Bipolar Disorder

I was surprised by the number of people who didn’t know what bipolar was. One person advised me it was a homosexual polar bear. I thought he was joking but he was serious.

So what is Bipolar Disorder?

Bipolar disorder is a chronic mental health condition with strong changes in mood and energy. One in 50 (1.8%) adult Australians experience bipolar disorder each year.

People experiencing bipolar disorder can have:

  • depressive episodes: low mood, feelings of hopelessness, extreme sadness and lack of interest and pleasure in things
  • manic or hypomanic episodes: extremely high mood and activity or agitation, racing thoughts, little need for sleep and rapid speech.

These changes in mood can last a week or more, and affect our thoughts and behaviour.

Bipolar disorder needs long-term management, which may include medication and psychological therapies. Bipolar disorder affects how we are able to function in our everyday life. Untreated, it makes it hard to consistently cope with work, home, school or socially.

Read more about bipolar disorder treatment.

People experience bipolar disorder in different ways. The pattern of mood swings is different for each person with bipolar disorder.

People often ask if there are warning signs? Yes, there is.

When someone is experiencing bipolar disorder, their behaviour and thoughts can be beyond their own control.

Friends, family and workmates can often be the ones to notice first.

What are the early warning signs of bipolar disorder?

One early bipolar symptom may be hypomania. When someone is hypomanic, they can feel great, highly energetic and impulsive.

Common early warning signs for hypomania and mania, include:

  • not sleeping (the most commonly experienced sign)
  • agitation, irritability, emotional intensity
  • energised with ideas, plans, motivation for schemes
  • intense expression laden behaviour with implied extra meaning
  • inability to concentrate
  • rapid thoughts and speech
  • spending money more than usual
  • increased sexual drive, flirtatiousness
  • increasing incidence of paranoid thoughts
  • neglecting to eat, losing track of time
  • reading extra symbolism into words, events, patterns (seeing ‘codes’)
  • increased use of telephone or writing – making contact with many people
  • insistent and persuasive
  • increased intake – or binges – of alcohol and/or drugs
  • arguments with friends or family
  • increased ‘driven’ activity without stopping to eat, drink or sleep
  • increased interest in religious/spiritual ideas or themes
  • taking on more work or working to extremes in hours or projects.

Some common early warning signs of bipolar depression, include:

  • change in sleep patterns – insomnia, or excessive sleeping
  • fatigue
  • staying up late to watch TV or work on projects
  • increased irritability
  • loss of concentration
  • lack of motivation
  • withdrawal – avoiding social contact, not answering phone, cancelling social activities
  • change in eating habits – loss of appetite, or overeating
  • reduced libido
  • increased anxiety and feelings of worthlessness
  • loss of interest in leisure activities and hobbies
  • listening to sad/nostalgic music
  • taking sick days
  • procrastinating and putting off responsibilities
  • bursting into tears for no apparent reason
  • thoughts of suicide.

I was surprised that there are different types of bipolar disorders. So I wanted to investigate what the different types are.

Types of bipolar disorder

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder
  • Other specified bipolar related disorder
  • Unspecified bipolar and related disorder
  • Substance or drug induced bipolar and related disorder
  • Bipolar and related disorder due to another medical condition

Bipolar I disorder – depressive and manic episodes

At least one manic episode needed for diagnosis. Major depressive episodes are typical, but not needed for diagnosis.

Bipolar I affects men and women equally.

Bipolar II disorder – depressive and hypomanic episodes (less extreme highs than Bipolar I)

At least one hypomanic episode and one major depressive episode needed for diagnosis. There is no instance of a manic episode. Bipolar II is more common in women.

Cyclothymic disorder – hypomanic and depressive symptoms

For at two years (one year in children and adolescents) an individual experiences multiple periods of hypomanic symptoms that don’t meet all the formal criteria for a hypomania or major depression diagnosis. Generally, mood changes are less severe than in those experiencing bipolar I and II disorder, however, cyclothymia still has a significant effect on how someone functions and copes.

Other specified bipolar and related disorder

These are bipolar-like disorders that don’t meet full diagnostic criteria for the above-mentioned disorders because of shorter duration or severity of illness. They can include:

  • short-duration hypomanic episodes (two-three days) and major depressive episodes
  • hypomanic episodes with insufficient symptoms and major depressive episodes
  • hypomanic episode without a previous major depressive episode
  • short-duration cyclothymia (less than two years).

Unspecified bipolar and related disorder

Symptoms of bipolar and the related disorders that don’t meet full diagnostic criteria for any of the previous categories.This diagnosis might be used in emergency room settings when there is insufficient information.

Substance or drug-induced bipolar and related disorder

A noticeable and persistent disturbance in mood, with high or irritable mood. It can occur with or without depressed mood and distinctly reduces pleasure in all or almost all activities. There needs to be evidence that the symptoms developed after substance use or withdrawal. The substances may be alcohol, hallucinogens, sedatives, amphetamine, cocaine and others.

Bipolar and related disorder due to another medical condition

This may be diagnosed when the symptoms of bipolar disorder are present and there is strong evidence of consequences of another medical condition, e.g. excessive thyroid activity (hyperthyroidism).

Co-morbidities (other medical conditions) that can occur with bipolar disorder

People with bipolar disorder can also have a higher risk of other conditions such as:

  • alcohol and drug abuse
  • anxiety
  • cardiovascular disease
  • diabetes
  • obesity
  • suicide.

Sometimes, these problems need to be managed together with bipolar disorder. It’s important to tell your doctor about any other problems and symptoms you are experiencing.

What is the impact of bipolar disorder on those living with the illness?

As a carer or someone living with bipolar disorder, it’s important to be aware that having bipolar disorder can present challenges.

Manic episodes can be very disruptive and lead to conflicts with family, friends and at work.

During a manic phase, people can become aggressive or impulsive. This can lead to risky behaviour, relationship breakdowns, financial problems and even legal issues if someone behaves erratically as part of their condition.

People with bipolar disorder have 15 times greater a risk of suicide than the general population, accounting for up to 25% of all suicides.

Bipolar disorder has other health consequences, and can often occur alongside other conditions such as diabetes, anxiety, cardiovascular disease, and drug and alcohol abuse.

Bipolar disorder can reduce life expectancy by up to nine years.

Bipolar disorder is a mental health condition that can be challenging to live with.

With the right treatment and help, people can manage the illness and are able to live full and productive lives.

People with bipolar disorder sometimes describe the highs associated with the illness as enjoyable. Someone experiencing mania can be in high spirits, feel amazing, enthusiastic, confident and invincible. However, others have a different experience and instead become irritable and aggressive.

Experiencing a ‘high’ has been described as a feeling that your brakes have failed – that you are going too far and too fast.

Once an episode of mania has passed, people can feel embarrassed or ashamed about what they did or said to others during their period of mania. They may avoid social contact for a time afterwards.

Someone might not remember what they did during an episode of mania, depending on the severity of the mania and on any medications that are taken.

A person who has been depressed may misread the onset of mania as a sign that their depression is lifting, rather than as another part of the illness.

The lows or depressive episodes experienced by people with bipolar disorder can be extremely difficult to cope with and are emotionally painful.

Depression can sometimes lead to suicidal thoughts.

Like any other medical condition, such as heart disease or diabetes, bipolar disorder is an illness that requires careful management.

Recurrence can happen, particularly if you’re not sticking to your treatment plan.

While there is no known cure for bipolar disorder, the good news is that its severity and the frequency of episodes can be reduced or prevented with medication and other supports, such as psychological therapies and family.

With the right medication and lifestyle management, many people with bipolar disorder can find stability and live successful and productive lives.