Imagine, if you can, feeling so off—so out of sorts—that you can’t work, maintain relationships, or take care of yourself on a daily basis.

Or think about this: You have mood swings that are so wild, unpredictable, and severe that they are virtually incomprehensible to you and your family.

Hard to fathom?

Not if you have bipolar disorder, a mental illness characterized by dramatic highs alarming and lows and behaviors that range from elated and grandiose to downright dangerous, impulsive, and self-destructive. Untreated, bipolar disorder can be frightening, highly impairing, and life-threatening. With treatment, many with the disorder can go on to live productive and satisfying lives despite the ups and downs of the disorder. Read on to learn more about bipolar disorder and how to find help for yourself or someone you love.

What is Bipolar Disorder?

Bipolar disorder (also known as manic depression) can interfere with the ability to act rationally, think clearly, carry out day-to-day responsibilities, handle finances, and go to school or hold a job. Many people with bipolar disorder require hospitalization for short periods of time.

Bipolar disorder is fairly common. The condition affects men and women in equal numbers. The average age of onset is 18, with as many as 30% having episodes before the age of 13.  Only about half of bipolar adults receive care. “Although we have some good medical and psychological treatments for bipolar disorder, getting them to the people who need them most is a constant problem”, says David J. Miklowitz, PhD, Director of the Child and Adolescent Mood Disorders Program at the University of California Los Angeles (UCLA) School of Medicine, and author of the best-selling book, The Bipolar Disorder Survival Guide (3rd Edition), Guilford Press, 2019. 

How Would You Know If You Have It?

While you may suspect that you or someone you love has bipolar disorder, only a trained professional can make that call, based on guidelines set out in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).1

But here’s something to remember: When health care professionals talk about bipolar illness, they are actually referring to a spectrum disorder—a range of disorders—that includes bipolar I, bipolar II, cyclothymia, and “unspecified” bipolar disorder.

Here’s what else you should know:

Bipolar I disorder is the most severe of the bipolar disorders. It consists of extreme highs (manic episodes) that last for at least a week—less if the individual requires hospitalization or emergency treatment. Most (but not all) people with bipolar I disorder also have depressive lows that linger for at least 2 weeks.

Bipolar II disorder is marked by less severe mania, known as hypomania, that lasts for at least 4 days, alternating with periods of depression that last for at least 2 weeks. Studies show that people with bipolar II disorder spend much more time depressed than hypomanic. Mental health professionals often miss the diagnosis of bipolar II disorder. “People with bipolar II usually present for treatment with severe depression, often longstanding depression, but they many not describe periods of increased energy and activity unless asked,” Dr. Miklowitz says.

Cyclothymic disorder is characterized by frequent fluctuations from hypomania to depression that are less extreme than those of bipolar I or II disorder. Many people with cyclothymic disorder have chronic depression or irritability that interferes with daily life.

The term bipolar disorder, unspecified is used when people have episodes of depression, mania or hypomania that “do not fulfill the duration or severity criteria required for bipolar I or II disorder, but nevertheless still have highly impairing moods,” Dr. Miklowitz says. Children and teens who develop mild or moderate bipolar symptoms often receive this diagnosis first.  People with rapidly cycling bipolar disorder—which can be of the bipolar I or II subtype—have multiple, rapidly rotating episodes of mania, hypomania or depression within a 12-month period. Research suggests that depression may be more severe and self-destructive behavior more common during rapidly cycling mood episodes.

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The Highs, the Lows, and Other Symptoms to Report

There is no test that can definitively rule in or rule out bipolar disorder. However, your doctor or health care provider may order a series of tests to exclude other disorders or illnesses—including drug use screens or blood tests for medical conditions (e.g., thyroid abnormalities). You may want to invite a close friend or family member to visit your doctor with you. They may add helpful information about your family’s history that you may not know, such as who else in the family tree might have had a mood disorder.

The following are some of the symptoms your provider will look.

For mania:

  • Feeling high, euphoric, or extremely happy
  • Irritability
  • Markedly increased energy or activity/agitation
  • Excessive talking; jumping from to topic-to-topic
  • Racing thoughts
  • Grandiose ideas or inflated self-esteem
  • Distractibility
  • Decreased need for sleep (not the same thing as insomnia)
  • Impulsive or risky behavior involving sex, money, work, school, or drug and/or alcohol use

And for depression:

  • Extreme sadness
  • Apathy, gloom or despair
  • Loss of interests in many or most activities
  • Severely decreased activity and energy levels
  • Fatigue
  • Sleeping more than usual or having difficulty falling or staying sleeping (insomnia)
  • Difficulty concentrating, remembering, or making decisions
  • Changes in appetite
  • Feelings of worthlessness
  • Thinking about or attempting suicide.

“These states don’t always come in alternating fashion,” says UCLA’s Dr. Miklowitz.  “Some people have mixed episodes, where they feel energized, their thoughts race, and their sleep is minimal, but they also feel intensely sad, hopeless about the future, and think about suicide.”  Mixed episodes can be harder to treat than elated manic episodes, he adds.

And keep this thought in mind: Some symptoms associated with bipolar disorder also signal other disorders that can co-exist with bipolar disorder. For example, some young people with manic-like behavior really have attention deficit hyperactivity disorder. The reverse can be true as well- people with ADHD may have bipolar disorder, or even have both illnesses.

Individuals with bipolar disorder also may struggle with substance abuse and anxiety and eating disorders, according to the National Institute of Mental Health. They also are at greater risk for migraine headaches, thyroid and heart disease, diabetes, obesity, and other ailments that may complicate diagnosis and treatment.

Causes and Treatment

Researchers have a lot to learn about the causes of bipolar disorder, but they are closing in on answers. They know, for example, that genes play a role in the disorder. When one member of an identical twin pair has bipolar disorder, there is about a 50% chance that the co-twin has bipolar disorder as well.  In fraternal (two-egg) twin pairs, the chance is only about 6%. Bipolar disorder seems to be equally linked to fathers’ and mothers’ family trees.

Other intriguing findings:2

  • Migraine headaches are far more common among people with bipolar disorder, compared with others. So are eating and anxiety disorders, and metabolic syndrome.
  • Cognitive abilities, including memory, executive functioning, and motor skills are weaker in bipolar subjects, compared with those who do not have the disorder.
  • The onset of bipolar disorder appears to be affected by life stressors as well as genetic background.

Many people with bipolar disorder experienced sexual, physical, or emotional abuse as children. This is also the case for many other psychiatric disorders.

Meanwhile, bipolar disorder is commonly treated in several ways, including psychotherapy (including family therapy and cognitive behavioral therapy); medications (specifically, mood stabilizers, antipsychotic medications, and in some cases, antidepressants). Also recommended: Self-care strategies, which include learning to recognize early symptoms and getting help as soon as possible, and exercise and meditation.3

Children with Bipolar Disorder

Diagnosing bipolar disorder in children can be difficult.4 It is under-diagnosed in some parts of the country, and over-diagnosed in others so prompt (and proper) treatment may vary, depending on where you live. Kids can display manic symptoms before age 10, but their symptoms may look quite different from those in adults.

Also, kids may have other disorders in addition to bipolar disorder, including, for example, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, substance abuse, or anxiety disorders. Nonetheless, they can be effectively treated with mood stabilizing medications and therapy. “A proportion of kids who had a manic episode at a young age—about 25% in some studies— look quite healthy as young adults”, Dr. Miklowitz continues. “But we don’t know yet how to identify these kids in advance so that we know who best to treat.”

The Toll on Family

How friends and family member respond to your illness will depend on several factors, including the severity of your symptoms, how you respond to treatment, and how well your symptoms are being managed.

Families of individuals with milder forms of the disorder may experience some disruption in their daily lives. But their day-to-day routines may not be up-ended, as long as you continue to get treatment, and family members master the skills needed to address the challenges of living with someone with bipolar disorder.

The lives of those caring for individuals with severe symptoms may be stressful, however. They may face financial problems stemming from reckless spending and/or reduced income, worry and emotional turmoil (often associated with fears about your risky activities or self-destructive behavior), and guilt or grief. Conflict between the person with bipolar disorder and their parents, siblings or spouse is quite common, Dr. Miklowitz says.

Of course, families should be involved in treatment whenever possible, Dr. Miklowitz advises. “It’s heartbreaking to watch someone in your family go through these episodes, and it can take a huge toll on family relationships.”

Hope for the Future

“Family members often play a central role in a person’s recovery, by recognizing early warning signs of the illness, helping the person maintain sleep and wake routines, and keeping the environment low in stress,” adds, Dr. Miklowitz, who has studied family relationships in bipolar disorder for 35 years. “Although the person may resent the active role of family members, it is often in their best interest, “The people who do best with bipolar disorder are those who have come to rely on family members to provide support and structure at key moments of need, without having to give up their sense of personal autonomy.”

If you believe you have bipolar disorder—or are worried about a loved one who does—ask your health care provider for a referral to resources or a doctor in your area for evaluation and treatment.  Or reach out to the National Alliance on Mental Health helpline at 1-800-950-NAMI (6264) or info@nami.org Monday through Friday, 10 am through 6 pm (EST), for information about local support groups, services, and education.

* Fact-checked and reviewed by David Miklowitz, PhD

 

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Last Updated: Jul 17, 2019