Bipolar Disorder: What Is Bipolar Disorder? – Part 1
by David Mintz, MD, team leader and staff psychiatrist at the Austen Riggs Center
Bipolar disorder, also called manic-depressive illness, is a serious mood disorder characterized by wide swings in mood, energy and activity levels. Though most patients with bipolar disorder experience depressions as a part of their illness, a manic, hypomanic, or mixed-manic episode is required to make the diagnosis of bipolar disorder.
A manic episode is characterized by an uncharacteristically elevated or irritable mood accompanied by disturbances of behavior including:
- Rapid and uninterruptible speech (pressured speech)
- Racing thoughts
- Decreased need for sleep
- Elevated self-esteem and unrealistic assessment of one’s capacities
- Increased goal-directed behaviors (e.g., new projects)
- Excessive engagement in pleasurable activities that are likely to have negative consequences (spending, gambling, substance use, sexual promiscuity)
In mania, the disturbances in mood or behavior can be so damaging, or the loss of sense of reality so extensive that patients must be hospitalized for their own protection. In a manic state, patients frequently do considerable damage to themselves through impulsive and risky behaviors and by damaging important relationships.
Hypomanic episodes are also characterized by elevated mood and energy levels and increased goal directed activities. The main difference between mania and hypomania is the degree of impairment (impulsivity, loss of reality). Patients with hypomania may also be quite high functioning, though hypomanic behaviors also frequently exact a toll on relationships
Mixed manic episodes may be particularly destructive and dangerous, as the energy and impulsivity of mania are combined with intense dysphoria and/or depression rather than euphoria or grandiosity.
The depressions associated with bipolar disorder may resemble typical major depressive states, with disturbances of sleep, appetite, energy, and concentration, physical slowing (or agitation), loss of interest, feelings of hopelessness and worthlessness, and suicidal thoughts. Sometimes, there are subtle differences between regular (unipolar) depression and bipolar depression (e.g., bipolar may more frequently present with excessive sleep and weight gain while unipolar depression tends more to present with sleeplessness and weight loss).
How common is bipolar disorder? What are its causes?
Bipolar disorder affects about 1 in every 100 people. There is a tendency for bipolar disorder to run in families. Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness. Painful life experiences play a similarly powerful role in the development of bipolar disorder. Early loss and/or trauma, in particular, predispose children to the development of bipolar disorder. Children who have lost their mother before the age of 5 are particularly vulnerable, with a fourfold increase in bipolar diagnosis. From a psychodynamic perspective, patients with bipolar disorder are frequently seen as struggling with issues of grief and loss.