Bipolar disorder describes a group of illnesses sharing a number of symptoms that include cycling mood episodes such as “highs” (mania, hypomania), and “lows” (depression), mixed moods as well as periods of normal mood (euthymia). When depressed, people with a bipolar disorder will have some or most of the symptoms of major depressive disorder (MDD).
Manic episodes
A manic episode includes a period of at least one week during which the person is in an abnormally and persistently elevated or irritable mood. While the stereotype of a manic episode is “too happy,” it can also be extremely irritable.
Mania is also characterized by the following symptoms:
- Inflated or extreme self-esteem, self-confidence or grandiosity
- Decreased need for sleep, not needing to sleep for days and not being tired
- Intensified or pressured speech (loud, rapid and difficult to interrupt, one-sided, seemingly focused on self-amusement, angry)
- Racing thoughts, rapid jumping around from idea to idea or topic to topic
- Heightened distractability
- Increase in goal-directed activity
- Excessive involvement in high-risk pleasurable activities
Untreated mania can worsen to a psychotic state that requires hospitalization. Manic episodes often end when the person is hospitalized and receives medication treatment.
Hypomanic versus Manic versus Mixed Episodes
The symptoms of a hypomanic episode are very similar to a manic episode but may be somewhat less intense. The main difference is that the person only needs to experience the symptoms for four days (vs. seven for a manic episode). People who are hypomanic are less likely to end up in hospital because the symptoms are less obviously debilitating and severe than mania. People who are hypomanic may need significantly less sleep, have significantly more energy, and be significantly more talkative, but may believe that they are just in a “really good mood,” “excited,” or “hyper.”
For both mania and hypomania, other people should be able to tell that the person is noticeably different from his or her regular, non-depressed mood and that the change has an impact on his or her functioning.
Finally, a mixed episode would fulfill the symptom requirements for both a major depressive episode and a manic episode nearly every day, but the mixed symptoms only need to last for a one-week period.
For all four of these mood episodes, the symptoms must have an impact on the person’s ability to function and should not derive from some other circumstance or illness that would logically, or better, account for them.
Sometimes, the mood changes in bipolar disorder are fast, dramatic and obvious, as if there is a biological “switch” that gets flipped on or off. However, usually, the mood changes in bipolar disorder are much more gradual and less obvious.
Hypomanic versus Manic versus Mixed Episodes
There are several types of bipolar disorder based upon the specific duration and pattern of manic and depressive episodes, including bipolar I, bipolar II, cyclothymic disorder, and bipolar not otherwise specified (NOS).
Bipolar I Disorder
The main difference between bipolar I and bipolar II is the presence of full mania (seven days) versus hypomania (four days). Anyone who has experienced one full manic episode meets diagnostic criteria for bipolar I.
There are actually six different sub-diagnoses for bipolar I. Basically, when a person is diagnosed with bipolar, the specific diagnosis is based on which type of episode the person is currently in, or has most recently experienced, and which types of episodes (if any) they have experienced in the past. Two of the six diagnoses do not require the experience of any major depressive episodes.
Bipolar II Disorder
To be diagnosed with bipolar II (no manic episode), a person then must have experienced at least one major depressive episode and at least one hypomanic episode.
Cyclothymic Disorder
To be diagnosed with cyclothymic disorder, a person must have experienced numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. In addition, people must report having had these experiences for two years or more and they cannot have been symptom-free for two months or more.
Bipolar Not Otherwise Specified (NOS)
The bipolar disorder NOS category is a category for symptoms that are sub-threshold and include a number of other disorders with bipolar features that do not meet criteria for any specific bipolar disorder. Such symptoms can include:
- Very rapid alternation of mood between manic symptoms and depressive symptoms
- Recurrent hypomanic episodes without depressive symptoms
- A manic or mixed episode that occurs with another disorder such as delusional disorder, residual schizophrenia, or psychotic disorder not otherwise specified
- Hypomanic episodes, along with chronic depressive symptoms, that are not frequent or severe enough to diagnose cyclothymic disorder
Treating Bipolar Disorder
Bipolar disorder is most often a chronic condition that requires medical treatment (medication). Recognizing bipolar disorder and diagnosing it correctly requires a high degree of specific professional knowledge and training. As for the other mood disorders, a proper and thorough differential diagnostic assessment by a psychiatrist or psychologist is the first step towards effective treatment.
However, once properly diagnosed, bipolar disorder is treatable with a combination of medication and evidence-based psychotherapy. Coming to terms with bipolar disorder as a chronic health condition, and sticking with medical and psychological treatment even during periods of wellness, can help reduce the frequency and severity of mood episodes and reduce likelihood of the condition worsening over time.
