Bipolar Disorder, more formally known as Bipolar Affective Disorder (BPAD), is less common than depression, and affects 1-2% of people. Men and women seem to be affected equally, and the disorder usually develops in a person’s late teen or early adult years. More than 50% of people with BPAD experience symptoms before age 25.
BPAD causes unusual shifts in a person’s mood, energy, activity levels, and the ability to carry out day-to-day tasks. It is considered a “relapsing / remitting” disorder because the symptoms come and go. However, the underlying cause of the symptoms, the disorder itself, is always present, so most people with BPAD need to be on medication or under medical supervision to ensure proper treatment.
People with BPAD used to be called “manic-depressive” because the mood symptoms can range from severe depression to severe mania (as illustrated below):
Symptoms of mania or a manic episode last at least seven days, and may include:
- A long period of feeling “high,” or an overly happy or outgoing mood
- Extremely irritable mood, agitation, feeling “jumpy” or “wired”
- Talking very fast, jumping from one idea to another, having racing thoughts
- Being easily distracted
- Increasing goal-directed activities, such as taking on new projects
- Being restless
- Sleeping little
- Having an unrealistic belief in one’s abilities
- Behaving impulsively and taking part in pleasurable, high-risk behaviors (i.e., spending sprees, impulsive sex, impulsive business investments, etc.)
Symptoms of depression or a depressive episode usually last at least two weeks and include:
- A long period of feeling worried or empty
- Loss of interest in activities once enjoyed, including sex
- Feeling tired or “slowed down”
- Having problems concentrating, remembering, and making decisions
- Being restless or irritable
- Changing eating, sleeping, or other habits
- Thinking of death or suicide, or attempting suicide
A milder form of mania (hypomania) causes a person to feel good and very productive. However, this disorder typically progresses to full-blown mania. People with BPAD are usually not aware that they are behaving abnormally. The mood disorder can impair their work habits, strain their social behavior and relationships, and can lead to psychotic symptoms where they have no real grasp of reality. Sometimes, people with BPAD can become a danger to themselves and to others and, in that event, require hospitalization.
People with BPAD frequently have recurrent episodes of major depression, and can also experience a mixture of manic and depressive symptoms.
There are four basic types of BPAD:
Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that hospital care is needed. Usually, the person also has depressive episodes. The symptoms of mania or depression must be a major change from the person’s normal behavior.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes. These episodes are not considered a manic or a mixed episode, but are clearly out of the person’s normal range of behavior, and require treatment.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is when a person has symptoms that do not meet diagnostic criteria for either Bipolar I or II. Symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with Bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior and require treatment.
Cyclothymic Disorder, or Cyclothymia, is a mild form of BPAD. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. The symptoms do not meet the diagnostic requirements for any other type of Bipolar Disorder, but are clearly out of the person’s normal range of behavior and require treatment.
In addition, rapid-cycling bipolar disorder is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. Some people experience more than one episode in a week, or even within one day. It can be difficult to tell the difference between true BPAD and a mood swing triggered by stress or a temporary problem. A thorough evaluation by a psychiatrist is recommended if a person may have rapid cycling bipolar disorder. Rapid cycling seems to be more common in people who have severe BPAD, and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men.
If left untreated, BPAD symptoms can become worse, so early intervention is important.