Bipolar disorder is a mental illness marked by extreme mood swings from high to low and vice versa. Each of these extreme episodes can last hours, days, weeks, or months. The mood swings may even become mixed, so you might feel elated and depressed at the same time.
Bipolar is not a rare diagnosis. Over 5 million people in the United States are living with some form of bipolar disorder. Symptoms tend to appear in a person’s late teens or early adult years, but they can occur in children as well. Women are more likely to receive bipolar diagnoses than men, though the reason for this remains unclear.
Bipolar disorder can be hard to diagnose, but there are warning signs you can look for.
Although there are four commonly recognized types of bipolar disorder, there are two types that are most commonly diagnosed:
This classic form of bipolar disorder used to be called “manic depression.” Bipolar I leaves no doubt as to whether someone is in a manic phase of illness. The person’s behavior and mood is one of extreme elation, as their behavior quickly escalates until they’re out of control. The person could end up in the emergency room or worse if left untreated.
To qualify as having bipolar I, a person must have a manic episode (characterized by elevated, expansive, or irritable mood which represents a marked changed from the person’s usual behavior) which lasts at least seven days, or manic symptoms that are so extreme that the individual requires immediate hospital care.
Bipolar II is four times more common than bipolar I. It’s characterized by much less severe manic symptoms, also referred to as hypomanic symptoms. These signs are harder for people to see in themselves, and it's often up to friends or loved ones to encourage them to get help. Hypomania often becomes worse without proper treatment, and the person can become severely manic or depressed.
Rarer types of bipolar
There are two other types of the disorder that are less common than bipolar I and II. Cyclothymic disorder involves mood swings and shifts similar to bipolar I and II, but the shifts are often less dramatic in nature. Though it may be difficult, a person with cyclothymic disorder can often function normally without medication. Over time, a person’s mood swings may develop into a diagnosis of bipolar I or II.
Bipolar disorder not otherwise specified (NOS) is a catchall category for a person who exhibits some bipolar symptoms, but does not fit the specific criteria for any of the other three types.
Bipolar disorder may include these warning signs:
7 signs of mania
- feeling overly happy, “high,” or elated for long stretches of time
- feeling easily agitated, which some describe as feeling jumpy or twitchy
- talking very fast, often accompanied by racing thoughts
- extreme restlessness or impulsivity
- impaired judgment
- unrealistic overconfidence in your abilities or powers
- engaging in risky behavior, such as having impulsive sex, gambling with life savings, or going on big spending sprees
7 signs of depression
- feeling sad or hopeless for long periods of time
- withdrawal from friends and family, and/or a loss of interest in activities that were once enjoyed
- significant loss or increase in appetite
- severe fatigue or lack of energy
- slow speech
- problems with memory, concentration, and decision-making
- thoughts or attempts of suicide, or a preoccupation with death
Bipolar disorder can be difficult to diagnose. Unless you have severe mania, in which case the signs are unmistakable, the symptoms can be hard to spot. People who have hypomania, the milder form of the manic side, may feel more energized than usual, more confident and full of ideas, and able to get by on less sleep. Hardly anyone complains about that. You're more likely to seek help if you're suffering from depression, but your doctor may not have the opportunity to observe the manic side then.
When doctors do suspect bipolar disorder, they may use a few different approaches to make the diagnosis:
- a physical exam to rule out any other medical conditions that could cause your symptoms, such as thyroid disease
- a mental health evaluation, which may include a questionnaire and interviews with family members
- a mood-charting diary to keep track of your sleep patterns and daily moods
- using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to compare your symptoms with the official criteria for bipolar disorder
If you're worried that you might have bipolar disorder, the best thing to do is educate yourself about the different types of mood disorders and their symptoms and then consult your doctor.
It can be harder to address if you’re concerned about a friend or loved one having bipolar disorder. Enlist the help of other friends or family members. People with bipolar disorder often deny any problems, especially during manic episodes. Think of bipolar disorder as you would any other serious disease, and get professional help right away.
People with bipolar disorder may have other psychological diagnoses, including obsessive-compulsive disorder (OCD), eating disorders, and substance abuse. The desire to medicate their bipolar with drugs or alcohol is what typically puts them at risk for substance abuse. Women with bipolar most often experience thyroid disease, obesity, and migraines as physical accompaniments to bipolar. Men are more likely to deal with substance abuse alongside their bipolar.
Approximately 1 in 5 people with a bipolar diagnosis can also be classified as having borderline personality disorder. There are some similarities between the two disorders, but there are also many differences in the symptoms and causes. More research is needed to understand the relationship between them.
Once you have a diagnosis, your doctor will decide on a treatment program that works best for you. Bipolar treatment may include:
- substance abuse treatment
- electroconvulsive therapy (ECT)
A licensed psychiatrist usually manages your treatment, but you may also have a social worker, psychologist, or psychiatric nurse practitioner involved in your care.
Common prescriptions for people with bipolar include mood-stabilizing drugs. Mood stabilizers, such as those containing lithium and valproic acid, will help decrease the rate and intensity of manic episodes. If mood stabilizers are not enough to improve a person’s quality of life, a doctor may next prescribe antidepressant-antipsychotic drug combinations such as Symbyax.
Treatment for bipolar must be ongoing. When people stop taking medication or meeting with their doctor, they will likely experience manic and depressive episodes again. However, with the proper treatment, bipolar disorder can be controlled and a person can lead a healthy and productive life.
How do bipolar symptoms in children and teens differ from bipolar symptoms in adults?
Children may demonstrate different depressive symptoms, if present in bipolar. For instance, children and adolescents may demonstrate an irritable mood, instead of a typical depressed mood. Similarly, instead of weight loss, they may fail to meet expected weight gain that’s considered normal for their particular developmental period. Specific to the manic stage of the illness, children may appear silly or goofy — beyond what would be expected as “appropriate” to the setting or developmental level of the child. In other words, at parties or other social events, children tend to be silly and elated, having a good time. But if they’re acting this way in school or at home when the current activity is not one that lends itself to these expected behaviors, the child may meet the “A” criterion for bipolar disorder. Similarly, children may overestimate abilities to the point of danger. They may begin elaborate and unrealistic plans for projects that are clearly beyond their abilities. The child may also abruptly begin sexual preoccupations which are inappropriate to the child’s developmental level (assuming of course that the child hasn’t been sexually abused or exposed to sexually explicit materials).Dr. Timothy Legg, PhD, PsyD, CRNP, ACRNAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.