We've all heard it somewhere another. Someone might say, "Sheesh, her moods go up and down so much, she must be Bipolar." Maybe you even told a therapist or doctor that you had a lot ups and downs with your mood and they said, "Sounds like you might have Bipolar Disorder." Whatever your experience, whether arm-chair psychology or less than rigorous diagnostic procedures, you undoubtedly have encountered a casual usage of Bipolar Disorder, a condition that should be treated as anything but casual. This, probably more than anything, is the reason it bothers me so much that Bipolar Disorder is overused both in casual conversation and by professionals.
So What is the Difference?
When I encounter the question of what the difference between Bipolar and your normal mood swings are I use this analogy to quickly describe it: If mood swings are matches, Bipolar Disorder is a bonfire. It really sums it up quite well. Normal people have changes in moods. They might even be quite a large change in moods, and it might happen dramatically and without much observable reasons. But that's nothing compared the Bipolar Disorder. The range of moods in Bipolar disorder is so dramatic it is hard to ever consider them in the same category of what would be a typical mood swing.
To understand the cycle of Bipolar Disorder, you must understand its component parts. The upper range in mood we call mania, or hypo-mania in the case of Bipolar II Disorder. The lower range in mood we refer to as depression. It is also helpful to understand that different types of Bipolar Disorder: Bipolar I, Bipolar II and Cyclothymia.
Mania is a period of extremely elevated mood. This is not necessarily a happy mood, irritability is actually a very common symptom of mania, but it is an overall good feeling about yourself. In a manic phase, people tend to see a jump in goal focused activity, and feel like they are on top of the world. Impulsive activity, such as running off on a shopping spree or going to parties or outings in unfamiliar places, are also indicative of a manic phase. This is often accompanied by distractibility, racing thoughts and a decreased amount of sleep. In fact, a stereotypical description of someone in the middle of Mania is deciding at 2am that they are going to re-model the kitchen, so they decide then and there to start tearing out the back wall.
Mania looks wild, and it is. Mania can actually be quite dangerous, as the person becomes a risk taker. The impulsiveness coupled with a feeling of near infallibility can lead to some disastrous situations. I have been told stories of young women jumping into cars with men they do not know, going off to places unknown for a party. I have had described to me a hang glider that a man was building in a manic phase that he had every intention of taking to test himself. These methods for decision making are what make Mania so concerning, and difficult to treat as the person experiencing Mania does not feel they have a problem. In fact, most of the time someone who is in a Manic phase feels very good.
A lesser degree of Mania is Hypomania, sort of Mania done halfway. You have most of the hallmarks of Mania, but not as extreme. There is a lot of creativity and impulsivity. There's the increased mood and the feeling of irritability, especially at those who urge caution. That said, the level of risk is generally significantly lower. Many people who experience Hypomanic episodes actually enjoy them, and view them as an asset. There is some school of thought that some of the more creative minds of history experience hypomanic periods in their life, and generated most of their work during those times.
The other period of Bipolar Disorders is a Major Depressive Episode. This is more than feeling blue, or down. We all have low periods, but Major Depression is more significant than that. In a Major Depressive episode you can experience a general loss of interest or pleasure in normal activity, changes is weight without intending to diet. There's also a change in sleep in that they will sleep either more (hypersomnia) or less (insomnia). Change in movement or physical activity, either being agitated or seemingly slowed down as well as a loss in overall energy. Related to that you can experience difficulty with thinking clearly and be indecisive. A feeling of worthlessness is also a common feature of depression, telling yourself you are a failure or stupid or some other such thoughts. And, as most people are aware, thoughts of death and suicidal thoughts are also common features of depression.
Most people are conceptually familiar with Depression, of course. It is a buzz word, but also one that gets a lot of genuine thoughtful attention. This is mainly due to the very real, high profile effects of depression, that brings highlights on the issue. This attention, if it brings action to support those who suffer, is good. But it can also lead to a casualness about understanding Depression, a casualness that relies on common knowledge vs. education, which is dangerous.
So let's start putting it all together...
Bipolar I Disorder
Bipolar I Disorder is periods of Manic episodes and Major Depressive episodes. This involves dramatic changes in mood, as you can see from the above graphs. There episodes can have various specifiers attached to them. The following are rather intuitive in their definition through their names alone: anxious distress, melancholic features, with seasonal pattern, or with psychotic features.
There are a couple more that deserve some elaboration:
- Rapid Cycling which means more than 4 episodes over the course of the year.
- Mixed Features which means they have some extra symptoms that usually are tied to the opposite side. For example feeling worthless during a manic phase, or feeling extra energy during a depressive phase.
- Atypical Features which means they have unusual characteristics in their depressive episodes where mood reacts to positive events along with some specified features of a typical depressive episode
- Peripartum Onset happens when the mood disturbance first happens during or immediately after pregnancy
Bipolar II Disorder
As you can see, the features of Bipolar II differ from Bipolar I in that the Manic phase is not so high. To be specific, Bipolar II disorder features Hypomania and Major Depression. Bipolar II create a lesser upward trend, but a the same downward mood. Due to the less dramatic fashion of Bipolar II's hypomanic episodes, many struggle with taking medications. One person I knew who suffered with this disorder told me, "Frankly, it feels really good when I'm in my 'up-phase,' I don't really like what the meds do to me then. The depression is awful, but when I'm up, why would I want to come crashing down?"
Bipolar II can have the same addition features that are seen above.
Cyclothymia is the least severe of the three Bipolar type disorders. Cyclothymia is a combination of hypomania and depressive disorders that do not qualify for major depression. To accurately make a diagnosis you are supposed to have at least 2 years, and have ruled out Major Depression and Manic Episodes. It is overly simplistic but easy to understand Cyclothymic Disorder as a "Bipolar-Lite" disorder. It's still more severe in its range than what would be a typical mood range, but is not as severe. Additional specifiers only include anxious distress.
Other Differences with Moodiness
It is worth noting that to qualify for Bipolar Disorders of any sort you typically need a disturbance of mood lasting at least a week. Going up and down the same day is not enough to qualify as a Bipolar Disorder. After all, what we call Rapid Cycling refers to more than 4 episodes a year, not 4 episodes a week. So if you are considering your mood changes based upon a day to day feeling, it is probably not a Bipolar Disorder.
Finally, and perhaps most importantly, it is worth noting that to qualify for a mental health disorder of any sort there is a very basic requirement. Any disorder must cause a significant disturbance in functioning that impairs your life in social or work life. In other words, just because you feel off does not mean you qualify for Bipolar or any other disorder. You have to be distressed or impaired to the point where it is distressing your life.
I still think I have a Bipolar Disorder, what now?
If you read though all this and think you found yourself, rather than being ruled out of a Bipolar Disorder, then I am glad I could help. I not only desire to help people away for being misdiagnosed but also help people find what might really be happening with them. Your next step probably needs to be with a psychiatrist. I am not a medical doctor, but my work tells me that most effective treatment is medication. You need to work with a medical professional who specialized in psychiatric issues to find the right combination of Anti-Depressant and Mood Stabilizing medication for your life. Medication is the biggest tool when dealing with Bipolar Disorder, as it is mainly an organic issue.
The other thing I would recommend you do is build a solid support group. You need to invite friends and family into your life to be able to speak into it. When our mood is disturbed our judgement is impaired. You need people who can love you well enough to call you out when you are out of control. Friends and family need to know the warning signs, and maybe even know them already better than you do. You then need to give them permission to get into your personal business. Give them permission to suggest, even demand you go to a psychiatrist if your behavior gets beyond a certain point. Give them permission to check on you, and be a sounding board. They cannot be jerks, but you need accountability.
Finally, in addition to medication, counseling groups may help manage the symptoms when combined with medication. Recognizing and challenging your thoughts when they get dysfunctional can help us in depressive moods. Learning to second guess the flight of ideas during a manic phase can help mitigate some of the dangers as well. That said, even as a counselor, I will point you back to medication as your biggest tool.