What Is Bipolar, Exactly?

Bipolar is a mood disorder characterized by a shift up in mood (mania) and a shift down in mood (depression). By contrast, unipolar depression (major depressive disorder), does not have the characteristic of bipolar where the mood shifts up into mania. There are similarities between unipolar depression and bipolar depression, but they aren’t exactly the same.

The two basic types of bipolar are “Bipolar I” and “Bipolar II.” To be diagnosed with bipolar I, the patient must have experienced a true manic episode, which is more severe than a hypomanic episode. A true manic episode may include a combination of:

-abnormally high self esteem or feeling important

-decreased need for sleep

-feels pressured to keep talking, more talking than usual

-racing thoughts, in experience or ideas

-easily distracted to external and internal factors

-increased activity to achieve ends – socially, work, school, or sexual pursuits, or purposeless activity

-engage in risky behaviors – spending sprees that can’t be afforded, sexual engagements, bad business investments

-significant social and occupational functioning impairment

-hospitalization to prevent harm to self or others

-psychotic features

-the episode is not related to any drug, medication, or substance use or other medical conditions

These characteristics mark a true manic episode, which is the main requirement for a bipolar I diagnosis versus a bipolar II diagnosis. Hypomania may be common in clients with bipolar I or bipolar II, and it is a similar, less functionally impairing, less severe form of mania. Hypomania may not last as long as a true manic episode, it doesn’t cripple the person (for instance, in work and social situations they are still very functional), the person doesn’t need hospitalization, and there are no psychotic features.

So, the type of mania separates the two major categories of bipolar: true mania is bipolar I territory (at least 1 manic episode experienced) and only hypomania with bipolar II (no true manic episodes experienced).

Depression is also associated with bipolar I and II, in a combination of the following lasting two weeks:

-depressed mood every day for the most of the day by report or observation

-decreased interest or pleasure in activities

-significant weight changes, gain or loss

-sleep too little or too much

-increased or decreased movement – being fidgety or sluggish

-decreased energy and fatigue

-guilty feelings, or feeling worthless

-inhibited ability to make decisions, think, or concentrate

-thoughts of death, suicide, suicide attempt, or a plan to carry out suicide

-causes significant social or occupational distress/impairment

-All of the above are not caused by any substance or other medical condition

This is what a depressive episode looks like, most of the day every day for at least 2 weeks.

(Excerpts taken from the DSM-V paraphrased, American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, pp 123-139.)

A mixed episode can also occur, which is being (hypo)manic and depressed at the same time. It’s a very unpleasant experience.

Another form of bipolar is Cyclothymic Disorder, marked by a more neutral shift in moods that don’t meet the diagnostic criterion for mania, hypomania, or depression. Seasonal Affective Disorder is similar to bipolar, in that there is a mood shift associated with seasons, and may be incorporated in other bipolar diagnoses.

There are many different patterns that bipolar can manifest, from rapid cycling -many times a minute, to very slow cycling – years or decades. Some have intense manic episodes, while others have brief hypomanic periods followed by a long depression. Every one who has bipolar possesses a different color of it from the full spectrum of bipolar disorders. Every experience of bipolar is different.

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