Bipolar Disorder

Bipolar disorder is a general term for a group of behavioral health conditions encompassing bipolar I disorder, bipolar II disorder, cyclothymic disorder, medication or substance induced bipolar and related disorders, bipolar and related disorders due to other medical condition(s), and other specified and unspecified bipolar and related disorders.

The DSM-5 situates bipolar and other related disorders between the section on schizophrenia spectrum/other psychotic disorders and depressive disorders as part of a diagnostic, etiologic (referring to the origins of the cluster of disorders as a result of genetics and family history), and symptomatic continuum.

Classic bipolar disorder (which includes all variations of bipolar I and bipolar II disorders), often historically and colloquially referred to as manicdepressive disorder, has been described in both lay and academic literature since the nineteenth century. It refers to a grouping of symptoms having to do with alternating periods of mood at opposite ends of the emotional spectrum, from elation and mania to clinical depression. Most individuals who experience a diagnosable manic episode will also experience a period of clinical depression at some point. Some individuals with rapid mood cycles, if not appropriately treated, will experience frequent alternating periods of mania and depression, sometimes several times daily; others may only experience mania or depression every few years or once or twice in their lifetime.

Bipolar I disorder (BPAD-I) is diagnosed on the basis of a manic episode, which may have been preceded by, or may be followed by, an episode of hypomania or clinical depression. Symptoms of BPAD-I manic episode, according to DSM-5, include, for a period of at least a week and lasting at least most of each day, “a distinct period of abnormally and persistently elevated, expansive or irritable and abnormally and persistently increased goal-directed activity of energy lasting at least one week and present most of the day, nearly every day.” The mood alteration must be of sufficient severity as to interfere with activities of daily life and may be of such magnitude that hospitalization is necessary in order to protect the client or those around the client or to manage psychotic symptoms, and there is no other reasonable explanation for the symptoms’ presence.

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. Greatly increased or pressured speech
  4. Either flight of ideas noticed by others or the selfdescription of racing thoughts
  5. Lack of focus and concentration, significantly increased distractibility
  6. Increased goal-directed activity (whether positive or negative) or presence of markedly increased motor activity that is not purposeful
  7. Engaging in activities that are non-beneficial: spending sprees, poor business or financial choices, multiple random sexual encounters, and the like

In order to meet diagnostic criteria for BPAD-I, the individual must experience at least one episode of mania in the person's lifetime that meets the above criteria.

It is possible for individuals with BPAD-I to experience one or more episodes of hypomania, although their presence is not necessary in order to meet diagnostic criteria. Hypomania includes the manic symptoms listed above, and the following:

  1. The symptomatic episode is associated with a noticeable change in functioning not typical of the individual's daily life, and it is readily apparent to others in the person's life.
  2. The behavior and functional changes, although indicative of significant decrement in typical daily performance, are not of sufficient severity or dangerousness to mandate hospitalization or to render the individual unable to participate in normal daily activities.

To meet BPAD-I criteria for a major depressive episode, individuals must experience a significant change in functioning from their baseline, including either depressed mood or loss of pleasure in previously enjoyed activities. The symptoms must cause clients clinically significant distress or discomfort or create significant impairment/decrease in typical levels of day-to-day functioning; they must not be attributable to any external or physiological cause. In addition, at least five of the following symptoms must be present for the majority of the day, nearly every day during a single two-week period:

  1. Depressed mood most of the day, nearly every day as subjectively reported by the client or observed by others in the environment
  2. Significant loss of interest in virtually all previously enjoyed activities most of the day, either observed by others or via self-report
  3. Either marked decrease or increase in appetite resulting in 5% or greater change in body weight over a period of a month
  4. Sleeping too much or too little
  5. Agitation or fidgety behavior, or very much slowed movement, as noted by others
  6. Decreased energy level or feelings of fatigue
  7. Intense, excessive feelings of guilt or worthlessness, possibly delusional
  8. Marked loss of focus, concentration, and decisionmaking ability
  9. Recurring thoughts of suicide, with or without intent or plan, along with preoccupation with thoughts of death and dying

Bipolar II disorder (BPAD-II) is similar to BPAD-I with hypomania but includes at least one current or past episode of hypomania as well as a current or past episode of major depression.

Adults who experience a two-year period (for children and early adolescents, the time period is one year) of both hypomanic and major depressive episodes without any episodes of mania are typically given a diagnosis of cyclothymic disorder.

Bipolar disorder occurs about equally in both males and females and in virtually every ethnic and racial groups in the developed world. The onset of bipolar disorder is typically during the teen or young adult years and is heritable and tends to run in families. Although estimates vary depending upon the sampling and research methods used, children of parents with bipolar disorder are significantly more likely to develop it than those whose parents do not have a mood disorder; if one identical twin is diagnosed, there is a very high probability that the other twin will develop the disorder. As of 2015, much research was underway to determine the gene sequences responsible for BPAD, as well as many other behavioral health disorders.

Many notable artists, writers, musicians, and other people prominent in both creative and other fields have been diagnosed with bipolar disorder, including composers Robert Schumann and Gustav Mahler; musicians/singers Chris Brown, Kurt Cobain, and Sinead O'Connor; painter Vincent van Gogh; writers Lord Byron, Virginia Woolf, Sylvia Plath, and Patricia Cornwell; and actors Patty Duke Astin, Kristy McNichol, Russell Brand, Jean-Claude Van Damme, Vivien Leigh, Linda Hamilton, Carrie Fisher, and Catherine Zeta-Jones.

A multimodal treatment approach is typical for bipolar disorder, using mood stabilizing medications; hospitalization when and if necessary; psychotherapy; psychoeducation; complementary therapies such as yoga, acupuncture, homeopathy, and herbal remedies; sleep medications when needed; and in situations where all other forms of treatment have been ineffective, electroconvulsive therapy.

See also Depression ; Diagnostic and Statistical Manual of Mental Disorders; Mania ; Mood stabilizers .

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. Washington, DC: Author, 2013.

Bennett, Paul. Abnormal and Clinical Psychology: An Introductory Textbook. Maidenhead, UK: McGraw Hill, Open University Press, 2011.

Bonder, Bette. Psychopathology and Function. Thorofare, NJ: SLACK, 2010.

Gnaulati, Enrico. Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder. Boston, MA: Beacon Press, 2013.

Ketter, Terence A. Handbook of Treatment for Bipolar Disorders. Washington, DC: American Psychiatric, 2010.

Richard, David C. S., and Steven Ken Huprich. Clinical Psychology: Assessment, Treatment, and Research. Amsterdam: Elsevier/AP, 2009.

Strakowski, Stephen M. Bipolar Disorder. New York: Oxford University Press, 2014.

Suppes, Trisha, and Ellen B. Dennehy. Bipolar Disorder Assessment and Treatment. Sudbury, MA: Jones & Bartlett Learning, 2012.

PERIODICALS

Kessing, Lars Vedel, et al. “Are Rates of Pediatric Bipolar Disorder Increasing? Results from a Nationwide Register Study” International Journal of Bipolar Disorders 2, no. 10 (2014): doi:10.1186/s40345-014-0010-0.

WEBSITES

American Psychiatric Association. “Bipolar Disorder.” http://www.psychiatry.org/bipolar-disorder (accessed September 15, 2015).

Mayo Clinic. “Diseases and Conditions: Bipolar Disorder.” http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/definition/CON–20027544?p=1 (accessed September 15, 2015).

National Institutes of Health. “Bipolar Disorder.” http://health.nih.gov/topic/BipolarDisorder (accessed September 15, 2015).

National Institutes of Health: National Institute of Mental Health. “What Is Bipolar Disorder?” http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml (accessed September 15, 2015).