Bipolar Disorder
Types, Causes, & TreatmentsBipolar disorder is a mood disorder characterized by impairing episodes of mania and depression. To qualify as a manic episode, the symptoms must result in marked impairment of social or occupational functioning, psychosis, or hospitalization.1 The manic episodes are likely to disrupt your normal daily living routine. Most individuals with BPD experience episodes of major depression, though this is not required for the diagnosis.
What Is Bipolar Disorder?
Types Of Bipolar Disorder
For a bipolar I diagnosis, an individual will have had to experience at least one manic episode in their lifetime. Major depressive episodes are typical but not needed for diagnosis. The mania also must last one week for it to be considered a manic episode. The mood in a manic episode is often described as euphoric, excessively cheerful, high, or “feeling on top of the world.”
Moreover, a clinical diagnosis requires a specifier related to the condition. These specifiers describe the course and impact of the illness. Specifiers include; mild, moderate, severe, with psychotic features, partial remission, in full remission, and unspecified. Concerning sex, bipolar I disorder affects men and women equally
There are some differences between bipolar I vs. bipolar II. For a bipolar II diagnosis, an individual will have had to experience at least one hypomanic episode and one major depressive episode in their lifetime. A hypomanic episode is less intense than a full manic episode. As opposed to a week for bipolar I, it must persist for at least four consecutive days.
Bipolar II should not be conceptualized as a less severe or substantial type of illness. Bipolar II has a high episode frequency, high rates of psychiatric comorbidities, and recurrent suicidal behaviors that impair quality of life. The diagnostic criteria for a major depressive disorder must also be met, which includes criteria such as depressed mood most of the day, markedly diminished interest in activities, significant weight loss/gain, insomnia/hypersomnia, psychomotor agitation, loss of energy, feelings of worthlessness, issues with thinking and decision making, and recurrent thoughts of death.4 Bipolar II disorder is most common in women.5
Cyclothymic Disorder (aka Cyclothymia) is a distinct diagnosable mental health issue. It is characterized as hypomanic and depressive periods that do not fulfill the criteria for hypomania or major depression for at least two years. The essential feature of cyclothymic disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms. The risk fluctuates and it can evolve into bipolar I or II. There is a 15% – 50% risk that an individual with cyclothymic disorder will subsequently develop bipolar I disorder or bipolar II disorder.
In this category fall those individuals with bipolar-like disorders that do not meet criteria for bipolar I disorder, bipolar II disorder, or cyclothymia because of insufficient duration or severity or characteristic symptoms of bipolar and related disorders that do not meet full criteria for other categories.
Individuals present with subclinical signs and symptoms that are not severe enough to present definite or readily observable. Included are short-duration hypomanic episodes with major depressive disorder, hypomanic episodes with insufficient symptoms with major depressive disorder, hypomanic episodes without prior major depressive disorder, short-duration cyclothymia, substance or drug-induced bipolar and related disorder, and bipolar and related disorders due to another medical condition.
Bipolar Symptoms
Bipolar symptoms vary based on intensity and frequency for bipolar disorders. However, the foundational signs and symptoms remain the same for each disorder under the bipolar umbrella. Consistent criteria across all disorders include some combination of mania, hypomania, and major depressive disorder.
Mania & Hypomania Symptoms
Mania is a feeling of euphoria that lasts about a week. Hypomania is a less intense mania presentation and must last for at least four days. An individual can feel invincible and present as frenzied. Mania/hypomania is usually liked by the individual and enjoys its presence.16
Symptoms of a manic or hypomanic episode may include:
- Elevated mood
- Increased motor activity-energy
- Increased sexual interest
- Decreased need for sleep
- Irritability
- Language or thought disorder
- Lack of insight
Symptoms of a Major Depressive Episode
A major depressive disorder is less tolerated than a manic episode. Depression is more than just feeling sad. It can be a debilitating experience that affects the person’s ability to have a fulfilling life. It can include disruptions in cognitive and physical abilities.7
Symptoms of a major depressive episode may include:
- Depressed mood
- Hopelessness
- Anhedonia
- Fatigue
- Physical pain
- Decreased motor activity
- Lack of motivation
- Poor concentration
- Disrupted sleep
- Disrupted appetite
Symptoms of a Mixed Episode
A mixed episode is when a person experiences the symptoms and effects of major depression and mania/hypomania at the same time. Rather than being distinct and separate states, the individual will experience both conflicting states together.
Symptoms of a mixed episode of bipolar may include:
- Sadness
- Hopelessness
- Increased energy
- Racing thoughts
- Disrupted motor activity
Bipolar Disorder Symptoms in Women vs. Men
Bipolar symptoms among men and women are relatively stable among the genders. The course of the illness varies depending on factors such as age at onset. The number of affective episodes of each polarity do not seem to differ across genders.8
Treatment considerations and risk factors likely differ as follows:
- Women are more likely to be hospitalized for manic episodes
- Women have a higher lifetime risk of alcohol use disorder4
- Women diagnosed with bipolar disorder are at an increased risk for comorbidity with alcohol and drugs8
- The course, in women, may be influenced by the menstrual cycle, pregnancy, the postpartum period, and menopause9
- Women are more likely to experience rapid cycling and mixed mania9
Bipolar Symptoms in Children & Teens
Early onset of illness is associated with an unremitting course of illness, frequent switches of polarity, mixed episodes, psychosis, a high risk of suicide, and poor functioning or quality of life.10 Symptoms between the two groups are similar to that of adults. The increased activity criterion can be difficult to distinguish in children as they can easily take on many tasks simultaneously, create elaborate and unrealistic project plans, and develop previously absent and developmentally inappropriate sexual preoccupations.14
Bipolar symptoms in children and teens may include:
- Irritability
- Isolation
- Poor communication
Bipolar disorder is a heritable genetic condition whose presentation and course are heavily influenced by the environment. While an individual may have a predisposition to bipolar disorder, the setting and circumstances in which the person lives have a tremendous effect. Like most mental health issues, there is no single cause to attribute to a burgeoning bipolar diagnosis.
The following may contribute to a bipolar diagnosis:
- Brain structure: Studies have demonstrated that different brain areas may be responsible for the formation of bipolar disorder. However, no one area of the brain or study is conclusive in its findings.
- Genetics: There is a strong link between the disorder being “passed down” in families. The recurrence risk for BPD in first-degree relatives of BPD patients is approximately 9%, nearly ten times that of the general population.
Twin studies have also demonstrated a strong genetic link for bipolar disorder. - Environmental factors like severe stress: Evidence suggests that the first episode of bipolar disorder often is associated with stress.
Several mental health concerns can overlap with bipolar disorder, including psychosis, substance use, suicide, anxiety, and eating disorders. Some of these comorbid conditions may make diagnosis of bipolar disorder challenging. Additionally, the secondary mental health concerns may not be given their appropriate concern as the bipolar diagnosis may overshadow any other issues. Common conditions that co-occur with bipolar disorder include:
- Psychosis: Reality-altering states must be present, including hallucinations, delusions, and disorganized behavior/thoughts.
- Anxiety disorders: Anxious rumination may be mistaken for racing thoughts (and vice versa), and efforts to minimize anxious feelings may be taken as impulsive behavior.
- Attention-deficit/hyperactivity disorder (ADHD): Persistent symptoms of inattention, hyperactivity, and impulsivity need to have been present before the age 12.
- Drug / alcohol use disorder: Alcohol or drugs would have to be the primary reason and explainer as to the dysregulation in the mood.
- Eating disorders: An individual will likely exhibit restrictive eating or binging and purging behavior. Food will take up an inordinate amount of time in their life, and losing weight will be a key factor.
- Post-traumatic stress disorder (PTSD): A traumatic event is likely to have occurred or the recurrence of many traumatic events within a chaotic environment. Symptoms such as re-experiencing, dissociation, and nightmares are needed for diagnosis.
Bipolar is diagnosed through a comprehensive clinical interview. Many different areas will be assessed including family history and the origin and nature of symptoms. There are several diagnostic criteria that need to be present for a bipolar disorder diagnosis. Some individuals may fall into the other specified and unspecified bipolar and related disorders if the full diagnostic parameters are not met. Differential diagnoses will also be considered as bipolar disorder may mask other mental health conditions, and other mental health conditions may take the appearance of bipolar disorder.
Prevalence & Cause of Eating Disorders
Bipolar Disorder Treatment
Medication
Psychotherapy
Other Bipolar Treatment Options
Finding Treatment
Source : Choosingtherapy.com