Being diagnosed with bipolar disorder is the start of the recovery process. Patients and their families typically feel overwhelmed by the diagnosis as they come to understand the causes and conditions of a mood disorder that often has arisen over many years.
The following questions and answers are designed to help patients and their families understand bipolar disorder – its causes, symptoms, challenges and treatment options. These questions help point the way, but they are far from comprehensive. The Sutherland Foundation encourages patients and their families to discuss these ideas with a doctor and to further research the causes, conditions and treatment options.
What Are Mental Illnesses?
Mental illnesses are medical conditions that affect a person’s thoughts, moods, feelings and/or behaviors. To be classified as a mental illness, the condition must cause distress and result in a reduced ability to function psychologically, socially, occupationally or interpersonally. People with mental illness often have trouble coping with emotions, stress and/or anger, and may be challenged by daily activities, family responsibilities, relationships, or work and school responsibilities.
There are several main classes of mental illness – mood disorders, anxiety disorders, substance-related disorders, psychotic disorders, cognitive disorders, developmental disorders, and personality disorders. (Sources: NAMI; Mayo Clinic)
What Is Bipolar Disorder?
Bipolar disorder, also called manic depression, is a mood disorder that profoundly affects a person’s emotional experiences. In its most classic form bipolar disorder is characterized by dramatic mood swings, fluctuating between euphoric highs (called mania) and depression. Fluctuations in energy and behavior accompany these changes in mood. Many (approximately 40% of those with bipolar disorder) not only experience mania and depression in alternating states but also experience them simultaneously in what doctors call “mixed states.”
Bipolar disorder affects at least one in 70 people. On average there is an eight-year lag between a first episode of mania or depression and the first time the disorder is diagnosed and treated. Episodes of mania or depression can last anywhere from days to months. (Sources: David Miklowitz; Providence Center)
For more information about bipolar disorder, including the various types of bipolar disorders, please click here.
What Are Common Signs and Symptoms of Mania?
A distinct period of:
- Abnormal elevated or irritable mood
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased activity
- Being more talkative than usual
- Racing thoughts
- Distractibility
- Engaging in risky behavior
(Source: Sutherland Center at CU)
What Are Common Signs and Symptoms of Depression?
Two weeks or more of:
- Depressed mood
- Diminished interest in activities
- Weight loss or weight gain, or increased or decreased appetite
- Sleep disturbance
- Feeling slowed down or restless
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
- Recurrent thoughts of death or suicide
(Source: Sutherland Center at CU)
What Causes Bipolar Disorder? Is It Genetic?
The specific causes of bipolar disorder are not yet known. Research suggests a strong genetic contribution, but the specific genes involved and exactly how these genes influence the development and expression of bipolar disorder are unclear. Environmental factors, such as traumatic experiences, daily life stressors, family conflict, and even positive life events, also play a significant role in the development of the disorder and the triggering of mood episodes. It is important to bear in mind that, as David Miklowitz states in his book, The Bipolar Disorder Survival Guide, “bipolar disorder is something that you have, but is it not who you are.” (Sources: David Miklowitz)
How Is Bipolar Disorder Diagnosed?
Bipolar disorder is diagnosed with a comprehensive clinical interview, usually by a psychiatrist or psychologist. The diagnosis is based on the symptoms the person has experienced. Brain scans, blood tests and other physiological tests cannot diagnose bipolar disorder. However, a doctor may order some tests to rule out medical conditions that could mimic bipolar disorder (for example, a thyroid problem). Hopefully, the doctor conducting the evaluation specializes in mood disorders and has extensive experience diagnosing and treating bipolar disorder as there are other disorders that are often confused with bipolar.
A comprehensive clinical interview typically includes a review of medical history, including prior diagnoses, treatments, response to treatments, and family history. Finally, the doctor will ask whether certain symptoms have been experienced over a given period of time. The doctor is likely to ask about not only bipolar disorder symptoms but also about symptoms of other disorders (such as anxiety disorders and substance use disorders) that may co-exist with or may be confused with a bipolar disorder. (Source: David Miklowitz)
What Psychiatric Orders Are Often Confused with Bipolar?
It is easy to confuse bipolar with other mental illnesses. The most common disorders confused with bipolar are:
- Attention-deficit/hyperactivity disorder
- Borderline personality disorder
- Schizophrenia or schizoaffective disorder
- Recurrent major depressive disorder
- Substance-induced mood disorder
(Source: David Miklowitz)
What Are Common Reactions to Being Diagnosed With Bipolar?
When diagnosed with bipolar disorder, people experience a range of emotion – anxiety, anger, bewilderment, fear and relief. Some reject the diagnosis; others agree with the diagnosis but downplay its significance; and others over-identify with the diagnosis so that bipolar disorder becomes their identity.
Commonly, people vacillate between denial and acceptance, even long after their initial diagnosis. Part of the challenge people face is understanding where normal mood variations end and where bipolar disorder starts. As David Miklowitz notes in The Bipolar Survival Guide, “having a sense of how your personality, habits and attitudes differ from your symptoms is an important part of learning to accept the disorder.” (Source: David Miklowitz)
How Does One Distinguish Between Normal Ups and Downs and Bipolar?
For some it is hard to think of mood swings as an illness, especially when emotional reactions seem justifiable and appear to be similar to what others experience. For this reason it is critically-important that a doctor be attuned to whether mood and behavior are significant departures from ones normal states. In making this assessment, a doctor must take into account factors such as how long the states last, how intense they are, and whether they impair ones functioning.
Making this diagnosis is challenging. In The Bipolar Survival Guide, David Miklowitz provides six questions a doctor might ask to distinguish bipolar mood swings from normal mood variability:
- Do your mood swings cause problems in your social and family life?
- Do your mood swings lead to decreases in your work productivity that last more than a few days?
- Do your mood states last for days at a time with little relief, or do they change when something good happens?
- Do other people notice and comment when your mood shifts?
- Do your mood changes go along with noticeable changes in thinking, perceiving, sleeping and/or energy or activity levels?
- Do your mood swings ever get so out of hand that the police have to be called or a hospitalization becomes necessary?
- ne of the critical reasons to distinguish between personality and bipolar disorder is to help people identify the beginning of a new episode. This is important not only for the person with bipolar disorder but also for close friends and family. People need to understand how bipolar disorder affects their relationship, how relationship conflict affects the disorder, and what relationship problems are unrelated to the disorder. Therefore, it is important for close friends and family to become educated about bipolar disorder and the particular way it is experienced by their loved ones. (Source: David Miklowitz)
Do Families, Friends and Doctors Experience A Patient’s Bipolar Disorder Differently Than The Patient?
- Often, family members, friends and doctors experience bipolar disorder very differently than the person with the disorder. These different perspectives can be a source of conflict over the treatment plan – with the patient pushing for one strategy, the family another and the doctor yet another.With family members, unless one has bipolar, it is hard for them to understand a patient’s experiences. Families tend to focus on how the patient’s behavior affects them. The same is often true with a patient’s friends. Doctors, in turn, are less concerned with the meaning a patient ascribes to his or her experiences and instead focus on the symptoms.To cut through these potential impediments, it is important for patients to communicate with their family, friends and doctors, and for them to work to understand your personal experiences. (Source: David Miklowitz)Is Medication Used To Treat Bipolar Disorder?Medication is generally considered to be the foundation for treating bipolar disorder and people who regularly take medication tend to have fewer recurrences than people with bipolar disorder who do not take medication. Medication requires careful monitoring, so it is important to work closely with the prescribing doctor. Like so many medications, drugs used to treat bipolar disorder may have unpleasant side-effects.
What Types of Medications Are Used to Treat Bipolar?
There are four types of medications most commonly used to treat bipolar disorder:
- Mood stabilizers
- Antidepressants
- Antipsychotics
- Antianxiety agents
Each drug serves a different purpose and a doctor’s determinations about what drug (or drugs) to prescribe are made on an individual basis. Additionally, bipolar disorder has different phases – an acute phase, where the doctor is treating an episode of illness, and a maintenance phase, in which medication is used to prevent or delay future episodes. Different medications (or combination of medications) can be used during these different phases. (Source: David Miklowitz)
Why Should A Person Get Psychotherapy?
There are many potential benefits of psychotherapy. First, many people with bipolar disorder have trouble taking their medications regularly, and psychotherapy has been shown to improve compliance with medications. Also, even when people take their medications consistently, they may not experience full symptom relief and/or they may not return to the same level of functioning (at school, work, or home) that they had before the bipolar disorder. Psychotherapy can help reduce symptoms, improve functioning, and lead to a better quality of life. Therapy also often focuses on helping people find a healthy level of acceptance of the disorder and its treatments.
Therapy can also help people make sense of their current and past episodes and can help people mourn losses they’ve experienced as a result of their illness (for example, relationships lost, an education or career interrupted). It can also help people develop a relapse prevention plan with the goal of identifying early warning signs and strategies to keep these symptoms from escalating into a full relapse. Therapy also may help patients address the social stigma associated with the disorder.
What Are the Different Types of Therapy People Use to Treat Bipolar?
It is important to find the right type of therapy. Depending on where you live there may be many options or few options. Types of therapies include:
Individual therapy – Patients meet one-on-one with a therapist. Individual therapies that have been shown in research to be effective for bipolar disorder (Interpersonal and Social Rhythm Therapy, IPSRT; Cognitive Behavior Therapy, CBT; Psychoeducation) tend to be structured and goal-oriented, targeting symptom reduction, relapse prevention and improved quality of life. Psychoeducation appears to be an essential component of effective psychotherapy.
Family and couples therapy – Sometimes bipolar disorder is best treated in a family or couples context. Bipolar disorder generally affects the entire family, and family distress can worsen the disorder while positive family support is a protective factor. Therefore, a therapy that includes the entire family can help all members of the family.
Group therapy/Support groups – Many people with bipolar disorder benefit from participating in therapy or support groups. With this approach people get together to discuss their feelings, experiences and attitudes about bipolar disorder. Dialogue includes discussing which medicines have worked and which have not, therapies that have proven beneficial, challenges with family members or social settings, plus much more. The group leaders can be either mental health professionals (group therapy) or others with bipolar disorder (support groups).
Family support groups – Like people with bipolar disorder, family members often benefit from support groups. Through such groups, family members share experiences, explore strategies for supporting people with the disorder, and discuss the fears, challenges and frustrations they face in helping others.
What Can I Say To Help Someone and What Should I Avoid Saying?
What you say to someone with bipolar disorder, especially if that person is experiencing a bipolar episode, can be very important. The Depression and Bipolar Support Alliance (www.dbsalliance.org) has posted on its website the following suggestions about what to say and what not to say.
What you can say that helps:
- You are not alone in this. I’m here for you.
- I understand you have a real illness and that’s what causes these thoughts and feelings.
- You may not believe it now, but the way you’re feeling will change.
- I may not be able to understand exactly how you feel, but I care about you and want to help.
- When you want to give up, tell yourself you will hold on for just one more day, hour, minute – whatever you can manage.
- You are important to me. Your life is important to me.
- Tell me what I can do now to help you.
- I am here for you. We will get through this together.
What you should avoid saying:
- It’s all in your head.
- We all go through times like this.
- You’ll be fine. Stop worrying.
- Look on the bright side.
- You have so much to live for; why do you want to die?
- I can’t do anything about your situation.
- Just snap out of it.
- Stop acting crazy.
- What’s wrong with you?
- Shouldn’t you be better by now?