What is Bipolar Disorder?

by Colleen Sullivan

Bipolar Disorder is a serious mental disorder of mood or affect. The word "Bipolar" literally means having two poles. Extreme mood swings from mania to major depression characterize this disorder. Everyone can relate to the word mood. We are all happy, excited, sad or depressed at some point in our lives. Bipolar Affective Disorder (Manic Depressive Illness) is a biochemical imbalance that causes gross mood changes from the high reaches of mania to the lows of severe depression. For the one percent or twenty million Americans who have this condition it can mean hospitalizations, a life time of medication, disability at an early age and the reduced income associated with it. Bipolar Affective Disorder can be life threatening.

People with manic depressive disorder can and do go over the edge, often becoming self destructive and sometimes losing touch with reality. Their lives can seem unbearably painful.

Bipolar Affective Disorder is nobody's "fault" - parents are not to blame for the way they raised you, nor are is the individual to blame for failing to deal adequately with the stresses of life. The cause of Bipolar Affective Disorder is unknown and at the present time there is no cure. There are, however, effective treatments available.

There are several recognized forms of Bipolar Affective Disorder as shown in The Bipolar Spectrum below. Following it are definitions of common terminology regarding the illness.

Hopefully one day soon there will be a cure for this illness that has impacted harshly, not only on bipolars, but on their families, friends and society.

The Bipolar Spectrum

Bipolar I: Both mania and major depression (alternating)

Bipolar II: Major depression and hypo mania

Bipolar III: Cyclothymia: Milder depression and hypo mania though disruptive to those who suffer from it

Bipolar IV: Depression and usually no mania. Mania may be triggered by some antidepressants.

Bipolar V: Depression and no mania. Some blood relatives have had mania

Bipolar VI: Mania and no depression. The theory for classifying this among the "bipolar" disorders is that almost every manic will eventually crash into a depressive episode.

Some Definitions

Affective Disorder: any disorder of "affect" or "mood" most often caused by biochemical imbalance.

Anhedonia: the inability to experience pleasure; a loss of interest in once pleasurable activities.

Antidepressants: drugs developed primarily to treat and relieve symptoms of depression.

Antipsychotics: drugs used to treat severe distortions in thought perception and emotion that characterize psychoses. (also known as neuroleptics).

Bipolar: Literally...having two poles. In bipolar affective disorder wide mood swings from mania to depression usually with periods of normal mood. Impaired insight into mood during an episode is common.

Cyclothymia: Comparatively mild mood swings from depression to mania. Often cyclothymics are always up or down, not staying in a normal mood for long.

Delusion: A fixed false belief regarding the self or the world persistently held despite clear evidence to the contrary. In depression, often of guilt, sin or crime. In mania of grandeur and unlimited power to save the world.

Depression: A mental disorder of lowered mood, slowed thinking, decreased pleasure, guilt feelings, hopelessness, despair, and problems in sleeping and eating.

Euphoria: An exaggerated feeling of physical and emotional well-being.

Euthymic Mood: The "normal" mood when not manic or depressed.

Hallucinations: A perception of sounds, sights, physical sensations or smells that do not exist.

Hypo mania: "less than manic" but still highly energized, in an unusually good or unusually irritable mood, making impulsive decisions and having mildly impaired judgment. Falls somewhere between euthymia and mania.

Lithium: a drug used for stabilizing the mood swings of Bipolar Affective Disorder.

Manic Depressive Illness: previous name for Bipolar Affective Disorder. Still commonly used.

Mental Health: A state of psychological and emotional well-being that enables an individual to love, work, relate to others effectively, and resolve conflicts.

Mixed Episode: A bipolar episode with features of both mania and depression,

Paranoia: The tendency to view the actions of others as deliberately threatening or demeaning; suspicious thinking based on misinterpretation of an actual event.

Psychological Symptoms: Symptoms or feelings of the mind that cause distress and interfere with normal functioning...eg. racing thoughts and elation in mania, and poor concentration and loss of interest in depression.

Psychoses: A major mental disorder characterized by gross impairment of an individual's perception of reality and relate to others. It can be biological or emotional in origin.

Rapid Cycling: A bipolar who has severe episodes of depression and mania occurring more than four times in one year.

Self Esteem: A sense of self-worth. The valuing of oneself as a person.

Self-Help Group: An assembly of individuals with a common problem who aid one another through personal and group support.

Vegetative Symptoms: Disruptions of the body's physical functioning...eg. insomnia and loss of appetite.

Criteria for Diagnosis of Bipolar Affective Disorder

Depression

At least 5 of the following symptoms - one of which must be depressed mood or loss of interest or pleasure - that persist every day for at least 2 weeks and represent a change in the way a person felt or functioned in the past.

1. Depressed mood (feeling sad or empty or seeming sad or tearful)
2. Greatly diminished interest in all or almost all activities
3. Significant weight gain or loss without dieting (more than 5 percent of body weight) or increased or decreased appetite
4. Sleeping much less or much more than usual
5. Slowing down or speeding up of activity that is observable by others
6. Fatigue, or loss of energy
7. Feelings of worthlessness, or excessive and inappropriate guilt, not merely self--reproach about being sick
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death (not just fear of dying), recurrent thoughts of suicide without a specific plan, or a suicide attempt or specific plan for attempting suicide

Mania

A distinct period of an abnormally and persistently elevated, expansive or irritable mood that lasts at least one week or requires hospitalization. Also at least 3 of the following symptoms (4 if the only change in mood is increased irritability) have occurred to a significant degree.

1. Inflated self esteem or grandiosity
2. Decreased need for sleep (eg. feeling rested after 3 hours sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or feeling that one's thoughts are racing
5. Distractibility
6. Increase in goal-directed activity (socially, sexually, at work or school) or physical and mental restlessness and agitation
7. Excessive involvement in pleasurable activities that are likely to lead to painful consequences, such as shopping sprees or sexual indiscretions

Cause of Bipolar Affective Disorder

The cause of Bipolar Affective Disorder is not known. Most mental health professionals believe that it is caused by abnormal brain functioning. Genetic, chemical, hormonal, psychological, social and developmental factors may also play a role.

Close relatives of individuals who have bipolar disorder are definitely at risk so heredity plays a role. If you have a parent, sibling or child with the disorder there is a 7-10 percent chance that you may develop the same disorder, and an 8-10 percent chance you may develop depression.

Stress may trigger an episode but is not usually accepted as a cause of the illness.

Another theory is that bipolar disorder stems from a defect in the brains internal clock, which controls daily and seasonal rhythms. Another is that an episode of depression, hypo mania or mania may alter brain chemistry in ways that create a predisposition to future episodes.

Research continues seeking a definitive cause. Until the cause is found there will be no cure. But there is hope!

Cycles

Changes in mood, thinking, behavior and physical condition for a distinct period of time, either to depression or mania, characterize bipolar disorder. These changes occur in cycles. An episode of mania may be followed closely by an episode of depression or vice versa. Or there may be a shorter or longer period of euthymic (normal) mood between episodes. Each individual is different but to experience 4 or more major episodes in a ten year span is not unusual. As a bipolar person ages his episodes may come closer together and last longer.

Rapid Cycling

Some bipolars (approx 5-15%) experience "rapid cycling" - four or more manic or depressive episodes in a year, each lasting at least 24 hours, and ending with a switch to the opposite state or stability.

Seasonal

Bipolar illness can follow a seasonal pattern with individuals sinking into depression at certain times of the year and swinging into hypo mania or mania a few months later. For me this is a definite pattern...with episodes occurring exclusively in either Spring or Fall.

Bipolar Illness and Creativity

Kay Redfield Jamison PhD of Johns Hopkins University, in her book "Touched by Fire: Manic Depressive Illness and the Artistic Temperament" estimates that the rate of bipolar illness is ten to forty times higher among artists than in the general public.

Certainly history shows that many famous creative people suffered from this disorder. Artist Vincent van Gogh, composers Robert Schumann and George Frederick Handl, poets Sylvia Plath and Robert Lowell and writers Virginia Woolf and Ernest Hemingway all suffered from Bipolar Affective Disorder. Virginia Woolf, in a letter to a friend wrote "as an experience, madness is terrific, I can assure you, and not to be sniffed at".

Creative bipolars sometimes do their best work when in a state of hypo mania. While depressed they are at a standstill and while manic they are too frenetic to accomplish a great deal. They worry about the effect that treatment will have on their creativity.

Generally treatment will channel their creativity and allow them to be more creative over the long haul. Certainly it does not take away from their creativity and allows them to work at their art more consistently.

© 1999 Colleen Sullivan

Colleen Sullivan was a contributing editor to Suite101.com's Bi-Polar Disorder site.