Bipolar Disorder: Symptoms, Types, and Treatment Approaches

Understanding Bipolar Disorder: Symptoms, Types, and Treatment Approaches

At the beginning of modern mental health practice, bipolar disorder was known by a different term—”manic depression.” However, due to stigmatization, potential inaccuracy, and misdiagnoses, the clinical terminology was officially changed to “bipolar disorder” in the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Following current best practices, this article will use the term bipolar disorder (abbreviated as BD).

The DSM-5 currently recognizes approximately seven types of bipolar disorder, generally characterized by significant shifts in mood, activity level, and energy that can disrupt daily functioning. While bipolar disorder typically cannot be “cured,” many individuals effectively manage their symptoms through a combination of therapy with licensed clinical social workers, medication management by appropriate medical professionals, and lifestyle adjustments.

Common Symptoms of Bipolar Disorder

Bipolar disorder is classified as a mood disorder. The mood fluctuations characteristic of bipolar disorder are often referred to as episodes, highlighting their typically transient nature for many individuals.

There are three primary subtypes of bipolar disorder—bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Depending on the specific type, a person might experience various combinations of hypomanic, manic, and depressive episodes—which can differ in duration or sometimes co-occur.

Episodes may last from a few days to several weeks or longer. Some episodes might include symptoms from all symptom categories, while others might manifest with just a few symptoms. Everyone experiences episodes differently. Between episodes, some individuals with BD may experience residual symptoms, while others may be symptom-free.

Here are the common symptoms of bipolar disorder by episode type:

Mania and Hypomania

Although mania and hypomania are distinct types of episodes, they share many symptoms. Manic episodes generally differ from hypomanic episodes in severity and cause more significant disruption to daily life. Additionally, mania can trigger psychosis, which may require intensive professional care. During manic or hypomanic episodes, symptoms may include:

• Feeling extremely happy or upbeat
• Speaking rapidly
• Experiencing a sense of self-importance and invincibility
• Abnormally high energy levels
• Becoming easily agitated or irritated
• Impulsive behavior, such as excessive spending or reckless driving
• High distractibility
• Reduced need for sleep
• Making potentially harmful choices that are out of character
• Delusions, hallucinations, and illogical thoughts (during psychosis)

People without bipolar disorder often misunderstand manic episodes. Some might assume that mania or hypomania is simply characterized by happiness and productivity. However, these states can be confusing and frustrating for people with bipolar disorder. Manic symptoms can also be challenging for family members to navigate. These episodes can disrupt daily functioning, damage relationships, and lead to risky behaviors. Working with a licensed clinical social worker through ReachLink can help individuals develop strategies to manage these symptoms effectively.

Depression

Major depressive episodes can significantly impair daily functioning and may include:

• Persistent sadness or hopelessness, low mood
• Loss of interest in previously enjoyed activities
• Changes in weight or appetite
• Sleep disturbances (sleeping too much or too little)
• Fatigue or inability to accomplish tasks
• Restlessness
• Feelings of guilt or worthlessness without apparent cause
• Difficulty concentrating or making decisions
• Thoughts of suicide

Types of Bipolar Disorders

Several conditions fall under the bipolar disorder umbrella, each involving various combinations of manic, hypomanic, and depressive episodes:

• Bipolar I disorder: Characterized by at least one manic episode, which may precede or follow a major depressive episode (though depressive episodes are not required for diagnosis). Many people with Bipolar I also experience depressive episodes lasting two weeks or longer.
• Bipolar II disorder: Characterized by both hypomanic episodes (less severe than full mania and lasting under five days) and depressive episodes.
• Cyclothymic disorder: Characterized by chronic periods of depressive symptoms (which may not meet full criteria for major depression) and hypomanic symptoms—lasting for two or more years. Periods between episodes are typically brief.
• Substance/medication-induced bipolar and related disorder: Defines depressive, manic, or hypomanic episodes that develop during or shortly after exposure to a medication or substance. Common triggers include alcohol, hallucinogens, amphetamines, and phencyclidine.
• Bipolar and related disorder due to another medical condition: To meet diagnostic criteria, a person must experience a persistently altered mood or energy level that cannot be explained by another mental disorder and is caused by a medical condition.
• Other specified bipolar and related disorder: Symptoms may not meet full criteria for bipolar disorder but cause significant distress and contain features of short-term bipolar episodes.
• Unspecified bipolar and related disorder: This diagnosis might be given when symptoms don’t meet full criteria for bipolar disorders for unspecified reasons.

The DSM-5 also includes specifiers to define additional features that may be present, such as rapid cycling, seasonality, atypical features, or mixed features.

Diagnosis and Treatment

The average age of bipolar disorder onset is 25 years—however, episodes can begin in early childhood or during mid-life. According to a 2012 study by Youngstrom et al., several red flags can indicate the need for bipolar disorder assessment in young people. These include family history, early-onset depression, manic symptoms during antidepressant use, mood fluctuations, episodes of high energy or aggression, psychotic symptoms, and sleep disturbances.

Healthcare providers may use several tools for thorough evaluation and to rule out other conditions, including physical exams, medical history reviews, and blood tests. A doctor may conduct a mental health evaluation or refer you to a mental health professional to determine whether you meet the diagnostic criteria for bipolar disorder or another condition.

After diagnosis, your providers can collaborate with you to establish a treatment plan. Many treatment plans involve a combination of psychotherapy with licensed clinical social workers, medication prescribed by appropriate medical professionals, and education. Therapy through ReachLink can help individuals with bipolar disorder access emotional support, identify symptom triggers, and address potential co-occurring mental health conditions. Common medications for bipolar disorder include mood stabilizers and antipsychotics, which must be prescribed by qualified medical professionals.

It’s essential to consult with a healthcare professional before starting or stopping any medication. Using a notebook to track symptoms and patterns (sometimes called mood charting) can be helpful during the diagnostic process.

Remember that ReachLink provides therapy services through licensed clinical social workers but does not provide prescription medications. If medication might be appropriate for your situation, your ReachLink therapist can help coordinate with medical professionals who can evaluate your needs and prescribe medications if necessary.

Diagnostic Challenges

Diagnosis during teenage years may be delayed when parents or doctors mistake episodes for normal adolescent emotional fluctuations. Additionally, bipolar disorder can be misdiagnosed as attention-deficit hyperactivity disorder (ADHD), depressive disorders, schizophrenia, substance use disorders, or borderline personality disorder (BPD). Misdiagnosis can delay effective treatment, so remaining open to diagnostic possibilities throughout treatment is crucial.

Treatment Options

There are many approaches to treating bipolar disorder, including a combination of psychotherapy, medication, lifestyle modifications, and ongoing support. Psychotherapy, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychoeducation, can help individuals recognize warning signs, develop coping strategies, and improve interpersonal relationships. Medication plays a crucial role in stabilizing mood swings and preventing relapse but should always be closely monitored by qualified healthcare providers due to potential side effects and the need for dosage adjustments.

In addition to clinical treatments, maintaining a regular routine, adequate sleep, balanced nutrition, and stress management techniques can significantly contribute to symptom management. Support from family, friends, and peer groups can also enhance overall well-being and encourage adherence to treatment plans. Comprehensive care tailored to the individual’s needs offers the best chance for managing bipolar disorder effectively.

Early diagnosis and integrated treatment strategies are vital to reducing the long-term impact of bipolar disorder on daily functioning and quality of life. While challenges remain, advances in mental health care and increased awareness provide hope for those living with bipolar disorder. With proper treatment and support, many individuals lead fulfilling, productive lives despite the condition’s complexities.