What You Need To Know About Bipolar Disorder

Am I moody? Do I have Bipolar Disorder?

Many people struggle with issues related to mood swings. A common concern that I hear is from individuals who experience mood swings and suspect they may have Bipolar Disorder. While Bipolar disorder is quite common, with an estimated 2.6% of adults in the U.S. experiencing the disorder according to the NIH, not everyone experiencing moodiness is Bipolar. While it is true that a common sign of Bipolar Disorder is fluctuating moods, there are several other causes of mood changes. It is important to differentiate between mood swings associated with a mental disorder and stressful environmental circumstances, which may result in mood changes. It is equally important to understand the several other lesser known symptoms that make up the criteria for Bipolar Disorder.

What’s the criteria for a Bipolar Disorder diagnosis?

The first thing that you may want to know is that there are two types of Bipolar Disorder.

Bipolar I Disorder is characterized by manic episodes whereas Bipolar II is characterized by hypomanic episodes and depressive episodes. In essence, for a diagnosis of Bipolar I Disorder, one manic episode at some point in his or her history is what is needed is for a person to have met the criteria. Even though it is not part of the criteria for Bipolar I, many times a person will have also experienced a depressive episode.  The requirement for Bipolar II Disorder is that a person has met criteria for a hypomanic and a depressive episode at some point in his or her history. The major difference between manic episodes and hypomanic episodes is that manic episodes last longer, over one week versus 4 days, and are more severe, sometimes involving psychosis, hospitalization and disturbance in work or social relationships.

What are signs of a manic and hypomanic episode?

The symptoms of manic and hypomanic episodes include 3 or more of the following criteria:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Attention is easily drawn to unimportant or irrelevant items
• Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions or foolish business investments)

It is important to note that certain substances, like drugs or alcohol, can bring about symptoms that are commonly associated with a manic or hypomanic episode.  If the episode occurs exclusively due to consumption of a substance, Bipolar is not diagnosed.

Bipolar Disorder is also often misdiagnosed in individuals with Borderline Personality Disorder (BPD) because BPD is frequently associated with rapid changes in mood. While the two can be co-occurring, they are distinct because the changes in mood related to Bipolar Disorder occur gradually.

How do I get help for Bipolar Disorder?

Bipolar Disorder can be treated with a combination of therapy and medication. Over several years of providing therapy to my clients, I have worked with many individuals who have struggled with such difficulties, many of whom can be considered successful in managing their disorder. I have also encountered others who presented in treatment, but chose not to continue therapy and/or medication. Whether they continued in treatment or not, individuals with Bipolar Disorder all had something in common: difficulty accepting their condition. A significant aspect of treatment involved acceptance of the diagnosis, which can be extremely hard. Individuals with Bipolar Disorder, like other mental health disorders, understandably experience many difficult emotions as they move through to acceptance.

Through the process of accepting a Bipolar diagnosis, individuals with the disorder often have a lot of important questions:

• How much of the mood shifts they experienced were associated with the disorder and how much was uniquely them?
• How much did their mood shifts have to be controlled through medication, if at all?
• What does the diagnosis mean for them?

Many times, individuals with Bipolar Disorder, even while on medication can experience some depressive symptoms or hypomanic symptoms. They may falsely conclude that their medication is not working, or that they are not making progress in therapy. In addition, many clients that I’ve seen enjoy the experience of grandiosity that comes with a hypomanic episode and are tempted to go off of their medication and quit therapy because they feel so “good.”  Unfortunately, not only can manic episodes put individuals at risk, both for themselves and others, but ultimately many individuals experience depression following such episodes, leading them back to treatment.

Understandably, the process can be frustrating, especially when one believes that a combination of medication and therapy is a cure. And herein lies the bulk of the problem:  Emotional changes can be managed and accepted, but not cured. The intention of both medication and psychotherapy with regard to Bipolar Disorder is management of extreme fluctuations in mood, not elimination of fluctuations in mood entirely. In essence, what’s required is an adjustment of expectations, which can be experienced as a loss. It’s hard to experience something that the majority culture might label as abnormal. This is a process that is difficult for anyone with a mental disorder, such as depression or anxiety.

Once, there is an acknowledgement that you experience emotions differently than most others, and that you would like to do what it takes to prevent putting yourself or others at risk, you are ready to fully engage in treatment. However, even if you are conflicted or confused about how or whether your behavior might put you at-risk, I encourage you to discuss this with your therapist.

If you think that you or a loved one may have Bipolar Disorder, are in the Nashville area, and have additional questions or would like to schedule an appointment, please do not hesitate to contact us at clientcare@nashvillepsych.com or call us at 615-582-2882.

Thanks for reading!

Take good care,

Dan