“She’s so bipolar!”
“One minute he’s happy and the next he’s yelling and screaming. He must be bipolar or something.”
“I just have these highs and lows.”
At one point or another, we have all probably heard one of these comments or had similar concerns about ourselves or someone we know. First and foremost, it is completely healthy to have shifts in our emotions throughout the course of the day, from frustration while sitting in traffic during our morning commute to happiness as we sit down and have our first cup of coffee, quickly followed up by panic as we find out the meeting we have to present it has been moved up, and then sadness as we realize our empty social calendar and growing feelings of loneliness.
Such fluctuations in mood can even occur within the course of a couple of hours and that does not necessarily mean there is anything clinically wrong with us. Despite the many benefits of social media platforms and several high-profile celebrities sharing their experiences with Bipolar Disorder, they have also contributed to several misperceptions regarding the illness and concern that any fluctuations in mood that deviate from “normal” must equate to a form of mental illness. So where does the line between normal and abnormal get drawn?
What is Bipolar Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5), Bipolar Disorder is an illness marked by unusual shifts in mood that affect a person’s functioning in various areas of their life, including employment, school, relationships, and self-esteem.
Again, while we all experience moments of sadness or elation, the mood shifts that happen within the context of Bipolar Disorder are much more extreme, prolonged, and impairing. They are also accompanied by additional symptoms that will be discussed below.
While the disorder used to be referred to as “manic-depression” given the belief that people with the illness would only fluctuate between mania and major depression, it has since been recognized that moods actually exist on a continuum between the two extremes/poles of mania and depression, leading to the updated term, Bipolar Disorder.
Each person experiences what we call euthymic mood, or their emotional baseline. This refers to their personal “normal” when they are stable or not experiencing a mood episode. I use quotation marks given the highly subjective nature of what normal constitutes based on a variety of factors, including your cultural background, gender, and natural disposition just to name a few.
By and large, euthymia is a state in which you experience a range of emotions that are appropriate to the context and do not repeatedly cause impairment in daily functioning. As we move farther from this center point of the diagram in either direction, we approach more extreme emotional states that reach clinical significance given the impairment they cause.
Depression:
To the left of the spectrum, we have Major Depression, frequently referenced in more casual conversation as simply depressionto describe feelings of sadness. Surely feeling sad is something everyone can relate to but a person may be experiencing Major Depression when they feel sad nearly all of the day for most days during a period of at least a couple of weeks in addition to some combination of the following symptoms:
- loss of interest in activities they once found enjoyable (including being around people),
- changes in appetite/weight, decreased energy or motivation,
- feeling worthless or excessive levels of guilt that are more than just low self-esteem,
- difficulty thinking/concentrating/making decisions,
- and suicidal thoughts that can range from passively thinking life would be easier if you were no longer alive to actively developing a plan to end your life.
Of note, some people experience a sad mood more in terms of feeling empty or without emotion while others experience it more as irritability. Additionally, it is not uncommon for individuals going through severe depression to experience psychotic symptoms, which basically refer to a break in reality in that they begin to see or hear things that are not present in the physical world (i.e., hallucinations) or develop strange, illogical beliefs (i.e., delusions) that may include feelings of paranoia.
Dysthymia:
When referring back to the above diagram, you can see reference to a term, Dysthymia, or low-grade depression. There are times when individuals experience an alteration in the mood when they are feeling sadness in a way that deviates from their usual mood but they either do not experience the accompanying symptoms or if they do, not to the level of severity or for the required length of time for it to be considered Major Depression. Some individuals experience this low-grade depression prior to or on their way to a Major Depressive Episode while others stop here and do not go on to experience more severe symptoms.
Mania:
If we look to the other side of the continuum, we see what is referred to as Mania and while this mood state has received more attention in recent years, I believe it is still much less understood (and even misdiagnosed) than Major Depression. According to the DSM-5, Mania is defined as a state of unusually euphoric or elevated mood that persists for at least one week (or less in specific circumstances).
This is more than a feeling of happiness but rather feeling like you are on top of the world or high on drugs despite not taking any and is accompanied by a combination of the following symptoms:
- inflated self-esteem or grandiosity such that you believe you are more important than other people in a way you do not normally feel you are when not in a manic state,
- decreased need for sleep,
- talking more than you usually do and at a faster rate such that you might start tripping over your own words or feel pressured to keep talking,
- racing thoughts,
- distractibility,
- increased activity or difficulty sitting still,
- and excessive involvement in risky behaviors, such as substance use, gambling, sexual promiscuity, overspending, and reckless driving.
Again, in extreme forms, individuals experiencing mania may present with symptoms of psychosis.
Hypomania:
A more attenuated form of Mania that people may experience either on their own or as they are beginning to swing into a full manic episode is called Hypomania, which consists of the same symptoms of Mania but in a less severe form and across a shorter period of time. Compared to Mania, people experiencing Hypomania experience less impairment and have more awareness of the changes happening within themselves, in turn creating more self-control when experiencing urges to engage in risky behaviors.
Of note, when referencing a mood episode, what we are describing is a period of time in which a person experiences mild symptoms that build up to a peak in severity, followed by an attenuation of symptoms and improvement. Individuals diagnosed with Bipolar Disorder can not only present with variation in how their mood episodes present but also in the pattern that they experience them, with some going straight from a Manic Episode to a Depressive Episode without returning to their baseline in between while others experience either Hypomania or Dysthymia before reaching a Manic or Depressive Episode.
Disclaimer:
I hope the aforementioned information provides you with a basic understanding of what Bipolar Disorder is (and what it is not) given the many misperceptions and colloquial use of the term in mainstream society. It is not intended to be a checklist to diagnose yourself or someone you know, as there is no substitute for meeting with a qualified mental health professional who specializes in mood disorders to provide a proper diagnosis.
It is important that the clinician gathers additional information before prematurely jumping to a diagnosis, such as any history of trauma, substance abuse, and/or medical conditions given several clinical syndromes can share overlapping symptoms. Despite the many advances in the mental health field over the years, we are not comparable to the medical field where a blood test or imaging results provide a quick diagnostic picture with fairly high accuracy rates.
It is my professional opinion that many psychiatric conditions take time and attention to detail to diagnose given the complexity of human beings and tools at our disposal. I would caution against any clinician who provides a mental health diagnosis utilizing a check-box approach without sufficient follow-up despite living within a society that thrives on quick fixes. Just as you would want to put your trust in a qualified medical doctor to provide you with an accurate diagnosis and treatment plan, so should you with your mental health.
Where To Go From Here:
If after reading this blog you have concerns that either yourself or someone you care about may be experiencing Bipolar Disorder, the next step would be to reach out to a mental health professional who specializes in this area to help with diagnostic clarification. Treatment approaches have advanced significantly in recent years with a more holistic and person-centered approach to care. Essentially, this refers to recognizing the uniqueness of the person in that two people with the same diagnosis can present very differently in the way they experience their symptoms and their goals for treatment.
It is important to find a clinician who elicits your input when it comes to developing a treatment plan, as it is your right to help decide what works best for you in a collaborative fashion. There has also been a shift in the field in terms of how we measure progress, with a greater emphasis on recovery, or the ability to function at an optimal level despitethe illness rather than striving for a life free of reoccurrences of symptoms, a goal that many argue is self-defeating.
By focusing more on recovery and resilience, we help people lead more meaningful lives and feel more in control of their future. By and large, treatment for Bipolar Disorder often entails both medication management and therapy aimed at,
- providing diagnostic clarification by examining your symptoms,
- developing a life chart that helps identify when you’ve experienced different mood episodes throughout your life in order to,
- pinpoint stressors that tend to lead to such episodes, and
- recognize patterns for your mood episodes.
This will help us to prepare for future episodes and determine which coping skills to develop and/or strengthen to help prolong periods of stability and reduce the level of severity/impairment of mood episodes when they do occur.
As a clinician with expertise in this area, I like to incorporate aspects of Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), both of which are evidence-based treatments that can help achieve the aforementioned goals, as well as coping with the stigma often associated with Bipolar Disorder, manage co-occurring disorders (e.g., anxiety + substance use), and aid in longstanding interpersonal difficulties, including conflict with family.
I would be honored to work with you or your loved one in their personal journey of recovery from Bipolar Disorder. Give me (Dr. Taylor Phillips) a call at (954) 391-5305 to arrange for a complimentary consultation today. I offer counseling in Coral Springs, Florida, and surrounding areas (Parkland, Coconut Creek, and Boca Raton).
