Bipolar Disorder: Understanding the Mood Spectrum
Bipolar disorder, formerly known as manic-depressive illness, is a mental health condition that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are several types of bipolar disorder, all of which involve periods of abnormally elevated mood known as mania or hypomania, alternating with periods of depression. These mood swings can range in severity and frequency, and they can significantly impact an individual’s life. This page provides a comprehensive overview of bipolar disorder, including its types (Bipolar I and Bipolar II), symptoms, potential causes, and diagnostic criteria, drawing upon established medical and psychological research.
Defining Mania and Hypomania
Mania and hypomania are distinct episodes characterized by elevated mood, increased energy, and other characteristic symptoms. While they share similarities, there are key differences:
- Mania: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). Mania is often severe enough to cause marked impairment in social or occupational functioning or to require hospitalization to prevent harm to self or others. It may sometimes include psychotic features.
- Hypomania: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. Hypomania is less severe than mania and does not cause marked impairment in social or occupational functioning. It does not require hospitalization and does not include psychotic features.
Bipolar I Disorder: The Manic End of the Spectrum
Bipolar I disorder is defined by the occurrence of at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. In some cases, individuals with Bipolar I may only experience manic episodes.
- Key Criteria for Bipolar I Disorder:
- At least one manic episode.
- The manic episode may be preceded by or followed by hypomanic or major depressive episodes.
- The symptoms are not better explained by another mental disorder.
Bipolar II Disorder: The Hypomanic and Depressive Seesaw
Bipolar II disorder is characterized by periods of hypomania alternating with periods of major depression. Individuals with Bipolar II never experience a full-blown manic episode.
- Key Criteria for Bipolar II Disorder:
- At least one hypomanic episode.
- At least one major depressive episode.
- No history of a manic episode.
- The symptoms are not better explained by another mental disorder.
Shared Symptoms of Bipolar Disorder (Mania, Hypomania & Depression)
Regardless of the specific type of bipolar disorder, individuals may experience a range of symptoms, which can be categorized as manic/hypomanic or depressive:
- Manic and Hypomanic Symptoms:
- Elevated, expansive, or irritable mood
- Increased activity or energy
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Racing thoughts
- Distractibility
- Increased talkativeness
- Risk-taking behaviors (e.g., reckless spending, sexual indiscretions)
- Depressive Symptoms:
- Persistent feelings of sadness, emptiness, or hopelessness
- Loss of interest or pleasure in activities
- Changes in appetite or weight
- Changes in sleep patterns (insomnia or sleeping too much)
- Fatigue or loss of energy
- Difficulty concentrating
- Feelings of worthlessness or guilt
- Thoughts of death or suicide
Citation: National Institute of Mental Health (NIMH). (n.d.). Bipolar Disorder.
Cyclothymic Disorder:
A milder version of Bipolar disorder that does not meet the diagnostic criteria for either bipolar I or bipolar II disorder. The person will experience many periods of hypomanic symptoms as well as depressive symptoms for at least two years (one year in children and adolescents)
Citation: Cleveland Clinic (n.d.) Cyclothymia
Potential Causes and Risk Factors for Bipolar Disorder
The exact cause of bipolar disorder is not fully understood, but it is believed to involve a complex interplay of genetic, biological, and environmental factors.
- Genetics: Bipolar disorder tends to run in families, suggesting a genetic component.
- Citation: McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry, 60(5), 497-502.
- Brain Structure and Function: Differences in brain structure and function may contribute to bipolar disorder. Studies have identified abnormalities in areas of the brain that regulate mood, such as the prefrontal cortex and amygdala.
- Neurotransmitters: Imbalances in neurotransmitters, such as serotonin, dopamine, and norepinephrine, are believed to play a role in bipolar disorder.
- Environmental Factors: Stressful life events, trauma, and substance abuse can trigger episodes in individuals who are genetically predisposed to bipolar disorder.
Diagnosing Bipolar Disorder: A Comprehensive Evaluation
Diagnosing bipolar disorder typically involves a comprehensive evaluation by a qualified mental health professional. This assessment may include:
- Psychiatric Interview: Gathering detailed information about the individual’s symptoms, mood patterns, medical history, family history, and substance use.
- Mood Charting: Tracking mood fluctuations over time to identify patterns of mania, hypomania, and depression.
- Physical Examination: Ruling out any underlying medical conditions that may be contributing to the symptoms.
- Psychological Testing: Using standardized questionnaires and assessment tools to evaluate mood and identify specific symptoms.
The diagnostic criteria for bipolar disorder are outlined in the DSM-5. A diagnosis is typically made when the individual’s symptoms meet the specific criteria for either Bipolar I or Bipolar II disorder and cause significant distress or impairment in their daily functioning.
Citation: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Important Disclaimer:
This page is for informational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- National Institute of Mental Health (NIMH). (n.d.). Bipolar Disorder.
- McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry, 60(5), 497-502.
- Strakowski, S. M., DelBello, M. P., Adler, C. M., Cecil, K. M., & Boyce, L. K. (2005). Neuroimaging in bipolar disorder. Molecular Psychiatry, 10(6), 526-546.
- Ashok, A. H., Marques, T. R., Jauhar, S., Nour, M. M., Goodwin, G. M., Young, A. H., & Howes, O. D. (2017). The role of dopamine in the pathophysiology of bipolar disorder: evidence from imaging studies. Lancet Psychiatry, 4(9), 731-737.
- Cleveland Clinic (n.d.) Cyclothymia