In the pantheon of mental health disorders, one that’s not always well understood by the general public is bipolar disorder. Formerly referred to as manic-depression, bipolar disorder is a complex condition that causes a wide variety of symptoms that can lead to a lot of disruption to daily life.
” Bipolar disorder is a mood illness that involves episodes of elevated mood or depressed mood,” says Dr. Samar McCutcheon, a psychiatrist in the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus.
Bipolar disorder actually presents as two varieties: Bipolar 1 and Bipolar 2. “Bipolar I disorder most commonly consists of episodes of depression and episodes of mania, while Bipolar 2 disorder most commonly consists of episodes of depression and episodes of hypomania,” McCutcheon explains. Hypomania is a mood that’s elevated above normal but not to the level of full mania.
Episodes of depression can involve:
— Low mood.
— Loss of interest in previously enjoyable activities.
— Changes to sleep patterns.
— Changes in energy levels.
— Appetite changes.
— Changes in concentration.
— Feelings of intense guilt, worthlessness or helplessness.
Episodes of mania or hypomania may involve:
— An elevated or expansive mood.
— An irritable mood.
— A decreased need for sleep.
— Racing thoughts.
— Impulsive behaviors. For example: risk taking behaviors such as suddenly traveling to a remote location with no clear plan or schedule, having multiple sexual partners in a short period of time and often without thoughts to the risks of these behaviors, sudden bouts of drug use, dangerous gambling or spending an excessive amount of money on unnecessary items in a short period of time, often more than what one can afford.
— Rapid or pressured speech. This is when a person seems to be talking very fast, almost as if they’re compelled to keep talking, making it almost impossible for anyone else to interrupt them or get a word in edgewise.
— Grandiosity. This is when a manic person believes that he or she has specialized knowledge or abilities or relationships (such as with a celebrity or with the president of the United States) that significantly exceed anything that loved one or coworkers would corroborate.
— Disorganized thoughts and behaviors. Disorganized thought patterns that are described in literature as “loosening of associations,” a situation where a person with mania will jump from one topic to the next in a conversation without any clear link between the topics. This loosening of associations indicates that the individual with mania is beginning to lose grips with reality. This can even devolve into frank psychosis wherein this tenuous grip on reality is completely lost and the manic person often exhibits bizarre thought processes and behaviors. These behaviors may be dangerous to the manic individual and to others, and there is an increased risk of suicide during these manic episodes. If you see someone in this state of mind, please call 9-1-1, or if it is safe enough to do so, bring them to the nearest emergency room so they can receive professional help.
[READ: Psychosis and Schizophrenia.]
Each of these episodes is “time-limited,” McCutcheon notes, and in between these sometimes-extreme highs and lows, “people will typically be at their baseline of functioning.”
However, during periods of mania or depression, “people may experience difficulties with their job, relationships or level of functioning,” McCutcheon says. The episodes can range in severity and vary from person to person, so “it’s not always possible to predict the level of impact bipolar disorder will have on someone’s life.”
Because of this wide variability in symptoms, bipolar disorder is sometimes difficult to diagnose conclusively. “People with bipolar disorder are often misdiagnosed, and many go through multiple visits to psychiatrists and therapists and try several medications before receiving an accurate diagnosis and effective treatment,” says Jeremy Schwartz, a psychotherapist in private practice in Brooklyn, New York, with a specialty in therapy for the LGBTQ community.
“It’s hard to get an accurate bipolar diagnosis because of the condition’s very nature,” he explains. “People go through manic, hypomanic and depressive episodes at different times, but health care providers only see one of those episodes at a time.”
If you’re experiencing episodes that suggest bipolar disorder might be at work, it’s imperative that you give your healthcare provider “as full and accurate a history as possible,” Schwartz says, adding that “this can be difficult to do when you’re going through a difficult time.”
Managing Bipolar Disorder
Currently, there’s no cure for bipolar disorder, but “that doesn’t mean it’s something you’ll have to battle forever,” Schwartz says. “With the right treatment and self-care, you can live a healthy and fulfilling life.”
Treatment for bipolar disorder includes education about the disorder, medication management and psychotherapy, McCutcheon adds.
Still, living well with bipolar can be challenging, and “people often face serious impairment in functioning,” Schwartz notes. However, it’s entirely possible to get better over time if you stick with the treatment plan and self-care advice your doctor provides.
Schwartz points to a few studies that show there’s hope for a better life after a diagnosis of bipolar disorder. For example, one 2017 study found that self-management of bipolar symptoms plays a strong role in personal recovery. Another 2017 study concluded that empowering people to manage their mood and view mood changes as normal may facilitate recovery.
“According to the results, decreased negative beliefs about the illness are significantly correlated with improved recovery outcomes. Self-esteem and hopefulness are important to achieving recovery,” Schwartz says.
Reframing how you think about bipolar disorder can change how you think about managing the condition, McCutcheon says. She encourages people with bipolar disorder to consider it as “one part of your medical history that can be managed with appropriate treatment.”
In other words, “when your mood changes, don’t despair,” Schwartz says. “View it as something to take care of, use your self-management tools and work with your healthcare provider” to get back on track.
McCutcheon adds that “maintaining an open line of communication with your treatment provider as well as learning about bipolar disorder and the lifestyle interventions” can go a long way toward helping you stay well.
For some people, “recovery can be a long process,” Schwartz notes. Sticking with your treatment plan is critical to managing the disruptions the disorder can cause when it’s not properly being managed. “Talk to your treatment team before making any changes. It’s common for mood disorders to follow a cyclical pattern. You may be feeling better right now, but that doesn’t mean you’re cured.”
5 Things to Do After a Bipolar Diagnosis
If you’ve recently been diagnosed with bipolar disorder, you probably have a slew of questions. Here are five key things Schwartz says you should know as you get back on the road to better living.
1. Understand that diagnosis is the beginning of a new chapter.
While some people might view a bipolar disorder diagnosis as scary, it’s really the beginning of a new chapter and can help empower you moving forward.
“Learning that you have bipolar disorder gives you valuable information about the difficulties you’ve been having and what they mean,” Schwartz says.
Because there are effective treatments and lifestyle changes you can make, you actually have more control over the disorder than you might realize at first. “Through a combination of self-management and quality treatment, many people live well with bipolar disorder.”
2. Know that medication helps, but it can’t cure bipolar disorder.
If you have bipolar disorder, you need to invest energy into caring for yourself. This means:
— Engaging in meaningful activities that build up resilience and “make you less vulnerable to negative emotional states,” Schwartz says.
You also need to pay attention to your moods and how you’re feeling. “Tracking your mood and your self-care behaviors consistently will help you notice the earliest signs of relapse,” Schwartz says. “Take these early signs seriously, and stay in contact with your health care providers so you can address them right away.”
3. Follow your provider’s treatment plan.
Schwartz notes that medications to treat bipolar disorder work “hand in hand” with therapy. “For some people, a mood stabilizer such as lithium can offer a complete remission of symptoms,” and the condition often responds well to medication. However, “stopping medication comes with a significant risk of relapse.”
Cognitive behavioral therapy — a common approach to talk therapy that helps patients learn to moderate their response to stressors — and dialectical behavior therapy — a form of CBT that was originally developed to treat borderline personality disorder — have also been found helpful in managing bipolar disorder.
“While medication helps stabilize your mood, therapy can help you develop new ways of thinking and being to create lasting change,” Schwartz says.
4. Seek support.
It’s difficult going it alone when you have a bipolar disorder diagnosis. Instead, reach out to those around you and ask for support.
“Let people know what you’re going through and how they can help,” Schwartz says, noting that you might also “need to assert boundaries and set limits when people do things that aren’t helpful. This can be uncomfortable at first, but there’s nothing to feel guilty about when you set limits and assert your needs.”
You can also join a peer support group. The National Alliance on Mental Illness, the Depression and Bipolar Support Alliance and similar organizations have local chapters that offer free support groups that may be helpful in learning how to move forward productively after a diagnosis. “Participation in peer support groups can even reduce the need for hospitalization and other treatments,” Schwartz says.
5. Know that recovery is possible.
Lastly, it’s important to understand that things can get better. “Recovery doesn’t necessarily mean being symptom-free forever,” Schwartz says, “but it can mean being able to live your life and achieve personally meaningful goals without bipolar having to be an insurmountable obstacle. Recovery is something you can define for yourself based on what you care about.”
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Update 07/30/21: This story was previously published at an earlier date and has been updated with new information.