I had no idea what bipolar disorder was until after I had been diagnosed with it, so I’m assuming that the percentage of the population that doesn’t fall into the 1-5% of the population diagnosed with the disorder may have a pretty vague idea as well. Even those with bipolar disorder might be unclear about their experiences. I know I was until I started researching it. I still am, to some degree.
Bipolar disorder is defined in two separate and major publications – the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), and the International Classification of Diseases, tenth edition (ICD-10). The former is what I will be basing this discussion on, seeing as it is the main text used in clinical practice in Canada (where I reside) and the USA. It’s interesting to note that the DSM-V and ICD-10 differ in their diagnostic criteria, but I will save that for a future post.
According to the DSM-V, the following types of bipolar disorder currently exist: bipolar disorder type I, bipolar disorder type II, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder. The first three are the diagnoses that get the most attention in research, from what I’ve read and seen. This may or may not have something to do with the “illness burden”, or how difficult these illnesses are for people to endure.
Bipolar Disorder Type I
Type I is by far the most heavily researched and thus we know the most about it. The DSM-V requires the occurrence of mania alone to diagnose type I; hypomania and a major depressive episode are common in type I, but not necessary.
Bipolar Disorder Type II
Type II is less studied than type I, but more and more is being seen as a distinct diagnostic entity – it used to be considered a less severe form of type I in the DSM-IV, though I still see that sentiment in some psychiatrists I have spoken with. In order to be diagnosed with type II, the presence of a hypomanic and major depressive episode are both needed.
Mania, Hypomania, and the Ladder of Neurological Excitability
…the topic that appears to be the most interesting when it comes to bipolar disorder, but what is it? Before I summarize the DSM-V criteria, I want to stress that individual difference is the special ingredient here. When it comes to mania/hypomania, every person has a unique story (or stories – usually stories) to tell. We who have been cursed/blessed (depending on your experience) with riding the waves of neurological excitability experience those waves in particular ways. Some ride them out like surfing stars, others drown and sink to the ocean floor, and still others find themselves wobbling on their boards not sure what to make of it. And still others have a completely different metaphor than I do for mania and that’s valid and true too. Here’s what the DSM says we experience when manic/hypomanic:
1. Elevated mood, grandiose thoughts/feelings
2. Little to no need for sleep
3. Desire to be more talkative or internal pressure to be that way
4. Racing thoughts
5. Easily distractible
6. The pursuing of goals with fervour, whether purposeful or not
7. Involvement in activities seen as reckless that one would otherwise not do
A manic episode is defined as a week or more with three or more of these symptoms, and hypomania is just four days or more with three or more of these symptoms. They both need to be independent of any other underlying condition and/or substance use. Mania also has the caveat of psychotic symptoms and can require hospitalization because of the lack of proper functioning a person usually experiences during mania. Hypomania, however, is usually seen as increased productivity/socialization/lifeness that doesn’t usually interrupt typical functioning in day to day life (but is still not the best way to function with your health in mind).
Personally, I find the descriptions of symptoms to be far too simple to describe what I experience during mania and hypomania. There are too many intricacies and it really just doesn’t do my experiences justice. I’ve heard similar sentiments from others with bipolar disorder.
Depression and the Black Dog that is More Like a Sea Monster
Depression is the other side of the bipolar spectrum. A major depressive episode includes five or more of the following symptoms for a two week period or more:
1. Depressed mood (thank you Dr. Obvious)
2. Lack of pleasure/interest in life in general
3. Significant weight loss/gain and increase/decrease in food intake
4. More/less sleep than normal
5. Feeling restless or slow
6. Feeling tired almost every day
7. Feeling worthless
8. Cognitive impairment recognized by self and/or others
9. Suicidal ideation, with or without tangible thoughts of a plan
Again, these symptoms need to be independent of any underlying medical condition and substance use and must cause clinical distress (still trying to find the person who doesn’t find depression stressful – thanks again Dr. Obvious). Depression is a tricky beast because there’s a line that one eventually crosses from “psychologically distressed” to “clinically depressed”, and gauging that line can be difficult internally and externally. I didn’t really have an idea of how depressed I could get until someone witnessed me at my worst, and yet some people would never guess that I struggle with depression. I have – like many others – mastered the art of faking a smile.
Would You Like Rapid Cycling with Your Order Today?
So there are these awful fun add-ons that you can have with your bipolar disorder, just in case cycling between feeling amazing/irritated/angry and depressed wasn’t enough. These two are the most common that I read about:
-Rapid Cycling: DSM-V describes this as having four or more episodes in a twelve month period.
-Seasonal Pattern: Essentially, Seasonal Affective Disorder (SAD) – for me, it’s mania/hypomania in the spring/summer and depression in the fall/winter (though there are exceptions). Thanks, brain.
The DSM-V also lists the following: “anxious distress, mixed features, melancholic features, atypical features, mood congruent/incongruent psychotic features, catatonia, and peripartum onset”. I haven’t encountered these things as much, and the DSM-V doesn’t go into them much so I have no wisdom to spread upon this issue.
Mixed Episode: The “I’m So Happy I Could Kill Myself” Meme
A peruse through google images makes that meme pop up a lot. A mixed episode is pretty much what it sounds like – a mix between manic and depressed features. It feels like you’re really losing your mind because nothing makes sense. It’s an insane concoction of mania and depression and it’s worse than depression, in my opinion. It’s not well understood, however. More on this one in a later post.
Comorbidity: A Gift with Purchase
There are a few disorders that tend to coincide with bipolar disorder. From what I’ve learned, anxiety disorders, obsessive compulsive disorders, and AD/HD tend to be the main culprits, as well as eating disorders. Bipolar disorder on its own is difficult to treat, never mind adding in some irrational fears about failing at life and needing everything to be symmetrical, for example. According to the DSM-V, bipolar disorder and some personality disorders tend to overlap as well, namely borderline personality disorder. Again, that’s an interesting topic that needs further debate.
So there’s a basic clinical guideline to what bipolar disorder is. Again, I want to emphasize the importance of NOT generalizing experiences from person to person just because they all have the same diagnosis. During mania, some people have crazy spending sprees, some engage in risky sexual acts, some find gods and get to know them too well, and still others just talk a lot about this really amazing idea that will save the world that you should believe because that’s all you need in life. It really just depends on the person. I firmly believe that thinking about bipolar disorder in this way will encourage more accurate research and treatment, as well as help the stigma and self-stigma associated with the disease. And on that note…
Yes, Bipolar Disorder is A Medical Condition and Here’s Why
There is a metaphorical giant pile of research papers (because we’d kill a lot of trees to print it all out) that exists explaining the neurological, genetic, and otherwise biological basis of bipolar disorder. To say it’s complicated would be an understatement, and summarizing the research isn’t really possible. However, a simple Google Scholar search of “bipolar disorder” and “biology” or “neurology” will clarify the issue and should erase doubt completely. Also, people who take medication for the disorder (like me) have been able to live productive, functional lives that they didn’t have before they started treatment.
A lot of people say depression is selfish and/or otherwise in a person’s head and they can just “stop being depressed”. That’s an entirely different conversation and I have quite a lot to say to those sentiments. For the time being, I will simply put forth this thought: Why criticize someone who feels sad? I just can’t fathom why people – be it clinical depression or simply sadness – would approach such a person with hatred rather than compassion. Likewise, calling someone “crazy” doesn’t help anyone, so why waste your time?
I hope this begins an educated discussion about the intricacies of bipolar disorder. This is an edited version of the post I first made on my other blog. Hello new blog!