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Bipolar Disorder: A Mood Disorder

| T. Franklin Murphy

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The Rollercoaster of Bipolar Disorder: A Personal Journey

Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood, energy, and activity levels. Individuals with bipolar disorder experience periods of intense emotional highs, known as mania or hypomania, as well as depressive episodes. This condition can have a profound impact on daily functioning and relationships if left untreated.

Bipolar disorder has a world lifetime prevalence rate of approximately 2.4% and is ranked 17th as the leading source of disability worldwide (Carvallo et al., 2020).

Key Definition:

Bipolar disorder is a mental health condition characterized by extreme shifts in mood, energy, and activity levels. These mood swings can range from depressive lows to manic highs. It can impact the ability to carry out day-to-day tasks and maintain relationships. Treatment often involves medication and therapy to manage symptoms and improve quality of life.

History of Bipolar Disorder

The history of bipolar disorder is long and complex, with its recognition and understanding evolving significantly over time. Here’s a brief overview:

  • Ancient Times: The earliest mentions of conditions resembling bipolar disorder date back to ancient Greece. Aretaeus of Cappadocia, a physician in the 1st century, described symptoms that are now associated with bipolar disorder, although his observations went largely unnoticed for many centuries (Post, 2008).
  • 17th Century: Robert Burton and Theophilus Bonet made contributions to understanding melancholy and its link to mania, recognizing the cyclical nature of these mood states (Healy, 2008).
  • 19th Century: French psychiatrists Jean-Pierre Falret and Jules Baillarger independently described what they called “folie circulaire” (circular insanity) and “folie à double forme” (dual-form insanity), respectively, which are considered early descriptions of bipolar disorder (Healy, 2008).
  • Emil Kraepelin: The German psychiatrist Emil Kraepelin was instrumental in the modern understanding of bipolar disorder. In the late 19th century, he distinguished it from schizophrenia and described it as “manic-depressive insanity” (Post, 2008).
  • 20th Century: The condition was classified under psychotic disorders in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952. It was referred to as “manic depression” and included severe mood swings (Healy, 2008).
  • DSM-III and Beyond: With the publication of DSM-III in 1980, the term “bipolar disorder” was introduced, reflecting a better understanding of the condition as characterized by the polarity of mood episodes (Healy, 2008).

Today, bipolar disorder is recognized as a complex neurological condition that affects mood and behavior, and it is treated with a combination of medication, such as lithium, and psychotherapy. The understanding and treatment of bipolar disorder continue to evolve with ongoing research and clinical practice.

Types of Bipolar Disorder

There are several types of bipolar disorder, each involving distinct patterns of mood swings:

Bipolar I Disorder:

Bipolar I Disorder is a complex mental health condition characterized by the occurrence of manic episodes lasting for at least seven days or requiring hospitalization. These manic episodes are often accompanied by depressive episodes, creating a rollercoaster of intense emotions and behaviors. Individuals with Bipolar I Disorder may experience extreme shifts in mood, energy, and activity levels, impacting their ability to function in daily life.

The manic episodes associated with Bipolar I Disorder are marked by elevated, expansive, or irritable mood, coupled with increased energy, decreased need for sleep, and impulsive decision-making. These periods of heightened mood can lead to risky behaviors and strained relationships. On the other hand, the depressive episodes are characterized by overwhelming feelings of sadness, worthlessness, and hopelessness, often leading to difficulties in concentration, decision-making, and self-care.

The fluctuating nature of Bipolar I Disorder can be challenging for both the individuals experiencing it and their loved ones. It’s essential for those affected to seek professional help for accurate diagnosis and effective management. Treatment often involves a combination of medication, psychotherapy, and lifestyle adjustments to stabilize mood fluctuations and improve overall well-being. With proper support and treatment, individuals with Bipolar I Disorder can lead fulfilling lives and effectively manage their symptoms.

Bipolar II Disorder:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) characterizes Bipolar II Disorder as a complex condition with a specific pattern of depressive episodes and hypomanic episodes. Accordingly, the depressive episodes are marked by persistent feelings of sadness, hopelessness, and a lack of interest in activities that were once enjoyed.

On the other hand, the hypomanic episodes are less severe than full-blown mania but can still cause significant changes in mood, energy, and activity levels. Individuals with Bipolar II Disorder may find themselves cycling between these two states, which can have a profound impact on their daily lives and relationships. It’s important for individuals experiencing these symptoms to seek professional help and support to effectively manage this condition.

Cyclothymic Disorder:

Cyclothymic Disorder, a relatively rare mood disorder, is characterized by early onset, persistent, spontaneous and reactive mood fluctuations, associated with a variety of anxious and impulsive behaviors, resulting in a very rich and complex clinical presentation (Perugi et al., 2017).  These mood swings persist for at least two years in adults, with a duration of one year being the diagnostic criteria for children and adolescents.

Professionals characterize the hypomanic episodes by a distinct period of persistently elevated, expansive, or irritable mood, accompanied by increased activity or energy, grandiosity, decreased need for sleep, and other manic symptoms. On the other hand, depressive symptoms include persistent feelings of sadness, hopelessness, loss of interest in previously enjoyed activities, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness or excessive guilt, and difficulty concentrating or making decisions.

Individuals with Cyclothymic Disorder may not experience symptom-free intervals longer than two months, and the fluctuating moods can cause significant impairment in social, occupational, or other key areas of functioning. While the symptoms are less severe compared to those of Bipolar I or Bipolar II Disorder, Cyclothymic Disorder can still have a profound impact on an individual’s life, highlighting the importance of early diagnosis and appropriate treatment.

See Cyclothymic Disorder for more information on this disorder

Symptoms and Warning Signs

Andre Carvalho, Joseph Firth, and Eduard Vieta explain that “the main characteristic separating bipolar disorders from other affective disorders is the presence of recurring manic or hypomanic episodes that may alternate with depressive episodes” (Carvallo et al., 2020).

The symptoms of bipolar disorder can vary widely, but may include:

  • Manic or hypomanic episodes: Elevated mood, increased energy, racing thoughts, decreased need for sleep, and impulsive behavior
  • Depressive episodes: Persistent feelings of sadness, hopelessness, loss of interest, fatigue, and thoughts of death or suicide.
  • Mixed features: Simultaneous occurrence of both manic and depressive symptoms.

Carvallo, Firth, & Vieta add:

“The first episode of bipolar disorder is usually depressive, and for more most persons with either bipolar I or bipolar II disorder, depressive episodes last considerably longer than manic of hypomanic episodes throughout the course of the illness” (Carvallo et al., 2020).

Mood Cycles

Randolph Nesse, M.D., Founding Director of the Center for Evolution and Medicine at Arizona State University, defines the disorder as:

“An inherited brain disease in which mania and depression arise and fade in cycles that are often unrelated to changing life situations” (Nesse, 2019).

Basically, a common pattern among those suffering from bipolar disorder is experiencing a cycle between manic episodes and depressive episodes. During the cycle it is common to have well periods as well. Often clinicians can help patients manage these cycles through treatment to minimize the impact of heightened moods on their day to day functions.

However, even during treatment the cycles may accelerate and well periods shorten or disappear.

Robert M. Post. M.D., explains this occurrence, He explains, “embedded in this process are several phenomena that can be characteristic of the course of bipolar illness.” He lists them as:

  1. cycle acceleration (shorter well intervals between successive episodes);
  2. progression to continuous cycling; and
  3. emergence of ultradian cycling (i.e., distinct and dramatic mood oscillations within a single day (Post, 2008).

Changes in cycles are a serious warning sign, that patients and family of patients should quickly act on by notifying their personal physician to adjust treatment.

Causes and Risk Factors

Researchers and medical professionals do not know the exact causes of bipolar disorder. Like many psychological disorders, science does not fully understand the mechanisms leading to the disorder.

Dr. Lawrence Heller, founder of the NeuroAffective Relational Model© (NARM), classifies bipolar disorder as an affect regulation disorder. Heller explains:

“The functions of the internal body, more particularly the operation of the viscera—respiration, digestion, blood pressure, temperature control, reproduction, etc., which are all responsible for the maintenance of life—are of critical consequence to the world of subjective emotional experience. There is very little conscious control in the autonomic innervation of the viscera, yet visceral experience is at the core of our sense of identity and our ability to adapt” (Heller, 2012).

Certainly, bipolar, by its very definition, is related to malfunctioning of affect regulation. However, what causes these circuits and processes to malfunction is a little more unclear.

Several factors may contribute to its development.

1. Genetics

The complex nature of bipolar disorder involves a combination of genetic, environmental, and psychological factors. A family history of bipolar disorder can significantly elevate the risk of developing the condition, shedding light on the influential role of genetics in its development. Research has shown that individuals with a first-degree relative who has been diagnosed with bipolar disorder are at a higher risk of developing the condition themselves.

This underlines the intricate interplay between genetic predisposition and the manifestation of bipolar disorder. Understanding these factors is crucial in providing more targeted and effective interventions and support for individuals and families affected by this challenging condition.

While we know there is a strong family connection to bipolar disease, research has yet to find the genetic markers responsible for these associations. Nesse wrote that “having schizophrenia, bipolar disorder, or autism depends almost entirely on what genes a person has, so most of us engaged in psychiatric research at the turn of the millennium thought the specific genetic culprits would soon be found. However, subsequent studies have shown that there are no common genetic variations with large effects on these disorders” (Nesse, 2019).

2. Brain Structure and Functioning

Research suggests that abnormalities in the brain’s structure and neurotransmitter imbalances may play a significant role in the manifestation of certain conditions. The intricate connections within the brain, encompassing both its physical composition and the delicate balance of neurotransmitters, have been the subject of extensive scientific inquiry. This exploration has yielded valuable insights into the potential factors contributing to various neurological and psychological phenomena. Understanding the impact of these abnormalities and imbalances is instrumental in advancing our comprehension of these conditions and devising targeted interventions to address them effectively.

V. S. Ramachandran suggests it is a malfunction of integration between the right and left hemispheres of the brain. He wrote:

“There is an analogy between the coping styles of the left and right hemispheres—manic or delusional for the left, anxious devil’s advocate for the right—and the mood swings of bipolar illness. In normal individuals there may be some spontaneous ‘flipping’ between the hemispheres and their corresponding cognitive styles. An extreme exaggeration of this oscillation may be regarded as ‘dysfunctional’ or ‘bipolar illness’ by psychiatrists” (Ramachandran, 2011).

3. Environmental Factors

Stressful life events, substance abuse, and traumatic experiences can significantly impact individuals diagnosed with bipolar disorder. These factors can act as triggers, leading to the onset of bipolar episodes or exacerbating existing symptoms. For individuals living with bipolar disorder, managing these aspects can be crucial in maintaining stability and overall well-being. It’s essential to create a supportive environment and implement coping strategies to navigate the challenges that may arise from these triggers.

Additionally, seeking professional help and building a strong support network can play a vital role in effectively addressing the complexities associated with bipolar disorder.

See Toxic Stress for more on this topic

4. Diathesis Stress Model and Epigenetics

Diathesis Stress Model

According to the diathesis stress model, biological or genetic traits (diathesis) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia. An individual’s genetic makeup creates certain vulnerabilities. Excessive life stress exploits these vulnerabilities leading to the development of a predisposed disorder, such as major depressive disorder.

See Diathesis Stress Model for more on this theory

Epigenetics

Epigenetics is similar to the diathesis stress model in function. A landmark study by Meaney and colleagues theorized that “early experience permanently alters behavior and physiology. These effects are, in part, mediated by sustained alterations in gene expression in selected brain regions” (Meaney, 2005). Basically, traumatic experiences can alter gene expression. these alterations may be a cause for psychological disorders, such as major depressive disorder.

See Epigenetics for more on this theory of possible causes for major depressive disorder

Treatment and Management

Effective treatment for bipolar disorder typically involves a combination of medication, psychotherapy, and lifestyle adjustments. A medical professional may prescribe medications such as mood stabilizers, antipsychotics, and antidepressants to manage symptoms and prevent relapses. In addition, psychotherapy, particularly cognitive-behavioral therapy, can help individuals better understand their illness and develop coping strategies.

Bipolar disorder is a lifelong condition that requires ongoing management. There are many treatment options available to manage its symptoms.

1. Medications

  • Mood Stabilizers: To control mood swings (e.g., lithium, valproate, carbamazepine, lamotrigine).
  • Antipsychotics: If symptoms of depression or mania persist (e.g., olanzapine, quetiapine, lurasidone).
  • Antidepressants: To manage symptoms of depression, though physicians and patients should use caution to avoid triggering a manic episode.
  • Anti-anxiety Medications: To reduce anxiety and improve sleep (e.g., alprazolam, clonazepam).

2. Psychotherapy

Various forms of therapy can be beneficial, such as:

See Different Therapy Styles for more on psychotherapy styles

3. Lifestyle Adjustments

Encouraging regular sleep patterns, exercise, and diet management can also help manage symptoms of bipolar disorder. Establishing a consistent sleep schedule can contribute to mood stabilization and overall well-being for individuals with bipolar disorder. Engaging in regular physical activity has been shown to have a positive impact on mood and can help reduce symptoms of depression and mania.

Moreover, adopting a balanced and nutritious diet plays a crucial role in supporting mental health and managing the symptoms of bipolar disorder. By incorporating these lifestyle factors, individuals can complement their treatment plan and potentially experience improved symptom management and overall quality of life.

See the Wellness Basics for more on this topic

4. Support Groups

The importance of support groups for individuals dealing with bipolar disorder cannot be overstated. These groups serve as safe spaces for sharing personal experiences, struggles, and coping strategies. By coming together, individuals can feel understood and supported in a way that may not be possible in other settings. Members can exchange valuable insights and advice, as well as receive empathy and encouragement from those who truly comprehend the challenges they face.

Additionally, belonging to a support group can help reduce feelings of isolation and loneliness, fostering a sense of community and belonging that is incredibly beneficial for individuals navigating the complexities of bipolar disorder.

It’s important to have a comprehensive treatment plan tailored to the individual’s needs, often managed by a psychiatrist specializing in bipolar disorder. Ongoing treatment is crucial, even during periods when the person feels better, to prevent relapse and manage symptoms effectively.

Support and Resources

Living with bipolar disorder can be challenging, but support is available. Support groups, educational resources, and trusted healthcare professionals can provide valuable assistance to individuals and their loved ones. It is important for those with bipolar disorder to prioritize self-care, maintain regular sleep patterns, and communicate openly with their support network.

For those dealing with bipolar disorder, a variety of support and resources are available to help manage the condition and improve quality of life:

  • Educational Resources: Websites like the International Bipolar Foundation offer articles, videos, and other materials to help understand bipolar disorder and its treatment options.
  • Support Groups: Organizations such as the Depression and Bipolar Support Alliance (DBSA) provide in-person and online support groups where individuals can share experiences and find community.
  • Online Communities: Platforms like 7 Cups offer online chatting services for peer support and connection with others facing similar challenges (Kerslake, 2022).
  • Advocacy and Education: The National Alliance On Mental Illness (NAMI) is a great resource for education and advocacy, helping to navigate mental health care and rights.
  • Crisis Hotlines: For immediate help, there are crisis hotlines available, such as 1-800-SUICIDE (784-2433) and 1-800-273-TALK (8255), as well as text services like texting “CONNECT” to 741741 for support.

These resources aim to provide hope, education, and a supportive community for those affected by bipolar disorder. It’s important to explore various options to find the right kind of support that meets individual needs.

Associated Concepts

  • Frustration Tolerance: This refers to an individual’s ability to withstand and cope with frustrating or challenging situations without becoming overwhelmed or distressed. It is the capacity to remain composed, patient, and emotionally stable in the face of obstacles, setbacks, or delays.
  • Frustration-Aggression Hypothesis: This theory posits that frustration often leads to aggressive behavior. When individuals are blocked from achieving a goal or fulfilling a need, it can generate a state of frustration, which in turn increases the likelihood of aggressive responses.
  • Hypomania: This is a distinct period characterized by persistently elevated, expansive, or irritable mood. It involves abnormally increased activity or energy. This state lasts at least four consecutive days and represents a noticeable change from usual behavior.
  • Intermittent Explosive Disorder (IED): This is a mental health condition characterized by impulsive, disproportionate outbursts of anger. Individuals with IED often experience significant distress and impairment in various areas of life.
  • Stress and Coping Theory: This theory, developed by Richard Lazarus and Susan Folkman, suggests that individuals experience stress when they perceive a discrepancy between the demands of a situation and their perceived ability to cope with those demands.
  • Disruptive Mood Dysregulation Disorder: This is a condition diagnosed in children and adolescents characterized by severe and recurrent temper outbursts that are out of proportion to the situation and developmentally inappropriate. These temper outbursts occur, on average, three or more times per week, and the mood between the outbursts is persistently irritable or angry.
  • State-Trait Anger: This concept examines individual variations of expressions of anger, including intensity, duration, and frequency of expressions of anger. The state-trait elements of the theory separates states of anger expressed in specific incidents from personality traits. Some personalities lead to more frequent, higher intensity, and longer duration of incidents of angry emotional states.

A Few Words by Psychology Fanatic

In conclusion, bipolar disorder is a multifaceted and often challenging condition that can significantly impact an individual’s life. However, it’s essential to remember that with the right diagnosis and tailored treatment plan, individuals can learn to navigate the complexities of their symptoms. The journey may be fraught with ups and downs, but there is hope for those affected. Support from healthcare professionals, family members, and friends plays a crucial role in fostering resilience and encouraging growth. By embracing therapeutic interventions such as medication management and psychotherapy while also adopting positive lifestyle changes, individuals can regain control over their lives.

Ultimately, each person’s experience with bipolar disorder is unique; it requires understanding and compassion not just from oneself but also from loved ones. Seeking help is a courageous step towards healing—one that paves the way for achieving personal goals and cultivating fulfilling relationships. Remember that you are not alone on this path; countless resources are available to support you in your journey toward stability and well-being. Together we can foster awareness about mental health challenges like bipolar disorder while advocating for greater empathy within our communities. There is always light at the end of the tunnel—never hesitate to reach out for support when needed.

If you or someone you know is struggling with symptoms of bipolar disorder, seek professional help. A clinician can give an accurate diagnosis and create a personalized treatment plan. Remember, there is hope and support available.

Last Update: March 5, 2025

References:

Carvalho, Andre; Firth, Joseph; Vieta, Eduard (2020). Bipolar Disorder. The New England Journal of Medicine, 383(1), 58-66. DOI: 10.1056/NEJMra1906193
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Healy, David (2008). Mania: A Short History of Bipolar Disorder. Johns Hopkins University Press; 1st edition. ISBN: 9780801888229; APA Record: 2008-00874-000
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Heller, Lawrence; LaPierre, Aline (2012). Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. North Atlantic Books; 1st edition. ISBN-10: 1583944893
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Kerslake, Risa (2022). The 8 Best Bipolar Support Groups. Healthline. Published: 4-26-2022; Accessed: 3-8-2024. Website: https://www.healthline.com/health/mental-health/bipolar-support-groups
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Meaney, M., & Szyf, M. (2005). Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience, 7(2), 103-123. DOI: 10.31887/DCNS.2005.7.2/mmeaney
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Nesse, Randolph M. (2019). Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry. ‎Dutton; 1st edition. ISBN-10: 0141984910
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Perugi, G., Hantouche, E., & Vannucchi, G. (2017). Diagnosis and Treatment of Cyclothymia: The “Primacy” of Temperament. Current Neuropharmacology, 15(3), 372-379. DOI: 10.2174/1570159X14666160616120157
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Post, Robert M. (2008). Treatment of Bipolar Illness: A Casebook for Clinicians and Patients. W. W. Norton & Company; 1st edition. ISBN: 9780393705379; APA Record: 2008-02059-000
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Ramachandran, V. S. (2011). The Tell-Tale Brain: A Neuroscientist’s Quest for What Makes Us Human. W. W. Norton & Company; Reprint edition. ISBN: 978-0-393-34062-4; APA Record: 2011-03365-000
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