There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder aren’t always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.
Manic Episodes
A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode. Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
People who are in manic states may indulge in activities that cause them physical, social or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly. They also occasionally develop psychotic symptoms, such as delusions and hallucinations, which can cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder. People with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesn’t last as long as manic episodes and it doesn’t interfere with daily functioning as much.
Depressive Episodes
During a depressive episode, you experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression, such as:
1. Tiredness.
2. Changes in appetite.
3. Feelings of worthlessness and hopelessness.
Why is Bipolar Disorder No Longer Called Manic-Depressive Illness?
In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using “manic-depressive illness” or “manic depression” to describe bipolar disorder. There are several reasons for this shift, including:
1. Healthcare providers used to use “manic depression” to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM), have become more sophisticated, the new term “bipolar disorder” allows for more clarity in diagnosis.
2. There’s a lot of stigma and negativity associated with the terms “manic” and “mania,” especially due to the use of “maniac.” Similarly, people use the term “depression” casually to describe periods of sadness that don’t qualify as clinical depression. Using “bipolar disorder” takes the focus away from these two words. “Bipolar disorder” is more of a clinical, medical term and less emotionally loaded than “manic depression.”
3. The term “manic depression” excludes the cyclothymic or hypomanic (bipolar II disorder) versions of the condition.
What are The Types of Bipolar Disorder?
There are four types of bipolar disorder, including:
1. Bipolar I Disorder. People with bipolar I disorder have experienced one or more episodes of mania. Most people with bipolar I will have episodes of both mania and depression, but an episode of depression isn’t necessary for a diagnosis. The depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episodes must last at least seven days or be so severe that you need hospitalization. People with bipolar I can also experience mixed states (episodes of both manic and depressive symptoms).
2. Bipolar II Disorder. People with bipolar II experience depressive episodes and hypomanic episodes. But they never experience a full manic episode that’s characteristic of bipolar I disorder. While hypomania is less impairing than mania, bipolar II disorder is often more debilitating than bipolar I disorder due to chronic depression being more common in bipolar II.
3. Cyclothymic Disorder (Cyclothymia). People with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood (euthymia), but these periods last fewer than eight weeks.
4. Other Specified and Unspecified Bipolar and Related Disorders. If a person doesn’t meet the diagnostic criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation, it’s considered other specified or unspecified bipolar disorder.
What is The Difference between Borderline Personality Disorder and Bipolar Disorder?
While Borderline Personality Disorder (BPD) and bipolar disorder have similar symptoms and are often confused for each other, they’re distinct conditions. BPD involves a longstanding pattern of abrupt, moment-to-moment swings in moods, behavior and self-image that are often triggered by conflicts in interactions with other people. Nonsuicidal self-injury is also common in BPD but not in bipolar disorder.
Bipolar disorder is different from BPD because it involves distinct, longer-lasting episodes of mania/hypomania and/or depression. Several things can trigger manic or depressive episodes, such as sleep changes, stress, medications and substance use.
Who Does Bipolar Disorder Affect?
Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s. Although bipolar disorder affects people Assigned Female at Birth (AFAB) and people Assigned Male at Birth (AMAB) in equal numbers, the condition tends to affect them differently.
People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called “rapid cycling.” Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population. People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.
What are The Signs and Symptoms of Bipolar Disorder?
The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while people with bipolar II disorder or cyclothymia experience hypomanic episodes. But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states don’t always follow a set pattern, and depression doesn’t always follow manic phases. A person may also experience the same mood state several times, with periods of euthymia in between-before experiencing the opposite mood. Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.
An important aspect of the mood changes is that they’re a departure from your regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression. The severity of the depressive and manic phases can differ from person to person and in the same person at different times.
Signs and Symptoms of Manic Episodes
Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life, others may experience them only rarely. Signs and symptoms of a manic episode include:
1. Excessive happiness, hopefulness and excitement.
2. Sudden and severe changes in mood, such as going from being joyful to being angry and hostile.
3. Restlessness.
4. Rapid speech and racing thoughts.
5. Increased energy and less need for sleep.
6. Increased impulsivity and poor judgment, such as suddenly quitting your job.
7. Making grand and unattainable plans.
8. Reckless and risk-taking behavior, such as drug and alcohol misuse and having unsafe or unprotected sex.
9. Feeling like you’re unusually important, talented or powerful.
10. Psychosis experiencing hallucinations and delusions (in the most severe manic episodes).
Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger, some people become suicidal in manic episodes, not just depressive episodes. If a person is having an intense manic episode, especially if they’re experiencing hallucinations and delusions, they may need to be hospitalized to protect themselves and others from possible harm.
Signs and Symptoms of Hypomania
Some people with bipolar disorder have milder manic-like symptoms. This is called hypomania. With hypomania, you may feel very good and find that you can get a lot done. People with hypomania can often function well in social situations or at work. You may not feel like anything is wrong during a hypomanic episode. But your family and friends may notice your mood swings and activity level changes and think that they’re unusual for you. After hypomania, you might experience severe depression.
Signs and Symptoms of Depressive Episodes
The symptoms of depressive episodes in bipolar disorder are the same as those of major depression. They include:
1. Overwhelming sadness.
2. Low energy and fatigue.
3. Lack of motivation.
4. Feelings of hopelessness or worthlessness.
5. Loss of enjoyment of things that were once pleasurable for you.
6. Difficulty concentrating and making decisions.
7. Uncontrollable crying.
8. Irritability.
9. Increased need for sleep.
10. Insomnia or excessive sleep.
11. A change in appetite, causing weight loss or gain.
12. Thoughts of death or suicide (suicidal ideation).
If you’re experiencing suicidal ideation (thoughts of suicide), it’s important to seek immediate care. Someone will be available to talk with you 24 hours a day, seven days a week.
Signs and Symptoms of A Mixed Episode
The symptoms of a mixed episode include both manic and depressive symptoms together. During a mixed episode, you have the negative feelings and thoughts that come with depression but also feel agitated, restless and high energy. People who experience mixed episodes often describe it as the worst part of bipolar disorder.
What Causes Bipolar Disorder?
Scientists don’t yet know the exact cause of bipolar disorder. But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions, more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesn’t necessarily mean you’ll also develop it.
Other factors that scientists think contribute to the development of bipolar disorder include:
1. Changes in Your Brain. Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition.
2. Environmental Factors Like Trauma and Stress. A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.
Scientists are currently performing research to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset and what role they may play in its treatment.