Understanding bipolar disorders

In my work as a college psychology instructor and a psychotherapist, I often am asked about the topic of bipolar disorders. I am always surprised at the amount of misinformation that people have about what specifically bipolar disorders are and how they present in an individual.

It is not uncommon for me to hear from students or clients that they believe bipolar is a moment-to-moment shift in mood with the suffering individual being happy for a few minutes and then instantly moving into a sense of despair.

It has become common for many people to assume that any sign of aggression or sadness can be labeled as bipolar.

This kind of misinformation often keeps people from getting the help they need as they believe they may be bipolar but in reality they could be suffering from some other disorder.

To gain an understanding of what specifically bipolar is and how it manifests, we need to define it correctly.

In the past bipolar disorders used to be referred to as “manic depression.” These disorders can cause extreme changes in a person’s mood.

These changes can include severe emotional highs in the form of “mania” or “hypomania” and lows in the form of depression.

When a person is in a manic state, they feel euphoric and full of energy. Over time their mood will shift in the other direction toward depression, in which he or she may experience feelings of intense hopeless, sadness and can lose interest in most activities.

There are several forms of bipolar and many subsets of the disorder, but for the purpose of this article I am going to focus on the two primary forms of bipolar disorder: Bipolar I and Bipolar II.

According to the Diagnostic and Statistical Manual of Mental Disorders, which contains the diagnostic criteria used by mental health professionals, Bipolar I has to have “a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary).”

This elevated mood is known as “mania.” A manic episode is usually characterized by such symptoms as needing very little sleep, excessive rapid speech, erratic and distracting thoughts, impulse control issues, poor judgment, delusions of grandeur, reckless behaviors and, in some cases, auditory hallucinations.

A manic episode can be very detrimental for the person who suffers from Bipolar I. With impaired judgment, he or she can engage in actions which have detrimental long-term consequences.

When a person is in the manic episode, he or she cannot determine between what is logical and what is not as impulse control is very limited.

If we reflect on the minimum criteria for at least one week of mania, we can understand that this person is not shifting back and forth in mood from moment to moment. The manic episode can last even longer than a week.

Over time the person with Bipolar I will gradually move out of his or her manic episode and move down in intensity level to occupy a more stable emotional level.

In time, he or she will move down even further to a level of deep depression which creates an inability for the person to function in daily life.

Bipolar II is characterized by the presence of “hypomania.” Hypomania is a less severe form of mania. Many may not perceive hypomania as a problem as it may create a sense of productivity and excitement in the individual.

For a person who is suffering from Bipolar II, hypomania has the potential to evolve into mania and may even switch into depression. People who exhibit the symptoms of Bipolar II will spend more time in depression than Bipolar I.

It is believed that the cause of bipolar disorders involves disruption in the balance of brain chemicals called neurotransmitters.

Three specific chemicals – serotonin, dopamine and norepinephrine – have been linked to bipolar disorders. Researchers believe that problems with the functioning of brain circuits which involve these neurotransmitters can lead to symptoms of mania, hypomania and depression.

As a result of this information, many have come to see bipolar disorders as both a medical and a mental health problem.

There has been an increasing rate of diagnosis of bipolar in children and adolescents over the past several years. It is essential that parents of children who may have bipolar issues see a mental health professional rather than simply relying on the family doctor to treat it.

Often children can be misdiagnosed by family doctors due to misunderstanding on the part of the parents who are misinformed about what Bipolar disorders really are.

In some cases, children and adolescents who have been through trauma have been labeled with a bipolar disorder diagnosis due to their erratic behavior instead of being treated for post-traumatic stress disorder. It is crucial that the diagnosis is correct particularly when medication is involved.

Although bipolar disorder can be a severe, long-term condition, research has shown that bipolar disorders can be controlled with medications and psychotherapy.

The combination of these two forms of treatment has been shown to have the best outcomes. If you believe you may have a bipolar disorder, it is best to consult with a licensed mental health professional for an accurate assessment.

By presenting a realistic view of what specifically bipolar disorders are and how they can manifest, it can go a long way toward dispelling unhelpful myths and misconceptions about the disorder.

Having access to more accurate information can also aid people who suffer from these disorders in being able to obtain the help they need.

Paul J. Leslie is a psychology instructor at Aiken Technical College and a psychotherapist at Aiken Counseling Group and Psychiatry. His website is www.drpaulleslie.com.