The Silver Ribbon

What is Bipolar Disorder?

Bipolar Disorder, also known as Manic Depression, is a common psychiatric disorder that includes periods of extremely elevated mood. Most people with bipolar disorder also experience periods of depression and periods of full or partial recovery. The cycles of high and low mood states and well periods may follow an irregular pattern.

However, it is important to understand a few of the many reasons why Bipolar Disorder can be hard to diagnose:

• Although diagnosis of Bipolar Disorder requires the occurrence of at least one episode of unusual mood elevation, most people living with Bipolar Disorder experience depression more frequently than mania or hypomania.
• Diagnosis can be delayed or made difficult when the first episode is depression; episodes of mood elevation are subtle, infrequent, or brief; symptoms of other disorders are present; or professionals use words without providing appropriate definitions.
• Bipolar Disorder is classified as a mood disorder, but nearly all people living with Bipolar Disorder also experience a wide variety of non-mood symptoms which are frequently as prominent as the mood epsiodes. The most common problems are anxiety disorders, substance misuse, attention problems, and medical problems like asthma and obesity.

What is Hypomania?

The term hypomania refers to a clearly altered mood state with mild to severe symptoms of mania that may last for a few days or may persist for many months. Thus, the key difference between mania and hypomania is not so much the severity or duration of symptoms, but the impact the symptoms have on the person’s social or occupational function . Mania typically causes obvious problems in daily functioning and often leads to serious problems with a person’s relationships or work functioning. By definition, hypomania does not cause problems to the same extent as mania.

While for some people the hypomania is a pleasant state of good humor and high productivity, for most people even hypomania can be problematic. Things said and done during a hypomanic episode often have negative long-term consequences.

Hypomania is seldom stable. It may occur as a phase in an evolving full manic episode, or it may precede a severe depression. In other words, a hypomanic episode may be a sign that a more severe manic episode is on the way, or it may be a sign that a person is going to “crash” and become depressed.

What is Mania?

Mania is the word that describes the activated phase of Bipolar Disorder. When it is less severe, it is called hypomania. The symptoms of mania may take a variety of forms. People on the “high” side of Bipolar Disorder may feel on top of things, productive, sociable, and self-confident. Many people have described the “high” of hypomania as feeling better than at any other time in their lives, but the feelings are exaggerated. They cannot understand why anyone would call their experience abnormal or part of a disorder.

They feel excited, have surges of energy, and describe feeling more creative, attractive, active, intelligent, important, and sexual. They may take on a tremendous amount of work, and most times accomplish only a fraction of it. For some people, the experience of elevated mood consists mostly of irritability and hostility. Hypomania is often very appealing to individuals who have recently come out of an extended episode of depression.

Unfortunately, the “high” frequently does not stop with hypomania. The mood becomes more elevated or irritable, behavior more unpredictable, and judgment more impaired as mania develops. People often make reckless decisions during periods of mania and put stress on their relationships; more often than not, the person is unaware of the negative consequences of these extreme actions.

Spending sprees, alcohol and drug abuse, and hypersexuality are common. These periods of perceived self-importance and uncritical self-confidence can advance into a state of psychosis, with delusions and loss of contact with reality. People with Bipolar Disorder rarely seek treatment during a manic episode, because they may not recognize that anything is wrong.

What is Depression?

Depression is more than just the sad mood that most people might experience when they have had a bad day. Major depression is a medical disorder that lasts at least two weeks and that produces a combination of physical and emotional symptoms that makes it very difficult to function in life. At the heart of clinical depression is a loss of pleasure in activities that used to be fun or exciting. Also, people often have feelings of sadness, hopelessness, and pessimism. These symptoms are accompanied by a wide variety of physical symptoms, such as difficulties sleeping, poor concentration and memory, low energy, and changes in appetite. Though not everyone experiences all of these physical symptoms.

When they are depressed, people who live with Bipolar Disorder are often in a profoundly sad, irritable, or “flat” mood. The inner pain may be intense and result in feelings that life is totally without pleasure and not worth living. When depressed, people who live with Bipolar Disorder lose interest in their usual activities. Even eating and sex are no longer enjoyable. Former interests seem boring or unrewarding, and the ability to feel and offer love may be diminished or lost.

The lows of depression are often so physically debilitating that people in this phase of the illness may even be unable to get out of bed. Sleep is disrupted. A frightening part of bipolar disorder for people in the depressive phase is their inability to concentrate, remember, and make decisions. Even minor decisions such as what to have for dinner can seem overwhelming. Self-esteem usually plummets, and the mind often becomes obsessed with losses and personal failures, guilt, and helplessness. “I am not worth much” and “the world is a terrible place” are examples of common negative thoughts.

What are the types and subtypes of Bipolar Disorder?

There are many types of mood disorders, depending on the symptoms that an individual experiences:

• Unipolar Disorders
• Bipolar I
• Bipolar II
• Cyclothymia
• Bipolar NOS

Each of these is characterized by the episodes of mania, hypomania or depression the person experiences and the alternating cycling of these episodes.

How common is Bipolar Disorder?

Bipolar Disorder is common. Approximately three percent of adults in the population have bipolar disorder. Overall, the disorder affects both women and men equally.

What is the course of the illness?

Bipolar Disorder can occur at any time, but usually begins before age 35. People between the ages of 15 and 25 years have the highest risk of developing this disorder.

Even among people who have frequent severe episodes, there may be long periods with normal mood states. Some doctors and family members may be tempted to interpret these periods of wellness as evidence that the diagnosis of bipolar disorder was incorrect. Unfortunately, this is seldom the case. Bipolar Disorder often has natural periods of remission, but those who meet criteria for Bipolar Disorder will almost always relapse without treatment.

Source: NAMI’s brochure ‘Understanding Bipolar Disorder and Recovery’ which be accessed here.