Together at the Poles

What Is Bipolar Disorder?

By Daniel Bader, Ph.D.


Bipolar disorder is a spectrum of disorders that affect mood. Those who have bipolar disorder will have periods of very high mood called “mania” or “hypomania” and periods of very low mood called “major depression”. Both of these periods can be very challenging for those suffering from the illness and for those around them. Manic and less-serious hypomanic periods can include reckless behavior and even delusions, while depressive episodes can lead to self-destructive behavior and are simply horrible in their own right.

Bipolar Moods

People with bipolar disorder have different mood states, usually in a cycle (though not necessarily a regular one). While one normally hears simply of bipolar disorder as being bipolar, it is quite common for people with bipolar disorder to have mixed episodes and to have other moods stirred into the pot:

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  • Mania: Mania is a state of extremely elevated mood that is often accompanied by delusional thinking and reckless behavior.
  • Hypomania: Hypomania is a state of elevated mood that often involves racing thoughts, a great deal of energy and sleeplessness.
  • Major Depression: Major depression is a state of extremely low mood, usually accompanied by loss of energy.
  • Mixed States: Mixed states combine symptoms from manic and depressive states at the same time. They can be quite dangerous because people are depressed but with the energy to act on self-destructive thoughts.

In addition to these episodes, there are a number of different emotional states that tend to accompany bipolar episodes at a far higher rate than they do in the rest of the population:

  • Irritability: In manic and hypomanic states, people can be far more irritable and are often even prone to rage.
  • Anxiety: People with bipolar disorder are more likely to suffer from increased anxiety, especially during depressive periods.
  • Paranoia: Paranoia is quite common in those with bipolar disorder both during the manic and depressive phases.

What Are the Different Types of Bipolar Spectrum Disorder?

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As mentioned above, bipolar disorder is actually a spectrum of disorders, usually measured in terms of acuteness of mania. In addition, there is one disorder that combines symptoms of both bipolar disorder and schizophrenia:

  • Bipolar 1: Bipolar 1 disorder will include incidents of mania.
  • Bipolar 2: Bipolar 2 disorder will include only incidents of hypomania rather than mania. However, depressive episodes tend to be longer and more severe.
  • Cyclothymia or Bipolar 3: Cyclothymia is sometimes called Bipolar 3 disorder, and includes long periods of hypomania followed by long periods of depression that do not meet the criteria for major depression.
  • Schizoaffective Disorder: Schizoaffective disorder combines symptoms of bipolar disorder with symptoms of schizophrenia, including hallucinations.

One is considered to have a “rapid cycling” form of the disorder if one has at least four cycles of manic, hypomanic or depressive episodes during a year. Any of the above types of bipolar disorder except cyclothymia can be of a rapid-cycling variant.

Negatives and Positives of Bipolar Disorder

Bipolar disorder presents a number of dangers to those who suffer from the illness. In fact, the manic and hypomanic periods can be more dangerous than the depressive periods. When people are manic or hypomanic, the following can all occur:

  • Reckless Spending: People in manic and hypomanic periods tend to have less regard for money.
  • Substance Abuse: Often people use addictive substances in an attempt to control their moods.
  • Hypersexuality: People with bipolar disorder can have their sexual desires greatly increased.
  • Anger: Mania and hypomania can lead to anger when lofty goals are frustrated.
  • Bizarre Behavior: People in manic periods can become delusional, leading to strange behavior.

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In addition, bipolar disorder has one of the highest rates of suicide among mental illnesses, with approximately thirty-three percent of people with bipolar disorder attempting suicide and fifteen percent succeeding. Unlike the consequences mentioned above, suicides usually take place during depressive states or mixed states.

However, there is a positive side to hypomanic episodes. Lately, there has been a lot of research to show that creativity is linked to hypomanic episodes, such as in Dr. Kay Redfield Jamison’s book Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. During hypomanic episodes, people with bipolar disorder are often full of original ideas and they have the energy to act upon those ideas. However, should they slide into full-blown mania, their thoughts are often too confused to actually follow through.

In addition, hypomanic episodes can simply be enjoyable. Before hypomania slips into mania, people with bipolar disorder are often more gregarious and appreciative of beauty and other pleasures. In fact, in the documentary “The Secret Life of the Manic Depressive” on the BBC, when Stephen Fry asked several bipolar people whether or not they would push a button and get rid of their bipolar disorder, more than half of them said “no”.

For those with the disorder, bipolar disorder is something of a “mixed curse”. The negative symptoms are terrible and often dangerous. However, the hypomanic periods provide a sense of being alive that many people with bipolar disorder would not be willing to do without.

How Common Is Bipolar Disorder?

According to a recent study in the Archives of General Psychiatry that studied eleven countries, 2.4% of people had had a diagnosis of bipolar disorder at some point in their lifetime. The prevalence of these diagnoses varied by country. Japan had the lowest rate at 0.1%, while the United States had the highest rate at 4.4%. This variance likely had less to do with the actual number of people with the disorder but with diagnostic practices in the relevant countries.

Note that this only refers to the number of diagnosed cases of bipolar disorder. It is impossible to know just how many undiagnosed cases there are.

Where Does Bipolar Disorder Come From?

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Bipolar disorder seems to be primarily a genetic disorder. On the one hand, people who have genetic family histories of bipolar disorder have a significantly higher chance of having bipolar disorder themselves. In fact, it seems to be the case that everyone who has bipolar disorder has at least one blood relative with some variant of the condition.

The incidence of bipolar disorder depends on who also has a bipolar spectrum condition in one’s family. According to an identical twin study published in The American Journal of Psychiatry in April 2004, bipolar disorder 1 is up to 93% attributable to heritable factors. Note that this number is higher than that reported in a number of other studies. What was different about this study is that controls were used to compensate for the possibility of underdiagnosis and a standardized test was used called the “Structured Clinical Interview for DSM-IV Axis I Disorders”. In other words, the study took into account the possibility that one identical twin may have undiagnosed bipolar disorder and ensured that both twins were being diagnosed using the same criteria.

As for the other seven percent, no one is entirely sure what the cause is. Bipolar episodes can be triggered by stress and many people with bipolar disorder report having had their first episode in a time of extreme stress. However, this may only imply that stress is triggering the first episode, not that it is causing the disorder itself. Other causes may also be in our diets or in the environment or as the result of childhood trauma. Unfortunately, the other causes of bipolar disorder are largely unknown at this time.

Summary

  • Bipolar disorder is a spectrum of mood disorders.
  • It has four different types of episodes: manic, hypomanic, major depressive and mixed.
  • The disorders on the spectrum are bipolar 1, bipolar 2, cyclothymia or bipolar 3, and schizoaffective disorder.
  • Negative consequences of mania and hypomania can include reckless spending, substance abuse, hypersexuality, anger and bizarre behavior.
  • Hypomanic episodes can be quite creative and positive experiences.
  • Bipolar disorder is incurable, but can be managed.
  • Diagnoses vary by country, with an average of between two and three percent.
  • Bipolar disorder is largely genetic.

More Information:

9 Responses to What Is Bipolar Disorder?

  • In 1989, I was prescribed Valium to help me “deal with” my mother’s terminal illness. After she died, I kept taking it. And the doctor kept renewing it. In 1999, I had my first, full blown panic attack. I was hospitalized in a mental hospital for 6 days. At discharge, I was diagnosed with bipolar disorder. I was put on a half-dozen medications including Klonopin. I had all the “symptoms” of bipolar disorder, thanks to the Klonopin, and went misdiagnosed for 14 years. I withdrew from Klonopin 4 months ago. My severe bipolar symptoms stopped almost immediately. How many others out there are victims of psychiatry and Big Pharma? (Do not stop taking benzodiazpine medication without the help of a KNOWLEDGEABLE physician. They are the most addictive medications and can cause severe withdrawal effects, including seizures.)

    • Hi Vicci,

      I’m sorry that happened to you. I think your experience really shows the way that we can be helped by seeking second opinions. I’m careful always to do what my psychiatrist suggests, but that doesn’t mean that I won’t talk to another doctor if I am uncomfortable with my treatment.

  • great article!

    • I have a diagnosis of Bipolar 1 but am unsure as I don’t think I fit in neatly with any bipolar diagnosis! For example until a few days ago I can’t remember the last time I had any symptoms of mania although I have had lowered mood probably due to my divorce status. However my ability to control my temper when I have been seriously provoked can be a major issue where I believe I am justified in having to emphasise my feelings. In twenty five years I have only experienced two major disruptions and one ? Not so serious. I must comment therefore on mental health services where I live as u feel they are totally inadequate, offer little in the way of treatment I.e. drugs, 15 minute appts. With psychiatrists and in my case two different talking therapies – psychotherapy and clinical psychology neither of which lasted any length of time because of changes and disruption to my local mental health service. In other words poor communication and lack of care. My future is now much more stable because of how I have dealt with my feelings and I refuse to be a victim and will retaliate if I believe I am being persecuted. More needs to be done I believe in educating the public as to what mental illness is all about and how persecuting sufferers is counter-productive to their illness. Give peace a chance so said the Beatles and that should apply across the spectrum of poor health physical, mental or psychology.

  • My husband suffered with Bipolar most of his life. In the begining of our marriage in 1963 I just thought he had a bad attitude. It was not well known then and I did not probe. I stayed out of his way and it would subside and things would be OK. He was a musician (good one) and also spent time drinking, which calmed him as the doctor said and therefore it was not evident that his mood swings really affected our life. I loved him and thought it was stress. We were married for 43 years and he passed away in 2006 from an overdose of drugs administered by the hospital. He went in for a routine check-up … and they should have stopped the meds as was advised but his kidneys could not take the pressure. Long story… but what I want to know is, I was never told that there were different levels of bipolar. Can that be explained to me. Please I am interested as I see this in a few other members of the family. best regards.

    • Hi Lorraine,

      I’m sorry to hear about what happened to your husband.

      Yes, there are different types of Bipolar. I’ve written a couple articles about it. This one is about the Bipolar 1-Bipolar 2 distinction, and this one is about cyclothymia and bipolar disorder, not otherwise specified.

  • Very informative and I hope more people who read this can lessen the stigma of people being bipolar because it can be managed.

    • Thank you, Shawn. You’re right: it’s important for us to remember that this is a manageable illness.

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Psychotherapy from Daniel

Daniel Bader, Ph.D., RP (Qualifying), CCC

Daniel Bader, Ph.D., is a Registered Psychotherapist (Qualifying) and Canadian Certified Counsellor specializing in bipolar disorder, offering in-person psychotherapy in Kitchener, Ontario, and online and telephone psychotherapy within Canada.

To book an appointment with Daniel, please visit his Psychology Today profile.