What is Bipolar Disorder?

According to the Diagnostic and Statistical Manual-IV-TR, Bipolar Disorder can be divided into three types:

  • Bipolar 1 Disorder – when the primary symptom is rapid cycling episodes of mania and depression.

  • Bipolar 2 Disorder – when the primary symptom is depression accompanied by mild manic episodes that are not severe enough to cause markedly impaired functioning.

  • Cyclothymic Disorder – when there is a chronic state of cycling between episodes of mania and depression but that do not meet the diagnostic criteria for Bipolar Disorder.

The lifetime prevalence of Bipolar Disorder is approximately 1.3% in adults (Kleinman et al., 2003).

Signs of Bipolar Disorder often manifest in the adolescent years or early adulthood.

Bipolar Disorder is highly genetic:

  • One study assessing the genetic and environmental contributions to the development of Bipolar Disorder found that first-degree relatives of people with Bipolar Disorder (n=40) were at significantly increased risk of developing the disorder (Lichtenstein et al., 2009).

  • Heritability has been estimated to range from 59-80%, the higher percentage being obtained from studies of genetic twins (Lichtenstein et al., 2009).

Despite the strong genetic aspect of Bipolar Disorder, the evidence shows that a number of other factors also contribute to the symptoms, including:

  • life events

  • coping skills

  • family environment

  • diet

Treatment is usually a combination of psychological input and pharmacotherapy (medication).

The aim of treatment is to reduce the frequency, acuteness, and duration of episodes of mania and depression.

In some instances, hospitalisation with intensive pharmacological treatment is required to stabilise moods.

Treatments are also often aimed at treating co-morbidities, which are frequently found in people with Bipolar Disorder, where excess behaviours such as binge eating, drinking or drug taking can lead to obesity, heart disease, diabetes, and drug addiction (Morriss & Mohammed, 2005).

In one study, 81% of people with Bipolar Disorder also had co-morbidity.

Psychological treatments with scientific evidence supporting their efficacy include:

  • Interpersonal Social Rhythm Therapy (IPSRT)

  • Family-Focused Therapy 

  • Cognitive-Behavioural Therapy (CBT)

All of these approaches encourage the use of medication alongside the psychological treatment (Mansell et al., 2007).

IPSRT focuses on training people with Bipolar Disorder to regulate disruptive sleep patterns, which can cause more frequent mood cycling. It also targets issues around daily routines, stress, and interpersonal relationships.

CBT targets the cognitive issues associated with cycling moods, such as over-optimism, feelings of grandiosity, and goal-oriented thinking, all of which can contribute to risky behaviours.

Family-focused therapy provides a combination of psycho-education, where the main goal is to teach people with Bipolar Disorder and their families about the nature of the illness and how family dynamics can help or hinder life with Bipolar Disorder.

First line medication is usually lithium, anticonvulsants, or atypical antipsychotics, but it has been found that some people benefit from:

  • thyroid augmentation

  • clozapine

  • calcium channel blockers

The combination of psychological treatment and medication is designed to treat the specific episode of mania or depression, but the objective also needs to be to produce a treatment plan that assists in managing the condition long-term.

References

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders/APA 2000. 4th edition.

Kleinman, L.S., Lowin, A., Flood, E., Gandhi, G., Edgell, E., Revicki D.A.  Costs of Bipolar Disorder. PharmacoEconomics, 21 (9), 601-622(22).

Lichtenstein, P., Yip, B.H., Björk, C., Pawitan, Y., Cannon, T.D., Sullivan, P.F., et al. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet, 17 (373), 234-9.

Mansell, W., Colom, & Scott, J., (2005).The nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation, Clinical Psychology Review, 25, 1076–1100.

Morriss, R. & Mohammed, F.A. (2005) Metabolism, lifestyle and bipolar affective disorder. Journal of Psychopharmacology, 19, 94–101.



Categories: Health

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5 replies

  1. Hi Nicola,
    We hear a lot of people being diagnosed with bi-polar now: I’m sure lots also suffered from these awful symptoms before doctors realised what it was they had. Could it be possible for someone to think they have bi-polar, but simply be depressive or manic? Maybe a kind of mild bi-polar. Perhaps this is the third type you mentioned.

  2. Hi Susan,

    Good question! It can be difficult to diagnose Bipolar because the depression or mania don’t always fluctuate rapidly, making it obvious that there is a rollercoaster of ups and downs. Some people experience long periods of each, which means it is less evident that they are having such extreme moods. So, sometimes the diagnosis can only come after a number of years, when there is a case history to go by.

    As with Borderline Personality Disorder, Bipolar comprises traits that we all have – but to heightened degree and to a degree that severely impacts health and well-being. However, because people can relate to the symptoms at a lesser degree they can start to think they have Bipolar, when this isn’t the case. Even health professionals misdiagnose, so self-diagnosis can lead to even more mistakes. I do think the mild Bipolar you describe is more of type 3 – Cyclothymic Disorder.

  3. Hi Nicole,
    THanks for writing about Bipolar Disorder!!
    I had BD for over 30 years before I was diagnosed… because as you write, it is not easy to do so and often happens when life spirals out of control in a dramatic way first.
    And I think that Cyclothymic Disorder doesn’t get enough attention – it seems to be the ‘lesser’ of the three, but includes being a type of personality disorder as well, making it an extra challenge to deal with. Plus, it does upset daily life, but in a less obvious way which makes it harder for people around you to understand what you are dealing with. But that is my 2 cents worth.
    Fenny

  4. Thanks for making this clearer for me Nicola. I love your posts, so interesting.

  5. Thanks for your input, Fenny. No one knows Bipolar better than someone such as yourself – someone who lives with it. You make a good point re Cyclothymic Disorder often being seen as the lesser of the three – merely because it doesn’t have ‘bipolar’ in the name! There definately needs to be more education on this condition, as I feel it is still so misunderstood.

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