Understanding Bipolar Disorder
Chances are, no matter where you live or who you are you know someone who is living with Bipolar Disorder. Bipolar Disorder, sometimes called manic-depressive disorder, is one of the most common mental illnesses in the United States.
More than 3 million cases of bipolar disorder are diagnosed each year. Quite often, individuals who are actually suffering from Bipolar Disorder are misdiagnosed with depression. In men, Schizophrenia can be a common misdiagnosis.
While some are open about their Bipolar Disorder diagnosis there are others who feel that it is best to keep their mental health issues to themselves due to the stigma that surrounds certain diagnoses. Sadly though, although they have been portrayed as “dangerous” in many movies and other media many individuals with bipolar are actually more likely to be the victims of violent crime then they are to be perpetrators.
There are many symptoms that can stem from Bipolar Disorder. However, it is most commonly associated with extreme mood swings and the inability to regulate moods. Unlike in neurotypical individuals, there are extreme highs that can cause agitation, euphoria, or psychosis. As well there can be extreme lows that can produce pronounced depressive states, suicidal ideation, and more.
The Cycles of Bipolar Disorder
For some individuals, these extreme highs and lows can take anywhere from weeks to months. A person may be depressed for several weeks but then suddenly feel like they are on top of the world. For others, the highs and lows can change every day or even within an hour.
The latter of these is known as rapid cycling. This can be frustrating to both those living with Bipolar Disorder as well as their loved ones as moods are unpredictable and unreliable. Meaning, while the person may be in a great mood one minute they could be triggered and depressed the next. Often there is no real way to tell whether the day will be a good or bad one.
In general, there are two main types of Bipolar Disorder. Sometimes, a less severe form of Bipolar Disorder known as Cyclothymic Disorder may be the cause of mental health issues. This form is generally free of the more severe symptoms such as psychosis or extreme depression.
Below you will find the classification structure for determining which form of Bipolar Disorder you may have based on your symptoms.
Bipolar Disorder I – Characterized by at least one manic episode preceded or followed by hypomania and/or a depressive state.
Bipolar Disorder II – Characterized by at least one major depressive episode and one episode of hypomania but no manic episodes. Generally, the depressive episodes will be longer and more pronounced in these individuals than those with Bipolar Disorder I. It is important to understand that BPII is not a milder form of Bipolar I but a completely separate diagnosis.
Cyclothymic Disorder – Characterized by 1-2 years of hypomania and depressive episodes (However, these depressive episodes are less severe than with BPI or BPII)
Mania and Hypomania
For those living with Bipolar Disorder and their loved ones, it can sometimes be difficult to decide whether an episode can be characterized as mania or hypomania. In many instances, mania will be accompanied by severe dysfunctional symptoms such as psychosis, extreme spending, extreme insomnia, extreme agitation, and more. In hypomania, there may be some dysfunction but it will not reach the extreme levels of true mania regardless of how long it lasts.
A few common symptoms of Mania or Hypomania include:
- Insomnia, or decreased need for sleep
- Racing thoughts
- Easily Distracted
- Abnormally upbeat or even jumpy
- Increased energy or agitation
- Unusually talkative
- Risky Decisions ( such as spending, sexual behavior, reckless driving, etc)
Major Depressive Episodes
It is important to understand that a major depressive episode is much more severe than “just being sad”. It is also a phenomenon that is difficult, if not impossible, for one to rationalize their way out of. On the outside, it can sometimes seem that someone who is dealing with a major depressive episode should “just snap out of it”. However, it goes much further than that for those who are dealing with a major depressive episode of Bipolar Disorder.
A few common symptoms of a major depressive episode include:
- Extreme fatigue or tiredness
- Feelings of sadness, hopelessness, or emptiness
- Slower behavior than normal
- Unexplained weight loss
- Indecisiveness or the decreased ability to concentrate
- Feelings of extreme, or inappropriate guilt
- Loss of interest or pleasure in everyday activities
The Cause of Bipolar Disorder
In many individuals who are living with Bipolar Disorder, there is an imbalance in the neurotransmitters that tell our brains the proper emotions to have. These include serotonin, dopamine, and norepinephrine. This can be due to a genetic difference or a trauma-induced change in brain chemistry.
Bipolar Disorder can also be comorbid (occurring along with) with other mental illnesses. For example, I have been diagnosed with Bipolar I since I was around 18 years old. I have also been diagnosed with Borderline Personality Disorder since then. About 5 years ago I was also diagnosed with a form of PTSD. A few years ago Adult ADHD was added as well. (Yup, I’ve basically got an alphabet going on when it comes to my mental health) Many individuals I have spoken with in support groups have a comorbid diagnosis of Bipolar Disorder and Borderline Personality Disorder as the two have many similar symptoms with a few key differences.
It was believed until recently that Bipolar Disorder was not seen in children. It is sometimes called Disruptive Mood Dysregulation Disorder in children and is characterized by irrational angry outbursts, sad irritable mood, and other severe symptoms that occur more often than normally seen in their peers.
I can say from my own experience (anecdotally only of course) that it was very obvious that I was living with Bipolar Disorder since around the age of 7 or 8. In my daughter, who is now 12, and is being treated for bipolar disorder and high-functioning autism, it was clearly distinguishable at around the same age. Many studies have shown that age of onset can vary, but generally follows the same patterns of those with a genetic link.
Managing Bipolar Disorder
Since Bipolar Disorder is characterized by an alteration in brain chemistry it is imperative that it be diagnosed and treated by a trained psychiatrist. Oftentimes, medications such as antidepressants, mood stabilizers, or those used to manage anxiety may be needed.
Unfortunately, Bipolar Disorder can trick those living with this mental illness into thinking that they no longer need medication. This occurs when an individual finds their way out of a depressive state, or when medication starts working to regulate mood swings. Other times, an individual can miss the extreme highs and lows as they are all that they have known. It’s hard to describe but to a person who has been bipolar all of their life, it can be very unnerving to suddenly be “normal”.
It is important to know that because our brains do not produce the proper levels of the chemicals needed to keep ourselves regulated we will most likely need to be on some form of medication for all of our lives. There is no “cure” for Bipolar Disorder as our brains will never be able to regulate their chemistry properly on their own. However, there are very effective ways to properly manage our disorder.
Some do choose to go with natural medicine. This can help to some degree. However, it is key to remember that all mental illness is on a spectrum. Something that may work well for one individual may not work at all for another.
The same can be said for natural medicine and prescribed pharmaceuticals. If you notice something is not helping it is important to discuss your medications and symptoms with your doctor. In addition, be sure to let your doctor know of all medications and natural supplements or products that you are using. Some of these can be very dangerous when mixed as they will cause our bodies to overproduce substances like serotonin which in some cases can have a deadly outcome.
A great way of determining the effectiveness of your medications or natural products is to keep a mood journal. This will help you to track your moods throughout the day, week, and even month. In time you will have a better understanding of your disorder, how quickly it is cycling, and whether mania, hypomania or depression is more of an issue for you.
Supporting Your Loved One with Bipolar Disorder
Living with an individual who has Bipolar Disorder can be confusing, frustrating, and downright angering sometimes. Some individuals just can’t wrap their heads around the extreme moods and inability to regulate them. Others feel a need to make everything right and get frustrated when they can’t “fix” the individual with Bipolar. This can lead to feelings of resentment, anger, and guilt on both sides of a relationship that involves Bipolar.
Be Understanding: Take the time to really get to know the disorder and understand that no matter how much they may want to it is something that the individual living with bipolar disorder cannot control. This is not to say that they aren’t responsible for their actions. However, they often have extreme difficulty regulating their emotions in what may to you seem like a mundane situation.
Be a Supporter Not an Enabler: It is very important to make the distinction between being supportive and being an enabler with an individual who has bipolar disorder. While we may be supportive of an individual who has a gambling problem, a drug problem, or other extreme behavior it is best to not help them into situations that may cause severe loss or dysfunction.
Set Boundaries: Let the individual know what lines you don’t want to be crossed and the penalties for crossing them. Would cheating be a deal breaker? Make that very clear from the beginning that this is something that is important to you. Unfortunately, hypersexuality is an issue that many with mania or hypomania deal with. However, it is still possible to deal with it in a healthy way that is respectful to our partners.
Accept Apologies: While it may not change the outcome of what happened it is important to know that many who are living with bipolar disorder are frequently filled with guilt from something they may have done during a manic or depressive episode.
Know When Enough is Enough: Of course I’m not saying to completely abandon an individual with Bipolar disorder ( unless they become completely toxic) but it is important to know when to say enough is enough and remove yourself from a situation or interaction.
Oftentimes, when a person is manic or depressive they are not coming from a rational place. You could talk until you are blue in the face but racing thoughts, overbearing guilt, or even the beginnings of psychosis may keep them from truly hearing you.
Show the Love: Let them know that you are trying to understand and that you are there for them if they need you. Sometimes, just having someone to vent to can help us keep from getting worked up to unmanageable levels. (but not every time!)
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