Facts about Bipolar Disorder

What is Bipolar Disorder?
Bipolar Disorder (also called manic-depression) is a major psychiatric disorder in which the person experiences
occasional episodes of extremely elevated moods (
mania).  Most persons with this disorder also experience intermittent
episodes of extremely low moods (
depression).  In between these extremes, the person's mood may be normal.
   The symptoms of bipolar disorder can cause significant disruption to the person's ability to work, fulfill household
responsibilities, and maintain interpersonal relationships.  The experience of bipolar disorder, as well as having a close
family member with the disorder, can be described as a roller-coaster ride that one cannot get off.

How Common Is Bipolar Disorder?
About one in every hundred people (1 percent) develops bipolar disorder some time during his or her life.

How Is the Disorder Diagnosed?
Bipolar disorder can only be diagnosed with a clinical interview.  The purpose of this interview is to determine whether
the client has experienced specific "symptoms" of the disorder for a sufficiently long period of time (at least two weeks).  
In addition to conducting the interview, the diagnostician must make sure that other physical problems are not present
that could produce symptoms similar to those found in bipolar disorder, such as a brain tumor, or alcohol or drug
abuse.  Bipolar disorder cannot be diagnosed with a blood test, an X ray, a CAT scan, or any other laboratory test.

The Characteristic Symptoms of Bipolar Disorder
There are two broad types of symptoms typically experienced by persons with bipolar disorder: manic symptoms and
depressive symptoms.  The diagnosis of bipolar disorder requires that the person has experienced a manic syndrome,
that is, a period of at least two weeks in which manic symptoms have been present to a significant degree.  If the person
has only experienced a
manic syndrome, he or she still qualifies for the diagnosis of bipolar disorder.  However, most
persons with this disorder also experience
depressive syndromes, periods of at least two weeks in which symptoms of
depression predominate.  Usually, the symptoms of mania and depression occur at different times.  However, it is
possible for manic and depressive symptoms to be present at the same time (called a mixed state).  If the person has
experienced only symptoms of depression, but not mania, he or she is given a diagnosis of
major depression, rather
than bipolar disorder.

   Symptoms of Mania
   In general, the symptoms of mania involve an excess in behavioral activity, mood states (in particular, irritability or
positive feelings), and self-esteem and confidence.  At least some of these symptoms interfere with the client's
day-to-day functioning.  Not all symptoms must be present for the client to have had a manic syndrome.

Euphoric or Expansive Mood.  The client's mood is abnormally elevated, such as extremely happy or excited
(euphoria).  The person may tend to talk more and with greater enthusiasm or emphasis on certain topics
(expansiveness).

Irritability.  The client is easily angered or persistently irritable, especially when others seem to interfere with his or her
plans or goals, however unrealistic they may be.

Inflated Self-Esteem or Grandiosity.  The client is extremely self-confident and may be unrealistic about his or her
abilities (grandiosity).  For example, the client may believe he or she is a brilliant artist or inventor, a wealthy person, a
shrewd business person, or a healer when he or she has no special competence in these areas.

Decreased Need for Sleep.  Only a few hours of sleep are needed each night (such as less than four hours) for the
client to feel rested.

Talkativeness.  The client talks excessively and may be difficult to interrupt.  The client may jump quickly from one
topic to another (called flight of ideas), making it hard for others to understand.

Racing Thoughts.  Thoughts come so rapidly that the client finds it hard to keep up with them or express them.

Distractibility.  The client's attention is easily drawn to irrelevant stimuli, such as the sound of a car honking outside on
the street.

Increased Goal-Directed Activity.  A great deal of time is spent pursuing specific goals, at work, school, or sexually.

Excessive Involvement in Pleasurable Activities with High Potential for Negative Consequences.  Common
problem areas include spending sprees, sexual indiscretions, increased substance abuse, or making foolish business
investments.

   Symptoms of Depression
   Depressive symptoms reflect the opposite end of the continuum of mood from manic symptoms, with a low mood and
behavioral inactivity as the major features.  Not all symptoms must be present for the client to have had a depressive
syndrome.

Depressed Mood.  Mood is low most of the time, according to the client or significant others.

Diminished Interest or Pleasure.  The client has few interests and gets little pleasure from anything, including
activities previously found enjoyable.

Change in Appetite and/or Weight.  Loss of appetite (and weight), when not dieting, or increased appetite (and
weight gain) are evident.

Change in Sleep Pattern.  The client may have difficulty falling asleep or staying asleep, or may wake early in the
morning and not be able to get back to sleep.  Alternatively, the client may sleep excessively (such as over twelve hours
per night), spending much of the day in bed.

Change in Activity Level.  Decreased activity level is reflected by slowness and lethargy, in terms of both the client's
behavior and his or her thought processes.  Alternatively, the client may feel agitated, "on edge", and restless.

Fatigue or Loss of Energy.  The client experiences fatigue throughout the day, or there is a chronic feeling of loss of
energy.

Feelings of Worthlessness, Hopelessness, Helplessness.  Clients may feel they are worthless as people, that
there is no hope for improving their lives, or that they are helpless to improve their unhappy situation.

Inappropriate Guilt.  Feelings of guilt may be present about events that the client did not even cause, such as
catastrophe, a crime, or an illness.

Recurrent Thoughts about Death.  The client thinks about death a great deal and may contemplate (or even
attempt) suicide.

Decreased Concentration or Ability to Make Decisions.  Significant decreases in the ability to concentrate make it
difficult for the client to pay attention to others or complete rudimentary tasks.  The client may be quite indecisive about
even minor things.

  
 Other Symptoms
   Clients with bipolar disorder also have other psychiatric symptoms at the same time that they experience manic or
depressive symptoms.  Some of the most common other symptoms include hallucinations (false perceptions, such as
hearing voices) and delusions (false beliefs, such as paranoid delusions).  These symptoms disappear when manic or
depressive symptoms have been controlled.

How is Bipolar Disorder Distinguished from Schizophrenia and Schizoaffective Disorder?
May persons with a diagnosis of bipolar disorder also have had, at some point, a diagnosis of schizophrenia or
schizoaffective disorder.  Diagnostic uncertainty results because during a symptom flare-up, a psychotic symptom such
as delusional grandiosity (for example, a belief that a person is Jesus Christ) may reflect either mania, schizophrenia, or
a schizoaffective disorder.  However, over time, the symptoms of these three disorders tend to differ.  Of particular
importance, when their moods are stable, persons with bipolar disorder do not usually experience psychotic symptoms,
while persons with schizophrenia or schizoaffective disorder often do.

What is the Course of Bipolar Disorder?
Bipolar Disorder often develops in late adolescence or early adulthood, but it can also develop later in life, in an
individual's 40s or even 50s.  Bipolar disorder is a lifelong disorder, with symptoms varying over time in severity.  In
most cases, clients with the disorder are able to function between episodes; for instance, they can work, maintain
household responsibilities, and raise children.  Many famous people have struggled with bipolar disorder (such as
Vincent Van Gogh, Patty Duke, Samuel Coleridge, Edgar Allan Poe, Carrie Fisher, and Robert Shumann), but have
been able to make significant contributions to society.

What Causes Manic-Depression?
No one knows the cause of bipolar disorder.  Theories suggest that the illness may be caused by an imbalance in
chemicals in the brain, particularly the chemical called norepinephrine.  It is believed that this imbalance is determined
by genetic factors.

Are There Factors That Might Increase the Likelihood of Relapse?
Sleep deprivation and substance abuse tend to increase the possibility that a manic episode will develop.  Depressive
episodes often occur when the individual is confronting a loss or life change.

How is Manic-Depression Treated?
Effective pharmacological treatments are available for bipolar disorder.  These medications do not "cure" the disorder,
but they reduce the symptoms and prevent relapses from occurring.  Lithium is the most common drug used for Bipolar
Disorder.  Carbamazepine (Tegretol) and valproic acid are also effective medications.  Some clients with psychotic
symptoms also benefit from antipsychotic medications.  A small subset of clients continue to have symptoms of the
disorder, even when they are receiving excellent pharmacological treatment.
   Dealing with episodes of bipolar disorder can be horribly disruptive and distressing.  Many persons with the disorder
can benefit from supportive counseling to learn how to manage the disorder, as well as deal with its impact on their
lives.  Some types of family therapy also can reduce stress and
teach family members how to monitor the disorder.




Recommended Readings

Copeland, M.E. (1992), The Depression Workbook:  A Guide for Living with Depression and Manic Depression,
Oakland, CA: New Harbinger.

Duke, P. & Hochman, G. (1992),
A Brilliant Madness:  Living with Manic-Depressive Illness.  New York: Bantam.

Goodwin, F.K. & Jamison, K.R. (1990),
Manic-Depressive Illness.  New York: Oxford: University Press.

Papolos, D. & Papolos, J. (1992),
Overcoming Depression (Revised Edition).  New York:  HarperPerennial

Whybrow, P.C. (1997).  
A Mood Apart.  New York: Basic Books.

*Note:  This handout is taken from the book
Behavioral Family Therapy for Psychiatric Disorders (1999) by Kim T.
Meuser and Shirley M. Glynn, published by New Harbinger Publications.  Used with permission.
Consult a mental health professional (such as a psychiatrist, social worker, or
psychiaric nurse) about any questions you have concerning this handout.