By Jan Cheek, MSW, LCSW

The term “Bipolar” is sometimes used casually to describe a person’s erratic behavior or emotions. However, Bipolar Disorder is an actual brain disorder causing severe impairment in multiple areas of functioning, primarily shifts in energy, mood, judgment and cognitive functioning.  It impacts millions of people in the United States who either have the disorder or who care about someone who has it and has tried to understand what is happening with them when life suddenly changes.  When energy, mood, judgment and cognition suddenly change, they are not typical shifts that most people experience, Bipolar Disorder produces extreme ups and downs in these areas of functioning.  The impairment can create serious problems with relationships, performance issues in school and work, sometimes resulting in substance use concerns, and increased struggles with suicidal ideation. The good news is that when accurately diagnosed, treatment is effective, and people with the disorder can lead very productive and fulfilling lives. The key is to understand the diagnosis, consistently treat it, and prevent “full blown episodes”.

What is an episode? Bipolar Disorder used to be known as and is still often referred to as “manic depression” or manic depressive illness. Bipolar indicates that there are two poles of the depressive spectrum—a manic pole (high) and a depressive pole (low). Mania is marked by elevated symptoms such as increased and excessive energy, restlessness, inability to sleep and little need for sleep, racing thoughts, poor concentration, poor judgment and poor decision making—often inconsistent with one’s values, poor insight, grandiose ideas, unrealistic and exaggerated beliefs about oneself and one’s abilities, increased irritability, heightened aggressive behavior, emotional volatility, spending sprees, sexually provocative behaviors, intrusive and obnoxious behaviors, and often there is denial that anything is wrong or out of the ordinary. Depression is marked by decreased energy, lethargy, low motivation, lasting sadness, sense of being void of emotion, inability to experience pleasure, sense of pessimism, hopelessness, worthlessness, negativity, sleep disturbances—sleeping too much or not enough, physical symptoms such as chronic pain and unexplained illnesses that have no medical origins,  and sometimes associated with thoughts of death and suicidal ideation.

Bipolar Disorder is diagnosed on a spectrum based on the length of time and the intensity of impairment with the areas of function (energy, mood, judgment, and cognition). The more moderate mood ranges are known as “hypomania” for that mild to moderate manic level, above the normal and balanced mood state, and just below that normal level will be the mild to moderate depressive symptoms or “dysthymia” if it is a chronic state of depression followed by the most severe depressive level. Some people experience “mixed episodes” having both manic and depressive symptoms nearly every day for at least a week. Some people also have a phenomenon known as “rapid cycling” where there are multiple extreme mood shifts in a day, a week, or when throughout a course of an illness a person may have 4 or more major manic and depressive episode shifts in a year. 

Bipolar I Disorder is diagnosed when a person experiences the extreme mood states, both manic and depressive episodes. Bipolar II Disorder is diagnosed when a person does not experience the extreme manic episode, but does experience hypomania and also severe depressive episodes and moderate depressive symptoms. There are other Bipolar Disorders in the diagnostic spectrum, but these two are the most prevalent and most commonly diagnosed.  Science has not yet determined with certainty what causes Bipolar Disorder. At this time, there is agreement that there is no single cause, but likely several factors. It is known that there is a strong genetic factor with this disorder and Bipolar Disorder tends to run in families.

Often people reach out for treatment themselves during the more moderate depressive phases. Typically during any phase of mania, a person is in denial that they need assistance.   If there is acknowledgment that anything is out of sorts a person in a manic state often blames others and the rest of the world and has little to no insight that their own mood state and behavior is at issue. Family members and loved ones, however, are often very concerned and quite eager during these phases for a person to get treatment because it is hard to watch them be reckless and destructive and have no insight to the impact of their own actions. During the deepest part of a depressive episode, on the other hand, there is little to no energy, fortitude, motivation, hope for improvement, or confidence that change could occur, so a person with Bipolar Disorder rarely seeks treatment or follows through on their own accord with treatment. It is when the mood is moderately low that a person tends to have the wherewithal to know the cycles and want to desire to break the patterns and they might seek intervention.

Research indicates that treatment is very effective especially when it is consistent. The best treatment involves a combination of psychiatric medications to balance and stabilize the neurochemistry in the brain combined with psychotherapy to teach about the impact of the illness and assist with tracking the shifts in functioning so the shifts might become predictable, to develop and improve coping skills, to understand life triggers, to teach relationship skills and management, and assist with overall well-being.

Bipolar Disorder is diagnosed mainly in the adult population, 18 and older, but children and younger adolescents definitely get the disorder. It is far more likely to affect children and teens who have parents and relatives with Bipolar Disorder. Diagnosing children and teens can be challenging because many of the symptoms do not exactly mimic adult symptoms, but the symptoms overlap with other mental health and developmental disorders. Children and teens with Bipolar Disorder with manic symptoms and with mixed symptoms tend to present with irritability, aggression, and extreme tantrums.  These same symptoms can be present with moderate depressive states, as well. However, these same symptoms can also be present in a number of other childhood issues.

It is critical for child, teen, and adult to have a thorough diagnostic evaluation to determine an accurate diagnosis and then an effective treatment plan. If you have concerns about yourself or someone you care about and you wonder if there may be an issue of Bipolar Disorder, or to find out what might be contributing to the impairments you or your loved one are experiencing, Behavioral Healthcare Associates, LLC is a multidisciplinary practice prepared to assist. Remember, Bipolar Disorder is very manageable with consistent treatment.  BHA, LLC has four psychotherapists and a double board certified Child/Adolescent and General Psychiatrist to meet your mental health needs. Call 919-292-1464 for an appointment or to seek more information… or follow up on our website      www.behavioralhealthcareassociates.org