Bipolar disorder, which affects about one percent of the world's population, is a serious neurobiological disease that needs to be treated as soon as it's diagnosed. According to research, severe depression — one of the two main episodes of the condition — leads to suicide in as many as one in five people who get diagnosed.
Another part of this debilitating illness is mania, a period of extremely elevated mood. This beingh the complete opposite of depression, it is not difficult to understand where the name "bipolar disorder" originated. Mania, or a manic phase, is not an illness of itself, but rather an episode characterized by at least seven days of elevated, expansive, or irritable mood.
Both men and women get bipolar disorder, but research shows that women tend to experience more depressive and mixed episodes than men.
How is bipolar disorder diagnosed?
When you first visit a doctor, they are likely to perform a complete physical exam to rule out other possible causes of your symptoms. If no physical disease is the culprit, the doctor will probably send you to see a psychiatrist for further evaluation.
Most people first seek help during the depressive phase of the illness, and they're often wrongly diagnosed with major (unipolar) depression. The difference between the two illnesses is that major depression doesn’t come with manic episodes, but people do sometimes experience some manic-like symptoms (depression with mixed symptoms), which can cause further confusion. This is why it’s important to thoroughly discuss your symptoms, personal history, and family history with your physician and later your mental health specialist.
Four types of bipolar disorder: What do you need to know?
The American Psychiatric Association divides bipolar disorder into four main categories according to characteristic changes in mood, energy, and activity levels:
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
- Bipolar disorder due to another medical or substance abuse disorder (the National Alliance on Mental Illness calls these factors "other specified")
Bipolar I Disorder
According to the diagnostic criteria laid out in the diagnostic and statistical manual of mental disorders (DSM-5), bipolar disorder type I is defined by at least one major episode of mania that lasts for at least seven days almost the entire day. During this period, a person must excessively be engaged in activities that bring pleasure — such as drugs, alcohol, sexual intercourse, gambling, and other forms of “recreation”, without regard for possible dangerous consequences.
During this time, a person can experience:
- Racing thoughts
- A flow of new ideas
- A decreased desire for sleep
- The desire to speak to anyone they encounter
- Either in-goal or non-goal directed activity
- Delusions of grandeur
The behavior usually causes impairments in social functioning, as well as in personal relationships, and a person may even need hospitalization. Mania can resemble substance abuse, as well as several other psychological conditions and a person needs careful evaluation before setting the final diagnosis.
Bipolar II Disorder
It was once believed that bipolar type II was a milder disease than bipolar type I and other types of the illness because the individuals never have to experience mania. While it’s true that diagnosis requires only one episode of hypomania (milder form of mania) and one episode of depression, these individuals often go through long and debilitating depressive phases that mess up their personal and social lives.
According to the DSM-5, adults who experience both hypomanic and depressive-like symptoms in a two-year period, but don’t meet the full criteria of hypomania, mania, or depression are diagnosed with cyclothymic disorder. For children, this period is one full year of symptoms.
It’s an impairing and relatively unknown subtype of bipolar disorder, especially when it occurs in children. Cyclothymic disorder is different from bipolar disorder type II, since bipolar II comes with at least one major depressive phase. If depression strikes after two years of being diagnosed with cyclothymia, the diagnosis can be changed to bipolar II disorder.
Other specified and unspecified bipolar and related disorders
There are people who go through certain symptoms of hypomania, mania, or depression but don’t meet the requirements for any of the three main types of bipolar disorder. Combinations can include:
- Short hypomanic period but long-lasting depressive period
- Long-lasting depressive episodes with mild hypomanic-like symptoms that don’t qualify for hypomania
- Only hypomania without depressive phases
- Cyclothymia-like symptoms that last less than two years.
If a person doesn’t meet the full criteria to be diagnosed with bipolar I or II disorder, or cyclothymia, they are likely to be given the diagnosis of unspecified bipolar disorder. This occurs mostly when a physician lacks information about a patient, or fails to specify the reason why someone doesn’t meet the criteria for either of the three other types, such as in cases of sudden visits to the emergency clinic.
There are also cases in which people go through four or more (hypo)manic or depressive episodes during the course of a year, and it is called rapid cycling. According to research, between 10 and 15 percent of patients with bipolar disorder experience rapid cycling. It’s possibly toughest to handle scenario of bipolar disorder, but it is manageable — many people respond well to the treatment.