Bipolar spectrum: What does it involve?
It is a long-term mental health condition, and, more specifically, a mood disorder. It can affect a person's ability to function in daily life, including in the workplace. However, the extent of its effect depends on the severity of the symptoms, which varies from person to person.
According to the National Alliance on Mental Illness, bipolar disorder affects around 2.6 percent of adults in the United States. It typically presents close to the age of 25 years, but symptoms can emerge in childhood or adolescence or even later on in adulthood.
What is the bipolar spectrum?
During a high mood, a person with bipolar disorder may experience great joy and excitement.
Some experts have described bipolar disorder as a spectrum disorder because it can involve moods at both ends of the spectrum, with people experiencing both very high and very low moods.
Its symptoms vary between individuals in both type and severity. Some people with bipolar disorder can function very well in everyday life, while others find it hard to do so.
Doctors diagnose bipolar disorder according to the current edition of the Diagnostic and Statistical Manual-Fifth Edition (DSM-5), which the American Psychiatric Association publish.
There are several different types of bipolar disorder. We provide more information about each type below.
Bipolar I disorder
A person will have had at least one manic episode lasting a week or more. It may be less if the symptoms are so severe that the person needs to spend time in the hospital.
The person may also have had a major depressive episode lasting 2 weeks or more, but a major depressive episode is not necessary for a diagnosis of bipolar I disorder. Some people may experience both high and low moods within a short period.
Severe manic and depressive episodes can both pose significant challenges. A person may need to spend time in the hospital if they experience psychosis or if there is a risk that they may harm themselves or other people.
Psychosis can happen during either a manic or depressive episode. It is a severe condition in which the individual loses their sense of reality. A person with psychosis needs urgent medical attention.
Bipolar II disorder
A person with bipolar II disorder will experience at least one major depressive episode that lasts for 2 weeks or longer and at least one hypomanic episode that lasts for a minimum of 4 days.
In hypomania, the highs are less extreme than those that occur during full mania. People with bipolar II disorder will never experience a full manic episode. If a full manic episode takes place, the diagnosis will be bipolar I disorder.
Click here to find out more about the differences and similarities between bipolar I and bipolar II disorder.
Adults who have this condition will have gone through numerous periods of hypomanic and depressive symptoms over 2 or more years. Children or teenagers will have experienced these symptoms for 1 year.
During this period, symptoms are present at least half of the time, and they never go away for more than 2 months.
Not otherwise specified
Doctors use this classification when a person has bipolar symptoms that do not fall under any of the other categories.
Each type of bipolar disorder can pose significant challenges to an individual's daily life.
Mania and hypomania
A manic period may involve:
- heightened mood, exaggerated optimism, and inflated self-esteem
- excessive irritability or aggressive behavior
- decreased need for sleep
- racing speech or thoughts
- impulsiveness or poor judgment
- reckless behavior
- in severe cases, psychosis, involving delusions and hallucinations
Click here to find out more about how psychosis can affect a person with bipolar disorder.
During episodes of hypomania, the person will have similar symptoms, but the severity will be less extreme. The person may function well and feel good, but people close to them may notice a change in mood.
A person with bipolar disorder also experiences low moods and, in some cases, major depression.
A period of depression may feature:
- a low mood
- prolonged sadness or unexpected, unexplained crying
- significant changes in appetite and sleep patterns
- irritability, anger, worry, agitation, and anxiety
- loss of energy
- feelings of guilt or worthlessness
- inability to concentrate
- unexplained aches and pains
- recurring thoughts of death or suicide
- a sense of doom or fear of having done something terrible
- psychosis, in some cases
The exact cause of bipolar disorder remains unknown, but it may involve several factors, such as:
- biological differences in the brain
- an imbalance in naturally occurring neurotransmitters in the brain
- inherited genetic factors, as a person with bipolar disorder often has a relative with the condition
There are several reasons why it can be difficult for doctors to identify bipolar disorder, such as:
- there are several types of the disorder and different levels of severity
- symptoms can vary between individuals
- other mood disorders can have similar symptoms
Major depressive disorder, attention deficit hyperactivity disorder (ADHD), and schizophrenia are some of the conditions that can have symptoms similar to those of bipolar disorder, despite being very different conditions.
A doctor will use specific criteria to diagnose bipolar disorder.
Doctors use the DSM-5 criteria to identify bipolar disorder.
Some people may not display all of the listed symptoms, but they must have had at least one episode of mania or hypomania that lasted for a specific period.
The doctor will carry out:
- a physical examination
- an interview
- in some cases, medical tests to rule out other conditions
Blood tests can confirm that other conditions, such as hyperthyroidism, are not responsible for the person's symptoms, but these tests cannot identify bipolar disorder.
A mood disorder questionnaire can help identify moods, sleep patterns, and other changes that might stem from bipolar disorder.
Many other mental health conditions can cause symptoms that are similar to those of bipolar disorder.
These conditions include:
- substance use disorder
- borderline personality disorder (BPD)
- post-traumatic stress disorder (PTSD)
These disorders, particularly personality disorders, can complicate diagnosis. Sometimes, it can take months or years to reach a correct diagnosis.
Some of the above conditions may occur alongside bipolar disorder. Substance use disorder, for example, affects a significant number of people with bipolar disorder.
An incorrect diagnosis can also complicate treatment. Some antidepressants that doctors prescribe to treat depression and obsessive-compulsive disorder (OCD) can make the symptoms of bipolar disorder worse, and they can even trigger a manic episode. The stimulants that doctors use to treat ADHD can have the same effect.
Bipolar disorder is a serious and complicated condition. A trained and qualified psychiatrist or psychiatric nurse practitioner will usually provide treatment.
Treatment options include:
Medications: These include mood stabilizers, antipsychotic medicines, and antidepressants.
Psychotherapy: Cognitive behavioral therapy (CBT) or family therapy may help the individual and their loved ones find new ways to cope with the changes that occur with bipolar disorder.
Electroconvulsive therapy (ECT): If symptoms are severe and other treatments do not help, a person may undergo ECT, which involves passing electric currents through the brain to induce a seizure. Doctors do not fully understand how the seizure improves symptoms.
Self-management strategies and education: Knowing the signs of a mood change and learning the triggers can help a person manage or even avoid some symptoms. The consumption of alcohol, a lack of sleep, and stress are three common triggers.
New approaches, such as functional remediation, can help people learn more about the challenges that they face and deal with them more constructively. Such issues may include workplace, financial, and relationship difficulties.
In this way, functional remediation could help lessen the impact of symptoms so that the person can continue to fulfill their role in their family, workplace, and community.
It can take time to find a treatment that works effectively, but it is possible, and many people with bipolar disorder live a full and productive life.
Different people may not respond the same way to medications, and some drugs produce side effects.
It is important to:
- use the medication as the doctor recommends
- stay under the care of a doctor or nurse practitioner for treatment and make them aware of any concerns or changes as soon as possible
Reducing stress can help prevent symptoms.
Other tips that can help the person and their family and friends include:
- joining a support group for people with bipolar disorder or their loved ones
- taking up hobbies
- learning ways to relax and manage stress
- getting regular physical activity
- developing healthy sleep habits
Researchers are looking into new ways of approaching treatment that include a focus on potentially positive traits, such as empathy and creativity, that may occur alongside the more challenging aspects of the condition.
In time, this may lead to new approaches in treatment that shift the focus from what a person cannot do to what they can do.
Bipolar disorder is a serious and lifelong condition that often needs ongoing medical attention.
Without treatment, it can increase the individual's risk of suicide or suicide attempts, relationship problems, legal problems, loneliness, and an overall inability to function and lead a "normal" life. However, symptoms vary widely among people with this condition.
Proper treatment and a focus on staying healthy can help many people with bipolar disorder live a full, active, and healthy life.