was estimated at 1.1 to 1 indicating the gender difference in prevalence of bipolar I is not large. The 12-month prevalence rate for bipolar II in U.S. adults is estimated at 0.8%.
The lifetime prevalence estimates for cyclothymic disorder range from 0.4% to 1%. In the general population, rates of cyclothymic disorder appear to be equal among males and females though estimates for clinical settings indicate a higher rate in women than men indicating women are more likely to seek treatment.
For Bipolar I the most frequently seen co-occurring disorders include:
- Separation anxiety
- Selective mutism
- Social anxiety
- Panic disorder
- Generalized anxiety disorder
- Oppositional defiant disorder
- Intermittent explosive disorder
- Conduct disorder
- Antisocial personality disorder
- Substance addiction
- Medical conditions (e.g. metabolic syndrome, migraines)
Approximately 60% of individuals with bipolar II have 3 or more co-occurring psychological disorders. The most common of these are:
- Anxiety disorders
- Substance addiction
- Eating disorders
For cyclothymic disorder, the most frequent co-occurring disorders are:
- Sleep disorders
- Substance addiction
The specific causes of bipolar disorder are unknown however there is support indicating certain factors are linked to the development of this group of disorders.
Genetic: Bipolar disorder has been recognized to run in families.
Brain Chemistry: Chemicals called neurotransmitters are responsible for communication in the brain. Some of these neurotransmitters, norepinephrine, dopamine and serotonin, have been implicated in the development of bipolar disorder. Abnormal levels of these neurotransmitters have been strongly linked to disruptions in both manic and depressed mood states.
Environmental: Children of parents with bipolar disorder often live in a chaotic environments. They must cope with the confusion associated with the parent’s mood swings, the effects of substance abuse, financial hardship, witnessing sexually promiscuous behavior and the absence of the parent. As these children are genetically predisposed to developing bipolar disorder, these stressors can lead to the development of bipolar disorder or other mental illnesses.
Signs and Symptoms
The symptoms of the two general mood states found in bipolar disorder are listed below.
Manic/Hypomanic Symptoms: (These types of symptoms differ by degree of severity)
- Significantly elevated mood
- Increase in self-esteem, self-confidence and belief in the capacity to accomplish tasks outside the individual’s skill set
- Delusions of grandeur
- The belief the individual is greater, more powerful or more influential than they are
- Continuously working on highly complicated or extensive projects which never are finished
- Pressured speech or increase in talkativeness
- Becoming involved in activities having risk or harm
- Increase in energy and activity levels
- Motor agitation
- Decreased appetite
- Less need for sleep
- Racing thoughts or thought process significantly speeded up
- Flight of ideas
- Rapidly switching from one topic to another with only loose associations between each
- Difficulty maintaining attention
- Highly distractible
Major Depressive Symptoms (must occur minimally over a two-week period)
- Depressed mood
- Inability to enjoy activities once pleasurable
- Feelings of insignificance, disgrace or feelings of constantly being at fault without cause nearly every day (may be delusional)
- Motor agitation or retardation (must be observed by others)
- Social withdrawal
- Inability to perform well at work or school
- Decreased productivity
- Decrease or increase in weight
- Increased or decreased hunger
- Insomnia or hypersomnia
- Exhaustion, lack of energy
- Insomnia or hypersomnia
- Memory difficulties
- Frequent intrusive thoughts of death or suicide
- Trouble thinking, focusing, attending, or making decisions
- Loss of goal-focused motivation
Some of the specific effects of bipolar disorder include:
- Feeling incapacitated
- Increased need for medical services and care
- Relationship problems
- Divorce or marital discord
- Negative impact on the lives of family members and friends
- Behavioral and emotional impulsivity leading to increased risk of incarceration
- Caregiver burnout
- When depressed the individual feels a sense of excessive guilt and shame due to blaming themselves for family members problems
- Financial problems and debt
- Needing to have a guardian assigned to help with financial and other decisions and responsibilities
- Feeling unable to function normally in daily life
- Sense of hopelessness and helplessness
- When depressed the individuals feels they have nothing to contribute to the world and must depend on others for everything
- When manic the individual may attempt to direct the activities of friends and family, convinced they know best resulting in increased social estrangement
- Problems carrying out job related responsibilities or being unable to remain employed
- Failure to think about the potential negative consequences of one’s actions
- Suicidal thoughts