Bipolar Disorder

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Bipolar Disorder

What is bipolar disorder?

Bipolar disorder, also known as bipolar affective disorder, is a mood disorder. It used to be called manic depression, and it typically develops before the age of 20, although some people can develop bipolar disorder later in life.

It is also possible that you have been experiencing symptoms for a long time but have not been diagnosed yet. Bipolar disorder can cause your mood to swing from extreme highs to extreme lows. ‘The highs’ are periods of overactive and excited or elated behaviour that can have a significant impact on your day-to-day life. The highs are described as hypomania and mania, with hypomania being a less intense form.

‘The lows’ are periods of severe depression, during which some people can become catatonic and are unable to move. Some people also experience psychotic episodes, such as seeing or hearing things that others around them do not experience or having strong beliefs that are not based on facts.

These experiences can feel very distressing and overwhelming, but it’s important to remember that you are not alone, and there is help and support available.

Is Borderline Disorder a mental illness?

Yes. According to diagnostic manuals (DSM-5 or ICD-10) used by Clinical Psychologists and Psychiatrists to diagnose people with mental illness, bipolar disorder is a type of mental illness. It falls within a wider group of mood disorders, and only a mental health professional can give a diagnosis of bipolar disorder following a diagnostic assessment.

There are several types of bipolar disorder:

  • Bipolar 1 – people experience mania, depressive episodes are common, although not everyone experiences them.
  • Bipolar 2 – it is common to experience periods of severe depression and hypomania (instead of mania).
  • Bipolar I or II disorder with mixed features – also called ‘mixed bipolar state’, where mania/hypomania and depression happen at the same time (e.g. feeling very sad and being overactive at the same time).
  • Bipolar I or II disorder with rapid cycling – characterised by four or more depressive, manic, hypomanic or mixed episodes in a year.
  • Bipolar I or II with seasonal patterns – depression, mania or hypomania are affected by seasons (e.g. feeling depressed in winter but no regular pattern for mania/hypomania).
  • Cyclothymia or Cyclothymic Disorder has similarities to Bipolar Disorder – characterised by regular episodes of depression and hypomania but over a longer period than in bipolar disorder (2 years and more); although the symptoms may be milder, they can last longer. Cyclothymia can progress to Bipolar Disorder.

It is common to feel stable or have neutral periods between episodes of depression and mania/hypomania.

What causes Bipolar Disorder?

There is no single cause to bipolar disorder, and several factors can contribute to someone developing a bipolar disorder, including genes, stressful life experiences, childhood trauma, and brain chemistry. Research suggests that a mixture of all the factors increases someone’s chances of developing bipolar disorder.

Genes and brain chemistry

Although there is no single ‘bipolar gene’, research suggests that you are five times more likely to develop bipolar disorder if someone in your immediate family (e.g., sibling or parent) experiences bipolar disorder. There is also some evidence that chemical fluctuations in your brain (either too little or too much of certain chemicals) could lead to someone developing mania or depression. However, it isn’t fully known if this is a cause or the result of bipolar disorder.

Stressful life experiences and childhood trauma

Certain stressful events, such as a loss of a loved one or financial hardship and poverty, can be a significant factor in someone developing bipolar disorder. Experiencing abuse, neglect, or a significant loss in your childhood have also been suggested as some of the causes of bipolar disorder.

Symptoms of Bipolar Disorder

Each person’s experience of bipolar disorder is unique to them. You might have similar experiences to others yet be affected in diverse ways. There are a number of symptoms that you may experience, both physical and psychological, and they fall into two groups, manic and depressive.

Hypomanic symptoms are also common, and they can feel more manageable and have less of an impact on your day-to-day life, so you might be able to go to work and socialise without any major problems. They also don’t last as long.

Depressive symptoms in Bipolar Disorder

  • feeling down, upset or tearful
  • lack of energy
  • feeling worthless
  • low self-esteem
  • suicidal thoughts, self-harm, or suicide attempts
  • not being interested in or finding enjoyment in things you used to
  • having trouble sleeping or sleeping too much
  • eating too little or too much
  • misusing drugs or alcohol
  • being withdrawn or avoiding people
  • being less physically active than usual
  • self-harming, or attempting suicide

Manic symptoms in Bipolar Disorder

  • increased energy – being more active than normal with significantly less sleep
  • excitement – feeling happy and euphoric
  • impulsive behaviour – e.g., overspending money or in a way that is unusual for you
  • agitation or irritability
  • increased sexual energy
  • you may feel like you can perform tasks better
  • talking a lot or very quickly, not making much sense to others
  • putting yourself in more risky situations – like drinking more, taking drugs, or having sex with strangers
  • saying or doing things that are inappropriate and out of character

Treatments for Bipolar Disorder

There is a range of treatments available for bipolar disorder, including psychological therapy and medication. Lifestyle can also have a major impact on how bipolar disorder manifests itself. An initial assessment is a critical part of the right diagnosis for Bipolar Disorder and the most helpful treatment.

During your assessment, a Clinical Psychologist would discuss a number of things with you, including:

  • how many symptoms you experience
  • how long your manic or depressive episodes last
  • how many episodes you’ve had, and how frequently they occur
  • the impact your symptoms have on your life
  • your family history

Psychological Therapy for Bipolar Disorder

  • Cognitive behavioural therapy (CBT) – looks at how feelings, thoughts and behaviour influence each other, and these patterns can be changed.
  • Interpersonal therapy – focuses on relationships with other people and how your thoughts, feelings, and behaviour impact you and are impacted by your relationships.
  • Behavioural couples therapy – focuses on recognising and trying to resolve the emotional problems that can happen between partners.
  • Enhanced relapse prevention/ individual psychoeducation – a brief intervention to help you learn coping strategies, such as learning about bipolar, developing a crisis plan or a mood diary with a mental health professional.
  • Group psychoeducation – involves working in a group of people with shared experiences, led by a trained therapist, to build up knowledge about bipolar disorder and self-management.
  • Family-focused therapy – involves working as a family to look at behavioural traits, identify risks and build communication and problem-solving skills.

Medication for Bipolar Disorder

People experiencing bipolar disorder are typically prescribed a medication called mood stabilisers. Lithium is the most common one. Several others are widely prescribed to manage periods of mania/hypomania, such as haloperidol or quetiapine and depression (e.g., fluoxetine).

Lifestyle Advice for Bipolar Disorder

Bipolar disorder can make you feel like you are out of control. However, there are several things you can do to manage your symptoms. These can include getting to know your triggers, being able to recognise your moods and looking for patterns to help you and your loved ones anticipate what is about to come. Having a clear daily routine (e.g., having a shower, taking your medication at the same time every day) is vital in helping you stay in control when you are feeling high or low.

Getting a night of good sleep, eating a healthy diet, and taking regular exercise can all help you feel more in control and manage your symptoms. Finally, having people around you that you trust and rely on, who can tell you when your behaviour changes or who can support you and keep you safe in moments of crisis, is invaluable.