Bipolar is one of those mental illnesses that gets thrown around into discussions about people we don’t like.
You know, the colleague who is in a bad mood, or the ex who snapped in anger a couple of times. However, Bipolar One is much more complex and discrete than just being a bit moody.
So what is it?
In order to be diagnosed Bipolar One, a person needs to have a manic episode.
What’s a manic episode?
Far from being just a bit strung out, a manic episode is a period of a week or longer of unusually elevated or irritable mood.
During a manic episode, a person may be very talkative, have inflated self esteem, decreased need for sleep, and flight of ideas. Risk taking behaviour may also be present, including risky investments, impulsive purchases, sexual misadventure, gambling, or otherwise risky behaviour with high consequences.
So imagine your bubbly type-A individual, going from here to there and kicking goals with little need for sleep – until the manic episode progresses to a more disorganised state…
Or – in some cases – the destructive type who is cash-happy and speeds along the highway with no thought for consequences.
A manic episode may also have psychotic features – which may include seeing and hearing things, delusions (false beliefs – for example, the belief they are being watched), paranoia, and anxiety.
Some of these psychotic features may go so far as to have an affected individual believe that there is a conspiracy with the federal police watching the house, ready to destroy them with evidence of a crime they aren’t actually sure they committed.
Many people suffering their first manic episode will be hospitalised – a person with Bipolar is around 15 times more likely to commit suicide than the general population and this risk is heightened in manic states, due to impulsivity. The likelihood of a psychotic episode also increases, the longer the mania is untreated.
Because mania can be such a heightened, productive state, a person at the stage of needing hospitalisation is likely to resist, resist, resist. When this happens, they may be held in a facility against their will – also known as being kept under the Mental Health Act.
A person suffering a manic episode may also be irritable, rather than heightened. They may also display a lot of goal-directed behaviour (completing tasks, unrealistic plans of tasks to be done, cleaning the house.)
As opposed to the “moody” stereotype of Bipolar, someone who is experiencing mania may appear high functioning, productive, and driven. However, as mania progresses, the lack of sleep and other symptoms can cause disorganisation and impaired functioning in all areas of life – which is required for a diagnosis.
A person with Bipolar One may also suffer a depressive episode. However, it isn’t required for a diagnosis. Depressive episodes can be characterised by a lack of energy and interest, sleep problems, thoughts of death, weight loss or gain, and diminished ability to concentrate.
Bipolar One is observed in males and females equally in most prevalence estimates. Interestingly, Bipolar is more common in high income countries and more common in separated, divorced, or widowed individuals, but the association is not clear in studies completed thus far.
Far from being an illness that can be cured with positive thoughts or yoga, Bipolar is largely biologically rooted. There is a 10-fold increased risk for a person to develop Bipolar if it is somewhere in the family. This risk increases depending on the degree of kinship of the individual to the family member with Bipolar. It can also be contributed to by stressful life events and trauma.
Treatment of Bipolar typically involves some form of medication, teamed with therapy. Medication is often an antipsychotic or anti convulsant, along with a mood stabilising medication. Psychoeducational therapies such as dialectical behaviour therapy, cognitive behaviour therapy, interpersonal and social therapy may be used.
But it’s not all bad.
Many people with Bipolar One do recover with the right treatments, even though it is likely to affect job performance at some stage. Working within mood episodes also presents significant challenges. Career and job changes are common with Bipolar One, however, the diagnosis of Bipolar One isn’t a death sentence, once it has been stabilised.
Moods in Bipolar are often to the extreme. For the person suffering this disorder, it can be an endless fight to find the middle ground, rather than existing on either exhausting side of the thermometer.