Understanding Bipolar Disorder
Have you ever heard someone say (or maybe you’re guilty of this yourself), “Oh my god, you’re so bipolar!” when a mood swing has been detected? Oy, even writing that sentence makes me cringe and is exactly the reason we’re talking about bipolar disorder this week. This diagnosis is an often stereotyped and totally misunderstood.
Let’s once again start with the basics, what is bipolar disorder? Bipolar disorder is actually two separate diagnoses (Bipolar I and Bipolar II) that are both categorized by unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. These moods range from periods of extremely “up,” elated, irritable, or energized behavior to very “down,” sad, indifferent, or hopeless periods. Bipolar I has a primary characteristic of manic episodes (we’ll get to those shortly) lasting at least seven days or having severity necessitating hospital care. These are typically followed by periods of depression that last two weeks or longer. These time periods are key along with level of intensity. This is not “Oh you were happy this morning and this afternoon you’re sad, you must have bipolar disorder”. Alternatively Bipolar II has a primary characteristic of alternating depressive episodes and hypomanic episodes. Hypomanic episodes are less intense than the manic episodes characteristic of Bipolar I. Again, we’ll get to what that means shortly. The depressive episodes of Bipolar II are potentially longer than those of Bipolar I.
Depression is generally better understood in the general population. For the sake of education though, depressive episodes are periods of time where one may feel sad, down, empty, or hopeless. They can also include:
· Irritability
· Marked loss of interest or feeling no pleasure in all — or almost all — activities
· Significant weight change
· Sleep disturbance
· Restlessness or slowed behavior
· Fatigue
· Feelings of worthlessness or excessive or inappropriate guilt
· Decreased ability to think or concentrate, or indecisiveness
· Thinking about, planning or attempting suicide
Again, generally well understood in the general population (with 20% of US adults experiencing depression, that makes sense)
When it comes to Bipolar disorder it’s way more important to understand what a manic or hypomanic episode is. Manic and hypomanic episodes share many characteristics but the intensity is a major differentiator with a manic episode being more intense and generally more impactful in arenas like school, work, social activities and relationships. Manic and hypomanic episodes can include the following behaviors:
· Abnormally upbeat, jumpy or wired
· Increased activity, energy or agitation
· Exaggerated sense of well-being and self-confidence (euphoria)
· Decreased need for sleep
· Unusual talkativeness
· Racing thoughts
· Distractibility
· Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
To better explain the difference between a manic and hypomanic episode, let’s use this last point. In a hypomanic episode, one may overspend or come close to maxing out a credit card, during a manic episode, someone may liquidate their bank account. Manic episodes can sometimes bleed into a break from reality, that’s not as common and generally involves hospital care. It’s also important that being in a manic episode does not make someone violent, although it can definitely make someone more vulnerable to being a victim of violence.
When it comes to challenging your own biases around Bipolar Disorder, a place to start is around your language. Bipolar is not a euphemism for experiencing standard mood swings. It’s not a joke. It’s also not something to be pitied. People with bipolar diagnoses are not inherently more violent or unpredictable or limited than the general population. Symptoms can generally be well maintained with a combination of medication and therapy.