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Bipolar disorder is a mood condition that may cause individuals to fluctuate between states of lows like depression to states of abnormal optimism, activation or hyperactivity “highs” in moods.
Bipolar disorder is often confused with depression and many trauma responses. The main difference is that depression is unipolar, characterised by only depressive symptoms whilst bipolar disorder cycles the components of mania, hypervigilance, hyperactivity. The mood swings from depression to abnormal optimism or hyperactivity back to depression. Depending on the mood spectrum, the two conditions may alternate in cycles. In other words, bipolar people have mood swings from one extreme to the other (which is also common in trauma). In some circumstances, the “mania” component is not an elevated mood, but hyperactivity or anxiety or the inability to sleep or present many anxiety or upbeat, jumpy or wired, high activity, energy or agitation, an overly exaggerated sense of well-being and self-confidence (euphoria), decreased need for sleep, talkativeness, racing thoughts or need to fulfil some endless list of tasks.
Bipolar does not present in the same way for all individuals which is why it is so often misdiagnosed. Some may feel depressed most of the time, while others have mostly manic phases. It often results in poor job or student performance, poor relationships and other problems. There is an increased risk of suicide, particularly during the depressive periods but also during the manic periods.
Symptoms of the depressive phase include:
On the other extreme, the manic episodes include:
There is a milder form of mania, called hypomania. The symptoms are similar to that of mania but less intense and not as long-lasting. Hypomania has less severe consequences than mania; however, if it escalates to mania, hospitalisation may be necessary.
There are also different types of bipolar disorder (see below).
Bipolar I
This is when the person has either alternating episodes of depression and mania, or mixed episodes (depression and mania at the same time), or pure manic episodes (without depression). In all cases the symptoms are very much out of character with the person’s normal conduct. The person may react so severely that it requires immediate hospitalisation and professional care.
Bipolar II
This is a pattern of depression interspersed with hypomania episodes. Usually the depression lasts longer than the hypomania. Though it is (clinically) less severe than bipolar I, it still requires treatment, as the severity and the person’s reaction is unpredictable – it can change or escalate very quickly.
Rapid-cycling Bipolar Disorder
People with this disorder have four or more episodes of bipolar I or II in one year. The cycles can come and go in a matter of days or hours. Bipolar II sufferers are more inclined to rapid-cycling. This is a very serious form of bipolar disorder and always requires urgent professional intervention.
Mixed-state bipolar
This is when people experience the states of depression and mania, both at the same time. Scientific tests have shown that we can have both episodes simultaneously, much like the common “laughing through the tears” phenomenon. When this happens, a bipolar person will be in a state of confusion and too unstable to carry out a task properly. One part of them wants to do it, while another part rejects it. It is not an exclusive phenomenon, as it can affect any bipolar I or II sufferer at any time. It causes extremely rapid and volatile shifts in emotions.
Cyclothymic Disorder (Cyclothymia)
Cyclothymic disorder is a relatively mild disorder, diagnosed when someone has mood swings that cycle between mild depression and hypomania, with periods of normality in between. Although milder than bipolar I and II, it might interfere with work and relationship functions. It increases the risk of developing severe bipolar disorder.
The causes vary a lot and can only be determined through individual analysis, but here are some general causes:
Mood disorders are treatable and it is important not to delay treatment – The person’s state and behaviour can change very quickly and unexpectedly, resulting in serious injury or damage.
The first avenue of treatment for bipolar disorder depends on whether a patient is medically compromised or not. A medical practitioner’s task is to apply immediate medical care, for instance treatment of injuries or coma, and to then refer the patient for psychological treatment combined with related medication.
If a patient has been on a certain course of medication, that medication should not be withdrawn suddenly, unless instructed to do so by a medical doctor or psychiatrist. It is essential to tell the doctor or counselor about all the symptoms and medications, past and present, so they can make the right diagnosis.
The status of bipolar disorder varies widely and determines the treatment the patient receives. Mania that occurs during medical treatment is usually quickly resolved, but there is a danger of relapse if the person does not receive preventative or maintenance treatment, such as cognitive behavioural therapy.
Psychological treatment of patients with bipolar disorder should be carried out by specialists, as this disorder is very complex and difficult to treat. Self-treatment of bipolar disorder is not viable.
Suicide and damage prevention
If you think someone is at immediate risk of self-harm, hurting others or causing damage:
If you suspect that you, or someone you know, may have bipolar disorder, call the number at the top of this page for more advice or a confidential interview with a professional psychiatric counsellor.