Introduction
Bipolar disorder is a complex and often misunderstood mental health condition that affects millions of people worldwide. Characterised by extreme mood swings, from deep depression to manic highs, it can significantly impact an individual’s daily life and relationships. This article aims to provide a comprehensive understanding of bipolar disorder, including its symptoms, causes, treatments, and personal experiences from those living with the condition.
What is Bipolar Disorder?
Bipolar disorder, formerly known as manic depression, is a severe mental illness characterised by extreme mood swings and changes in energy levels. People with bipolar disorder can experience periods of stability but can also swing to extremes, either going ‘low’ into deep depression or ‘high’ into hypomania, mania, or even psychosis. These mood swings go far beyond the everyday experiences of feeling a bit down or happy.
Bipolar UK uses a Mood Scale to help explain these extremes, where 0 represents deep depression (suicidal ideation) and 10 represents extreme mania with psychosis. While people without bipolar disorder typically experience moods that range between 4 (feeling down) and 6 (feeling happy), those with bipolar disorder experience a much wider range of moods, from 0 to 10.
Who Has Bipolar Disorder?
Bipolar disorder affects individuals of all ages and backgrounds. Symptoms usually become noticeable in teenagers and young adults. Research indicates that nearly 50% of people who get it, experience symptoms before the age of 21. Studies have shown that younger people are more likely to screen positive for bipolar disorder than older people.
How Many People Have Bipolar Disorder?
Globally, it is estimated that between 1% and 5% of people have bipolar disorder. In the UK, over 1 million people live with the condition, which is roughly 30% more than those with dementia and twice the number of those with schizophrenia.
Symptoms of Bipolar Disorder
Bipolar disorder symptoms are categorised based on mood episodes, which can be depressive, hypomanic, manic, or mixed.
Depression (Mood Scale 0-3):
- Suicidal thinking (0, 1)
- Depression (2, 3)
- Symptoms: Hopelessness, fatigue, worthlessness, lack of interest in activities, changes in sleep and appetite, and suicidal thoughts.
Hypomania (Mood Scale 7-8):
- Energetic, happy, confident, creative, irritable, and distracted.
- Symptoms: Talking a lot, being very friendly, reduced sleep, and increased productivity.
Mania (Mood Scale 9-10):
- Euphoric, very excited, extremely confident, more sexually aroused, and irritable.
- Symptoms: Talking quickly, making impulsive decisions, reckless spending, inappropriate behaviour, and little need for sleep. Severe mania can lead to psychosis.
Mixed State:
- Symptoms of depression and hypomania or mania occurring simultaneously.
At the extreme ends of the Mood Scale, individuals may experience psychosis, involving hallucinations, extreme paranoia, and delusions.
Personal Anecdotes
In this video by mind.org.uk Joe, Laura, and Steve, who all have lived experiences with bipolar disorder, shared their insights during a recent discussion.
Joe emphasised the invisible nature of the illness: “It’s an illness. It really is an illness. People can see if you’ve got a broken leg. But you can’t see what’s in your mind and in my opinion, it can be worse.”
Laura described her fluctuating mood patterns: “For a while I used to get maybe kind of two or three episodes a year where I’d have maybe an episode of hypomania that lasted a couple of weeks, and then that was followed by a sort of episode of depression that would last a couple of weeks as well.”
Steve spoke about the deceptive onset of manic episodes: “I wouldn’t even know that I’m actually becoming manic. It might be just thinking that I can push the envelope a bit here, I can spend a bit more money, I can go out another night, you know, I can work until three or four o’clock in the morning.”
They all agreed on the importance of having a support network. Joe noted, “If you’ve got that network of people around you who can support you, particularly when you’re depressed, it’s so important.”
What Causes Bipolar Disorder?
Bipolar disorder is believed to result from a combination of genetic and environmental factors. Studies on twins suggest that bipolar disorder is primarily genetic. If one identical twin has bipolar disorder, the other twin has a 70% chance of developing it. No single gene is responsible, but a collection of over 100,000 genes associated with schizophrenia, anxiety, and depression are implicated.
Environmental factors, such as exposure to adversity at a young age, can also play a role. This exposure might be due to unmanaged bipolar symptoms in a parent, leading to a higher risk for the child.
Types of Bipolar Disorder
The type of bipolar disorder affects the severity and types of mood episodes experienced:
- Type 1: Characterised by episodes of depression, hypomania, and mania.
- Type 2: Involves long periods of depression and hypomania without full-blown mania.
- Cyclothymia: A milder form of bipolar disorder with periods of depression and elevated mood lasting at least two years.
The Impact of Bipolar Disorder
Bipolar disorder can have a profound impact on the lives of those affected and their loved ones. During manic and depressive episodes, individuals may engage in behaviours they later regret, such as reckless spending, making mistakes at work, or damaging relationships. This can lead to feelings of guilt, shame, and frustration, further exacerbating the condition.
However, a diagnosis of bipolar disorder opens the door to effective treatment, support, and self-management strategies. With proper treatment, individuals with bipolar disorder can manage their symptoms, maintain a balanced mood, and live fulfilling lives.
Living with Bipolar Disorder
Managing bipolar disorder involves recognising triggers, adhering to treatment plans, and maintaining a healthy lifestyle. Support from healthcare professionals, as well as self-help and peer support groups, can provide valuable assistance in navigating the challenges of living with bipolar disorder.
As Laura shared, “One of those [tools] is definitely my medication. I’ve also had CBT in the past year and that again I think is a really kind of important sort of tool.” Steve and Joe echoed the sentiment, highlighting the importance of routine and staying busy.
Misconceptions about Bipolar Disorder
There are many misconceptions about bipolar disorder that contribute to stigma and misunderstanding. One common misconception is that people with bipolar disorder are always either extremely manic or deeply depressed. However, as Laura pointed out, “You can be manic but not be really happy. You can feel really agitated and really kind of frustrated.”
Another prevalent misconception is that individuals with bipolar disorder are inherently violent. In reality, the vast majority of people with bipolar disorder are not violent and are more likely to be victims of violence. The stigma surrounding mental health can make it harder for individuals to seek help and support.
Causes of Bipolar Disorder
The exact cause of bipolar disorder is unknown, but it is believed to result from a combination of genetic, environmental, and biochemical factors.
Genetics:
- Bipolar disorder tends to run in families. If you have a parent or sibling with the illness, you are more likely to develop it yourself. Studies on twins have shown that if one identical twin has bipolar disorder, the other twin has about a 50% chance of having it too.
Environmental Factors:
- Stressful life events, such as the death of a loved one, divorce, or job loss, can trigger episodes of bipolar disorder. Childhood trauma, including abuse or neglect, is also linked to an increased risk of developing the condition.
Biochemical Factors:
- Differences in brain chemistry and structure may play a role in the development of bipolar disorder. Studies have shown that neurotransmitters, which are chemicals responsible for transmitting signals in the brain, function differently in people with bipolar disorder.
The Complicated Relationship with Drugs and Alcohol
The relationship between bipolar disorder and substance use is complex. Some individuals with bipolar disorder may use drugs or alcohol to cope with their symptoms, but this can exacerbate the condition.
Drug Use:
- Heavy use of cannabis and other substances can increase the risk of developing bipolar disorder. Some drugs can trigger or worsen mood episodes, leading to a vicious cycle of substance abuse and mental health issues.
Self-Medication:
- Individuals may turn to drugs or alcohol to manage their symptoms, but this can lead to dependence and further complications. It’s important to seek professional help to manage both bipolar disorder and any substance use issues.
Research and Progress in Bipolar Disorder
Research into bipolar disorder is ongoing, with many institutions focusing on understanding the underlying causes and developing better treatments.
The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London:
- Researchers at IoPPN are investigating the genetic and environmental factors that contribute to bipolar disorder. They are also studying the brain’s structure and function to identify biomarkers that could lead to earlier diagnosis and more targeted treatments.
The Stanley Center for Psychiatric Research at Broad Institute:
- This centre is dedicated to understanding the genetics of bipolar disorder and other psychiatric conditions. Their research aims to identify specific genes associated with the disorder and develop new medications that target these genetic pathways.
Current Progress:
- Advances in neuroimaging have provided insights into the structural and functional abnormalities in the brains of individuals with bipolar disorder. Additionally, new medications and therapeutic approaches are being developed to improve the management of symptoms and overall quality of life for those affected.
Conclusion
Bipolar disorder is a challenging and complex condition that requires comprehensive understanding and management. By recognising the symptoms, understanding the causes, and seeking appropriate treatment, individuals with bipolar disorder can lead fulfilling lives. It is crucial to continue supporting research efforts and to challenge misconceptions to reduce the stigma associated with this mental health condition. If you or someone you know may have bipolar disorder, reaching out to a healthcare professional is the first step towards effective management and recovery.