What is Bipolar Disorder?

Previously called manic depression, bipolar disorder is named for the two “poles” of mood – the lows of depression and the extreme highs of mania. For people with bipolar disorder, predicting and coping with the swings in mood can be very difficult.

Bipolar disorder can also be dangerous for the individual with this condition. The agitation and excessive energy levels of manic episodes can lead to risky behavior, while bouts of depression raise the risk of suicide. Bipolar disorder treatment encompasses medication, psychotherapy and other forms of holistic and experiential therapy.

What are the Signs of Bipolar Disorder?

Bipolar disorder can be difficult to diagnose, especially initially. One study found that it takes six years on average for people with bipolar disorder to receive a diagnosis.

This condition is sometimes misdiagnosed as depression or in younger people, as attention-deficit hyperactivity disorder (ADHD).

A common reason for the delay in diagnosis is that many of the signs of bipolar disorder overlap with other mental health conditions. Bipolar disorder also affects each person differently. To diagnose bipolar disorder, clinicians look for signs that a person has a history of both depression and mania, along with other signs and symptoms that could indicate the onset of bipolar or bipolar that’s not being treated effectively.

Symptoms of Mania

  • Overly “happy” or an abnormally elevated mood.
  • Excessive energy, restlessness.
  • Inflated self-esteem, overconfidence or grandiose thoughts.
  • Decreased need for sleep, staying up all night.
  • More talkative than usual, taking unusually fast.
  • Scattered thoughts, jumping from one topic to another.
  • Distractibility, agitation, irritability, short fuse.
  • Engaging in risky behavior, such as shopping sprees, reckless gambling, impulsive sex.

Because mania is marked by both euphoria and irritability, people may experience mania as a pleasant experience or unpleasant. People may enjoy the elevated mood and increased productivity, but not the emotional crash that comes after. Some manic episodes involve hallucinations (false or distorted sensory experiences) or delusions (strongly held belief in ideas or experiences that aren’t real or are beyond the realm of possibility). Signs of mania that may involve delusions include:

  • Disheveled appearance.
  • Wearing unusual clothing.
  • Combative or aggressive behavior, without cause.
  • Overly vigilant behavior.
  • Poor decision-making.

Symptoms of Depression

  • Feeling sad or hopeless for long periods of time.
  • Withdrawing from friends and family.
  • Losing interest or enthusiasm for activities that the person once enjoyed.
  • A significant change in appetite, weight loss or weight gain.
  • Insomnia.
  • Feeling fatigued or a lack of energy with no medical explanation.
  • Poor concentration or memory problems.
  • Suicidal thoughts.

While it’s normal to feel blue or down in the dumps at times, what differentiates depression is its duration, intensity and severity of symptoms. People who are not clinically depressed may feel sad but can usually shake off those feelings in a few days or even hours.

Depression lasts longer, often re-occurs, and interferes with relationships and the enjoyment of life. Depression is more pervasive, and can be accompanied by other symptoms such as problems sleeping, problems getting up in the morning and changes in weight. Depression takes away energy, motivation and interferes with the ability to experience joy, pleasure, satisfaction and purpose.

People can also experience what is known as a “mixed state,” or the presence of both high and low symptoms at the same time.

Bipolar and Anxiety Disorder

If dealing with the highs and lows of bipolar disorder isn’t difficult enough, research has also shown that many people with bipolar also have an anxiety disorder. According to a meta-analysis of 2,120 adults with bipolar disorder, 35% met the diagnostic criteria for an anxiety disorder. Other studies put the rate even higher, with as many as half of those with bipolar having a co-occurring anxiety disorder.

Signs of anxiety disorders can include panic attacks, severe worries or nervousness, sleep problems and social anxiety. A co-occurring anxiety disorder is associated with more severe impairment. People with both disorders are at higher risk of substance use and suicide. Other conditions that often co-occur with bipolar and substance use disorders are eating disorders and personality disorders.

The Effects of Substance Abuse on Bipolar Disorder

Substance use disorders, including drug and alcohol addiction, are also very common in people with bipolar disorder. A meta-analysis published in the Journal of Affective Disorders looking at the link between substance use and bipolar disorder found that people with an alcohol use disorder were four times more likely to have bipolar disorder than those who didn’t drink excessively. People who used illicit drugs were five times more likely to have bipolar compared to people who didn’t use illegal drugs.

Other research estimates that about 60% of people with bipolar disorder have also had a substance use disorder at some point.

The reason for the connection isn’t fully understood, but it’s thought that people with bipolar disorder may use alcohol or drugs as a way to self-medicate or soothe unpleasant symptoms. There could also be an underlying susceptibility to both bipolar and substance use.

While drugs and alcohol may lift the mood or calm irritation temporarily, substance abuse is associated with worse outcomes and more severe illness for people with bipolar disorder. Alcohol and drugs can also interfere with the effectiveness of medications for bipolar. Having a substance use disorder and bipolar also raises the risk of attempting suicide. It’s crucial that people in treatment centers for bipolar disorder or addiction receive help for both at the same time.

What Causes Bipolar Disorder?

Bipolar disorder is a brain disorder. Although the underlying causes of bipolar disorder are unknown, research indicates there is a genetic component to the illness, meaning if a family member such as a parent of sibling has it, then you are more likely to develop it yourself. Traumatic experiences, such as physical, sexual or emotional abuse in childhood, are also risk factors for bipolar disorder.

In addition to what predisposes a person to developing bipolar disorder, researchers have also sought to understand additional bipolar disorder causes in terms of what specifically triggers a manic or depressive episode. When asked what triggered a manic episode, men and women ages 18 to 30 diagnosed with bipolar disorder said triggers included falling in love, use of stimulants, starting a creative project, late night partying, going on vacation and listening to loud music, according to a study in the Journal of Affective Disorders. Triggers associated with depressive episodes included stressful life events, general stress, fatigue, lack of sleep, physical injury or illness, menstruation and lack of physical activity. Understanding potential triggers may help people recognize when they’re facing a situation or time in their lives that could send them into a manic or depressive episode, and take preventive or protective steps.

Prevalence of Bipolar Disorder

About 2.8% of U.S. adults , or about 6 million people, have bipolar disorder. Bipolar disorder is a chronic condition, typically lasting throughout the person’s life. However, the onset of the first signs of bipolar disorder can vary. For most people with bipolar disorder, symptoms emerge during the early to mid-20s. Some patients can experience bipolar disorder symptoms as early as the teenage years and as late as the mid-thirties. No matter when onset happens, the condition can be debilitating – an estimated 83% of people with bipolar disorder are considered to have severe impairment, which is very high among mood disorders. It’s crucial for patients to work with a team of mental health professionals to manage the disorder and keep the person as healthy and safe as possible.

Types of Bipolar Disorder

There are four types of bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified/unspecified bipolar disorders. During the assessment process at Bluff, our psychiatrists in conjunction with our multidisciplinary team of clinicians will conduct a full medical history to determine if a bipolar diagnosis is accurate. An accurate diagnosis is a first step in getting the right treatment to manage the condition.

  • Bipolar I Disorder is characterized by long stretches of manic and depressive cycles. During these varying cycles, the patient may require hospitalization. Depressive episodes can also be “mixed,” which means there can be periods of mania embedded within the longer depressive cycle.
  • Bipolar II Disorder alternates between depression and hypomania, a milder form of mania. Hypomanic episodes are not as severe or prolonged as manic episodes. Yet, signs of bipolar II disorder should not be considered a less serious form of bipolar, since the periods of depression can be severe and have a long duration.
  • Cyclothymic Disorder is defined by less severe depressive and hypomanic episodes. While this diagnosis still requires professional treatment, it is much less severe than Bipolar I or II Disorder.
  • Other Specified/Unspecified is a catch-all category that includes any bipolar symptoms that are not categorized in the previous three diagnoses.

Between periods of mania and depression, people with bipolar disorder may experience relative mood stability.

Treating Bipolar Disorder at Bluff

Bluff has a full team of mental health professionals onsite and available to patients on a daily basis. This expertise allows us to conduct comprehensive assessments of each patient’s overall health history, substance use history and mental health history.

Bluff is one of the most comprehensive bipolar treatment centers in the Southeast. Treating bipolar disorder and substance abuse takes a multi-pronged approach, incorporating the careful use of medications, psychotherapy and holistic/experiential therapies that help patients relax, relieve stress, find healthy sources of recreation, as well as identify how they enjoy spending their time or where they find a sense of meaning and purpose.


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