Bipolar disorder is frequently talked about in the media, but there is a lot of confusion as to what it is. Many people wonder if they have Bipolar Disorder. Bipolar Disorder, also known as manic depression, is a mental illness which is characterized by mood swings. Bipolar Disorder is relatively rare, affecting approximately 3.9% of the population of the United States during their lifetime. The American Psychiatric Association’s Diagnostic and Statistical Manual 4th Edition (DSM-IV) classifies Bipolar Disorder in two different categories, Bipolar Disorder I and Bipolar Disorder II. If you have either type, you will likely have a Major Depressive Episode followed by a period of higher energy and possibly irritability. If you have Bipolar I Disorder, you will experience at least one Manic or Mixed Episode and one Major Depressive Episode. If you have Bipolar II Disorder, you will experience at least one Hypomanic Episode and one Major Depressive Episode. Often these episodes happen in cycles.
Major Depressive Episode
A Major Depressive Episode is often a very difficult experience. There are many signs of depression, but to be diagnosed with a Major Depressive Episode, you must have a period of depressed mood that lasts at least two weeks, or you must have a two-week period where you experience a loss of interest or pleasure in nearly all of the activities that you enjoy, such as spending time with family, work, school, or your favorite hobbies. In addition, if you have a Major Depressive Episode, you will also experience four or more of the following symptoms: (1) changes in your appetite or weight, where you eat much less or much more; (2) difficulty sleeping (insomnia) or sleeping too much (hypersomnia); (3) feeling agitated or lethargic; (4) fatigue or loss of energy; (5) feeling worthless or guilty; (6) difficulty concentrating or making a decision; (7) thinking a lot about death, suicide, planning for suicide, or trying to commit suicide. Major Depressive Episodes are typically very distressing.
To be diagnosed with Bipolar I Disorder, you will experience both a Major Depressive Episode and a Manic Episode, one after the other. Many people have an elevated mood from time to time, but a Manic Episode is extreme and has certain distinctive features. A person with mania exhibits bizarre and disorganized behavior that is different from his or her regular behavior. If you are experiencing mania, you and/or others will notice that your mood is abnormally and persistently elevated, expansive (grandiose, euphoric), or irritable for at least a week. In addition, to be considered manic, you will need to have three to four or more of the following symptoms: (1) unusually high self-esteem; (2) less need for sleep; (3) more talkative than usual; (4) racing thoughts or ideas; (5) being very distractible; (6) increasing goal directed behavior (for instance, working very intensely) or agitation; (7) increasing your involvement in pleasurable activities (for example, going on shopping sprees, spending money foolishly). If you are truly manic, you may experience psychosis, which is when a person loses touch with reality. If this happens, you may believe things that are not true and see or hear things that are not there. A manic episode will impair your life at work or school and your relationships. Many people require hospitalization during a manic episode. During a Manic Episode, it is common for people to be unaware they are impaired and in need of treatment.
To be diagnosed with Bipolar I Disorder, you may also be experiencing what is called a Mixed Episode. In a Mixed Episode, a person has symptoms of both mania and depression. If you are having a Mixed Episode, you can be diagnosed with both a Manic Episode and a Major Depressive Episode for at least a one week period. Also, if you are experiencing a Mixed Episode, you will have difficulty with work or relationships, and you may also have psychosis.
To be diagnosed with Bipolar II Disorder, you will experience both a Major Depressive Episode and a Hypomanic Episode, one after the other. In a Hypomanic Episode, a person has a period of elevated, expansive (grandiose, euphoric) or irritable mood that lasts at least four days and is unusual when compared to a person’s normal mood. In addition, to be diagnosed with a Hypomanic Episode, you must also have three to four or more symptoms described in the section for Manic Episode, such as unusually high self-esteem and less need for sleep. A Hypomanic Episode differs from a Manic Episode in that you will not experience psychosis. A Hypomanic Episode is less likely to impair your functioning or relationships. If you are experiencing a Hypomanic Episode, you will be less likely to be hospitalized as someone experiencing a Manic Episode.
As you might imagine, both types of Bipolar Disorder can be very upsetting, debilitating, and difficult, both for the person experiencing it and his or her loved ones. However, there are treatments for Bipolar Disorder. If you or someone you know is experiencing symptoms of mania or depression, contact a health care provider as soon as possible. If you or someone you know is thinking about suicide or is showing symptoms of psychosis, get emergency medical assistance immediately.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Fourth Edition. Washington, DC: American Psychiatric Association.
Kessler RC, Berglund PA, Demler O, Jin R, & Walters EE. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62:593-602.