Posted by Aurora on Wed, 05/09/2012 - 1:43 PM
BIPOLAR DISORDER(1)
Formerly called manic-depressive disorder, Bipolar Disorder (BPD) is a brain disorder characterized by shifting highs and lows in mood, energy, activity level, and daily functioning. A shift in polarity between manic and depressive symptoms is characteristic of BPD; thus, the name ‘bipolar’. The symptoms of Bipolar Disorder may be severe and may contribute to damaged relationships, poor school and work performance, and even suicide.
Onset of Bipolar Disorder is generally late teens or early adult years, although some children require treatment for BPD. In at least half the cases symptoms appear before age 25.(2) Although BPD is considered a lifelong condition requiring treatment over the lifespan, when treated properly, "people with this illness can lead full and productive lives."(3)
Bipolar Disorder manifests as episodic and unusually intense emotional states. Extreme changes in energy, activity, sleep, and behavior, and/or irritability and explosiveness may indicate Bipolar Disorder. A 'high' or manic episode may be characterized by euphoria (unusual happiness), overexcitement, and/or irritability. The person with BPD also experiences an extremely sad or hopeless state, called a depressive episode. In addition, rather than distinct periods of depression and mania, long-lasting periods of unstable mood may occur. A mixed episode includes characteristics of both mania and depression. Symptoms of a mixed state often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. In this state people may feel very sad or hopeless while feeling extremely energized. Work, school, social and home functioning is affected.
Symptoms of mania may include a long period of feeling 'high'; an overly happy or outgoing mood; an extremely irritable mood; agitation; and feeling 'jumpy' or 'wired'. Behavior may include rapid or more incessant speech; racing thoughts; jumping from topic to topic; being easily distracted; an increase in goal-directed activities, such as taking on new projects; restlessness; decreased need for sleep; having a unrealistic and exaggerated belief in one's abilities; impulsivity; and increased participation in high-risk pleasurable activities, such as spending sprees, large purchases, impulsive sex and business adventures. These symptoms last at least a week; are not the result of substance abuse, medication, or a medical condition; cause marked impairment in social and/or occupational functioning; require hospitalization; and/or are accompanied by hallucinations or delusions.
Symptoms of depression include long periods of feeling worried or empty; problems concentrating, remembering, and making decisions; being restless or irritable; change of eating, sleeping, or other habits; fatigue and loss of energy; unrealistic feelings of guilt or worthlessness; diminished interest in normal activities; exaggerated slowness or agitation in movement; and thinking of death or suicide, or attempting suicide. These symptoms cause significant distress and functional impairment for at least two weeks and are not due to substance abuse, medication, or a medical condition.
A less severe form of mania, hypomania includes manic symptoms that are uncharacteristic of the person; that are observable to others; that are less severe than mania; that last less than a week; that do not require emergency care; that are not due to substance abuse, medication, or a medical condition; and that are not accompanied by hallucinations and/or delusions. Without treatment, people with hypomania may develop severe mania or depression.
When depression and mania are severe, psychotic symptoms may occur, such as hallucinations or delusions. Medication is available to help with these. Behavioral problems may occur as well, including alcohol or drug abuse, relationship problems, or poor performance in school or work.
The four basic types of Bipolar Disorder include Bipolar I, Bipolar II, Bipolar Not Otherwise Specified, and Cyclothymia:
Bipolar I Disorder includes at least one manic or mixed episode and may or may not include a depressive episode. Symptoms must be a major change from the normal behavior of the person, and other causes of the behavior must be ruled out before a diagnosis is made.
Bipolar II Disorder is a pattern of depressive episodes alternating with hypomanic episodes, but without a full-blown manic or mixed episode.
Bipolar Disorder Not Otherwise Specified (BP-NOS) shows symptoms of the illness clearly atypical of the person's normal behavior but with not enough symptoms or with symptoms not lasting long enough to meet the diagnostic criteria of Bipolar I or Bipolar II.
Cyclothymic Disorder, or Cyclothymia is a mild form of Bipolar Disorder that includes episodes of hypomania alternating with mild depression for at least two years without meeting the criteria for other forms of Bipolar Disorder.
Rapid-Cycling Bipolar Disorder is diagnosed when four or more episodes of major depression, mania, hypomania, or mixed symptoms occur within a year, sometimes more than one in a week or even a day. More common in women than men, RCBPD typically has earlier onset and increased severity.
Without proper treatment, Bipolar Disorder may worsen over time with more frequent and more severe episodes. Resultant compromise of personal, social, and work functioning typically increases without treatment. Both genetics and environment play a role in the development of BPD, i.e., an identical twin of a person with BPD does not always develop the disorder.
Treatment of Bipolar Disorder includes medication and psychotherapy to prevent relapse and reduce symptom severity. Mood stabilizing medications are usually prescribed by a psychiatrist. A daily life chart of mood symptoms, sleep patterns, and life events can help the doctor treat the illness. Medications should not be stopped without consulting the prescribing physician, as 'rebound' or worsening of symptoms may occur, as well as other uncomfortable or potentially dangerous withdrawal effects.
- Elizabeth S. York, M.Ed., LPC, LMFT