Bipolar Disorder

Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.

There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder aren’t always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.

Manic episodes

A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode.

Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.

People who are in manic states may indulge in activities that cause them physical, social or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly. They also occasionally develop psychotic symptoms, such as delusions and hallucinations, which can cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder.

People with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesn’t last as long as manic episodes and it doesn’t interfere with daily functioning as much.

Depressive episodes

During a depressive episode, you experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression, such as:

• Tiredness.
• Changes in appetite.
• Feelings of worthlessness and hopelessness.

Why is bipolar disorder no longer called manic-depressive illness?

In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using “manic-depressive illness” or “manic depression” to describe bipolar disorder. There are several reasons for this shift, including:

• Healthcare providers used to use “manic depression” to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM), have become more sophisticated, the new term “bipolar disorder” allows for more clarity in diagnosis.
• There’s a lot of stigma and negativity associated with the terms “manic” and “mania,” especially due to the use of “maniac.” Similarly, people use the term “depression” casually to describe periods of sadness that don’t qualify as clinical depression. Using “bipolar disorder” takes the focus away from these two words. “Bipolar disorder” is more of a clinical, medical term and less emotionally loaded than “manic depression.”
• The term “manic depression” excludes the cyclothymic or hypomanic (bipolar II disorder) versions of the condition.

What are the types of bipolar disorder?

There are four types of bipolar disorder, including:

• Bipolar I disorder: People with bipolar I disorder have experienced one or more episodes of mania. Most people with bipolar I will have episodes of both mania and depression, but an episode of depression isn’t necessary for a diagnosis. The depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episodes must last at least seven days or be so severe that you need hospitalization. People with bipolar I can also experience mixed states (episodes of both manic and depressive symptoms).
• Bipolar II disorder: People with bipolar II experience depressive episodes and hypomanic episodes. But they never experience a full manic episode that’s characteristic of bipolar I disorder. While hypomania is less impairing than mania, bipolar II disorder is often more debilitating than bipolar I disorder due to chronic depression being more common in bipolar II.
• Cyclothymic disorder (cyclothymia): People with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood (euthymia), but these periods last fewer than eight weeks.
• Other specified and unspecified bipolar and related disorders: If a person doesn’t meet the diagnostic criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation, it’s considered other specified or unspecified bipolar disorder.

What’s the difference between borderline personality disorder and bipolar disorder?

While borderline personality disorder (BPD) and bipolar disorder have similar symptoms and are often confused for each other, they’re distinct conditions.

BPD involves a longstanding pattern of abrupt, moment-to-moment swings in moods, behavior and self-image that are often triggered by conflicts in interactions with other people. Nonsuicidal self-injury is also common in BPD but not in bipolar disorder.

Bipolar disorder is different from BPD because it involves distinct, longer-lasting episodes of mania/hypomania and/or depression. Several things can trigger manic or depressive episodes, such as sleep changes, stress, medications and substance use.

Who does bipolar disorder affect?

Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s.

Although bipolar disorder affects people assigned female at birth (AFAB) and people assigned male at birth (AMAB) in equal numbers, the condition tends to affect them differently.

People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called “rapid cycling.” Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population.

People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.

How common is bipolar disorder?

Bipolar disorder affects approximately 5.7 million adult Americans or about 2.6% of the U.S. population.