Understanding bipolar disorder
Bipolar disorder is an illness of the brain that includes a variety of symptoms indicative of exaggerated mood states. Individuals with this condition display unusual shifts in mood, activity level, and energy. Additionally, they may lack motivation, have decreased desire to engage in interpersonal interactions, and have difficulty functioning normally on a day to day basis. Symptoms of bipolar disorder differ somewhat in severity depending on the type of the disorder, however, no matter which form the illness takes the symptoms are significantly different from the regular ups and downs that we all experience from time to time.
There are three primary types of bipolar disorder. Bipolar I includes manic with or without the occurrence of depressive symptoms or mixed episodes. Those suffering from Bipolar II experience at least one hypomanic episode, a milder form of mania, and one major depressive episode. Cyclothymic disorder includes hypomanic-like symptoms and depressive symptoms, both of which are below threshold for meeting the criteria for either condition.
Mania encompasses greatly enhanced energy levels, euphoria, less need for sleep, excessive talking, and sometimes delusional grandiose plans for completing tasks the individual may not have the skills to accomplish. Depression involves extreme sadness, fatigue, a poverty of speech, and the loss of motivation to carry out even important tasks.
Although most adults don’t cycle often, the times between cycles are often filled with excessive anxiety related to the onset of the next extreme mood state. Given the distress caused by the anxiety, even the neutral periods between the mood states are experienced as overwhelming.
Bipolar disorder symptoms can result in broken relationships, declines in job or school productivity and achievement, and financial ruin. However, despite how devastating this condition may be, it can be effectively treated with the appropriate medication, psychotherapy, and follow-up. People suffering from this disorder can gain control over their symptoms and lead happy and fulfilling lives.
Statistics of bipolar disorder
The 12 month prevalence rate for bipolar I for adults in the U.S. has been estimated to be .6%. There is no significant gender difference for this type. For bipolar II the 12 month prevalence rate of U.S. adults has been estimated at .8%. Similarly, there has been no gender differences discovered. While no 12 month prevalence rates have been reported, the lifetime prevalence rate for adults in the U.S. with cyclothymic disorder has been estimated to range from .4% to 1%.
There are numerous psychiatric and substance use disorders that may co-occur with bipolar disorders in adults. These include:
- Specific phobias
- Social anxiety/social phobia
- Panic disorder
- Generalized anxiety disorder
- Substance/medication induced anxiety disorder
- Binge eating disorder
- Adult ADHD
- Intermittent explosive disorder
- Substance use disorders including alcohol abuse, stimulant abuse, and benzodiazepine abuse
- Metabolic disorder
Causes of bipolar disorder
While there is support for certain factors regarding their role in the development of bipolar disorders, it is generally agreed upon that ultimately it takes a combination of factors to cause this condition to manifest. It is also accepted that these disorders likely result from different combinations for different individuals and condition type.
- Genetic-Similar to other mood related disorders, it is clear that bipolar disorders run in families. Current thinking also reflects research indicating that genetic contributions to bipolar disorder are complex and likely involve a number of gene mutations, chromosomal abnormalities, and the interaction of certain genes linked to mood and mood regulation.
- Brain Structure and Functioning– In the front of the brain is an area responsible for impulse control, emotional regulation, and the ability to alter actions and reactions to rapidly changing situations. Imaging studies have determined that this area of the brain is smaller and does not function as well in those with bipolar disorder compared to those without these disorders
- Physiological Predisposition – In addition to role of genetics and specific structures within the brain in the development of bipolar disorder, it is believed that there is an inborn predisposition related to this disorder. However, whether or not the predisposition leads to the development of a bipolar condition is dependent on the interaction with environmental factors. Specifically environmental stressors and negative life events are believed to trigger this predisposition in some individuals.
Signs and symptoms of bipolar disorder
The symptoms of the two general mood states found in bipolar disorder are listed below.
Manic/Hypomanic Symptoms (The two types of symptoms differ by degree of severity):
- Excessively elevated mood
- Being overly optimistic
- Excessive energy and activity level
- Physical agitation, restlessness, the inability to sit still
- Significantly increased goal related activity that the individual does not have the skills to complete
- Delusions of grandeur regarding capabilities, popularity, and social position, among other areas
- Excessive involvement in activities with great risk for resulting in harm (e.g. investing in schemes with no foundation, promiscuous sexual activity, driving at high speeds)
- Increased self-esteem
- Less need for sleep
- Decreased appetite
- Pressured or rapid speech or increase overall speech output
- Racing thoughts
- Flight of ideas
- Decreased ability to maintain attention or severe distractibility
- Impaired judgment
Depressive Symptoms (must occur minimally over a two week period for Type I or Type II; for Cyclothymic Disorder depressive symptoms are less severe and occur over a shorter period):
- Depressed mood (based on self-report or observation by others)
- Loss of enjoyment in previously pleasurable activities
- Feeling numb or empty
- Change in appetite and/or unintended weight loss or weight gain amounting to at least a 5% change in body weight in a single month
- Sleeping significantly more or less than usual
- Psychomotor retardation or agitation (must be observed by others even when it is reported by the person)
- Decreased energy, tiredness
- Loss motivation to engage in even important activities
- Social withdrawal
- Inability to perform well at work or school
- Feeling worthless, shameful or overly guilty without cause (may be delusional)
- Difficulty concentrating, thinking logically, or paying attention
- Impaired decision making
- Difficulty remembering even recently learned information
- Thoughts of death, suicidal ideation
Effects of bipolar disorder
The consequences of living with untreated bipolar disorder affect every area of an individual’s life, along with those around them. The effects of bipolar disorder include:
- Reduced functional capacity
- Loss of important relationships
- Marital problems and divorce
- Legal problems
- Financial problems and increasing debt
- Increasing anxiety between mood states
- Decreased work productivity, lost work days, and inability to maintain employment
- Family problems and fractures due to the negative effects on each member’s quality of life
- Damaged relationships leading to the loss of a social support network
- Poor job or school performance, leading to lack of achievement
- Physical problems from prolonged abuse of drugs, alcohol, or prescriptions taken in an effort to self-medicate
- Sense of hopelessness and helplessness that the future will get better
- Increased need for physical health services
- Increased dependency on others for day to day functioning results in feelings of weakness and uselessness