Bipolar Disorder Facts

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Bipolar disorder is one of the most poorly understood mental health disorders. Research has found that people with bipolar disorder are also at increased risk of other mental health problems, such as substance abuse and suicide. It is, therefore, essential to understand how it can affect you and the misconceptions surrounding it. Doing so could help you recognise if you or a loved one is suffering and needs support.

What Is Bipolar?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorders are a group of brain disorders which cause fluctuations in your mood, energy, and ability to function. People with bipolar disorder will switch between manic and depressive episodes which is why it was previously known as manic depression. Between these episodes you may experience periods without symptoms of either. Bipolar disorder is the fourth most common mental health problem worldwide after depression, anxiety, and schizophrenia.

There Are Three Types of Bipolar Disorder

Bipolar disorder symptoms vary depending on the person, but there are also three types of bipolar disorder with different presentations in terms of length and severity of symptoms.

  • Bipolar I Disorder – manic episodes that last seven or more days or are extreme enough to require immediate hospital care. With most depressive episodes lasting for at least two weeks, this is the most severe form and may include mixed and even psychotic episodes.
  • Bipolar II Disorder – depressive episodes and hypomania. This type of bipolar disorder is seen as a less severe form and typically does not inhibit function.
  • Cyclothymia – symptoms of hypomania and mild depression which last for at least two years. Cycles tend to be brief episodes of hypomania and depression, but there may also be symptom-free periods. While this tends not to be severe enough to require treatment, it can develop into more severe bipolar disorders.

A doctor may also say that you have unspecified bipolar and related disorders if you experience symptoms of bipolar disorder which do not fit into the criteria set by the DSM-5.

Depressive Episodes Can Look Like Depression Disorders

In order to know whether a depressive episode is caused by bipolar disorder or a depressive disorder such as major depression, it is necessary to know the history of the person suffering to recognise mania. Depressive symptoms of bipolar disorder include:

  • Low energy
  • Feelings of hopelessness
  • Loss of enjoyment in activities you usually enjoy
  • Change in sleep pattern
  • Feeling empty
  • Fatigue
  • Change in eating patterns
  • Decrease activity
  • Problems concentrating and remembering
  • Suicidal thoughts

Severe episodes can involve psychotic symptoms such as psychosis, delusions, or hallucinations.

Manic Episodes Are Not Just Positive Feelings

There is a misconception that a manic episode is a positive feeling. This is an oversimplification and fails to consider symptoms which can be challenging and damaging. Manic symptoms of bipolar disorder include:

  • Unusually high energy
  • Increased activity
  • Feeling wired
  • Elation
  • Agitation and irritability
  • Overconfidence
  • Problems sleeping
  • Speaking quickly
  • Taking on too many responsibilities at once
  • Racing thoughts
  • Distractedness
  • Risky behaviour, such as unprotected sex and taking financial risks

When you experience hypomanic episodes, you may experience some of the milder symptoms or a milder version of others. Symptoms can seem helpful, for example, giving you the energy to do things you need or want to do. Some people will only experience hypomania, which can develop into severe mania. Mania can be dangerous as you can experience a sense of invincibility, leading to poor judgement and delusional thoughts.

You Can Experience Mania and Depression at the Time

Experiencing mania and depression at the same time is known as mixed episodes. This is where you feel high energy and activity but also hopelessness and despair. This can be very dangerous, putting you at risk of suicide as you have the energy and motivation to act on feelings of hopelessness. The lifetime risk of suicide for people with bipolar disorder is twenty times higher than that of the general population.

If you or someone you know is having suicidal thoughts, you can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255) or text the Crisis Text Line (text HELLO to 741741). These services are confidential, free, and available twenty-four-seven.

There Is No Known Single Cause of Bipolar Disorder

While there is no known single cause of bipolar disorder, three risk factors have been identified: genetics, brain structure and functioning, and family history of bipolar disorder. It is one of the most heritable conditions, according to research. Identical twin studies have shown that if one twin has bipolar, the chances of the other having it is 50 to 60%. So, while you will not necessarily develop bipolar disorder if someone in your family has it, there is a higher risk than for those who do not have a family history.

Bipolar Is Often Misdiagnosed

Bipolar is often misdiagnosed as a different mental illness. The most common disorder to be misdiagnosed is depression. Research shows that 69% of people with bipolar disorder are initially misdiagnosed, mostly with depression. More than 30% of these people remain misdiagnosed for ten or more years, and the average patient will be misdiagnosed for between five and seven-and-a-half years.

Things which contribute to not getting an accurate diagnosis include not having a clear history, psychiatric and medical comorbidities, and limitations in diagnostic criteria. It is more likely that people reach out for help during a depressive episode and your first episode is more likely to be depression rather than mania. Therefore, a doctor may diagnose you with depression if you have not had a manic episode yet or they do not get a clear history of it.

It is common to suffer from bipolar and other disorders such as obsessive-compulsive disorder, eating disorders, autism, a personality disorder, or attention deficit disorder. This can lead to atypical symptoms, which make it harder to diagnose. Bipolar II is particularly at risk of being misdiagnosed due to mania not being so noticeable and not affecting your daily life negatively.

Misdiagnosis is dangerous, partly due to the high risk of people with bipolar disorder misusing drugs and alcohol, which puts them at risk of additional health complications and overdose. A study showed that 46% of patients with bipolar suffered from alcohol use or dependence and 41% from drug abuse or dependence. Some studies even suggest the figure is as high as 69% for alcohol abuse and 60% for drug abuse.

If you are misdiagnosed with depression, there are also risks associated with being prescribed antidepressants. This can result in rapid cycling between manic and depressive episodes. A study looking at people with rapid cycling bipolar disorder found that in 51% of cases, it was associated with antidepressants. 73% of people were taking antidepressants when their cycling started.

Bipolar Disorder Tends to Develop in Your Late Teens

Most people who develop bipolar disorder will do so in their late teens or early adulthood. Although symptoms are still seen in childhood and early teenage years, they are often not recognised as they may not fit the diagnostic criteria. Symptoms of bipolar disorder can overlap with symptoms of other more common childhood disorders such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and conduct disorder.

Manic Episode Symptoms in Children and Teens

  • Extreme changes in mood
  • Short temper
  • Talking fast about different things
  • Trouble sleeping but not feeling tired
  • Trouble focussing
  • Overly interested in pleasurable but risky activities
  • Poor judgement

Depressive Episode Symptoms in Children and Teens

  • Frequent
  • Unprovoked sadness
  • Frequent pain, such as stomach aches and headaches
  • Increased sleep
  • Feeling hopeless
  • Difficulty communicating or maintaining relationships
  • Eating too much or too little
  • Little energy or interest in activities
  • Suicidal thoughts

It is normal for children to have ups and downs, but if this is due to bipolar disorder, they tend to be more extreme and unprovoked.

Most people will have experienced symptoms of bipolar before fifty though a significant number of people experience late-onset bipolar disorder. It can be difficult to diagnose bipolar disorder later in life as there may be other causal factors which must be ruled out first.

Medication Is Almost Always Required for Treatment

Treating bipolar disorder is almost always done through medication. Common medication includes mood stabilisers, antidepressants, and antipsychotic medications. Lithium is a mood stabiliser which was first used as an anticonvulsant and antiseizure medication. As mentioned, antidepressants can trigger manic episodes and rapid cycling. They are, therefore, typically paired with mood stabilisers or antipsychotic medications.

Therapy and Lifestyle Can Also Help

If you experience hypomania, you may not require medication. Hypomanic episodes are often triggered by sleep deprivation or too much caffeine. You may be able to reduce symptoms by changing your lifestyle. Things that can help include eating regular nutritious meals, exercising frequently, and sleeping between seven to eight hours per night.

Therapy can also help you to come to terms with your diagnosis. It can help to process how you have behaved during mood episodes and to reframe experiences and self-understanding. It can also help you manage stressors which make symptoms worse and recognise a mood episode before it becomes severe.

People With Bipolar Disorder Can Live Happy and Healthy Lives

While bipolar disorder is a lifelong illness, which requires continuous treatment, symptoms can are manageable. Many people with bipolar disorder lead healthy and happy lives. Medication can help to stabilise moods, while therapy can help you to understand your condition, how it affects you, and how to come to terms with your past.

Get Help Today

If you believe you or a loved one is suffering from bipolar disorder, please consider reaching out to us at The Wave. We specialise in trauma, mental health, and addiction treatment for teenagers, young adults, and families. Many teenagers who come to us have not been valued before. We believe it is important to build self-confidence and stable foundations to recover. We focus on education as part of treatment so those who leave us have confidence in themselves and their abilities.

Please visit our website or call us on +60125227734 if you want to find out more. We look forward to welcoming you to the program.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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