If you ask the average person what “bipolar disorder” is, what are they likely to say? They will probably talk about mood swings, or they might mention the terms “mania” and “depression.” Obviously, there is more to the story than that, especially since what is commonly called “bipolar disorder” may actually refer to a number of distinct but related conditions.
Identifying which condition is the best diagnosis for a patient requires the ability to recognize the nuances between different types of bipolar disorder. And it all starts by recognizing the terms and symptoms associated with the illness: mania, hypomania, and major depressive episodes.
Manic or Hypomanic Episodes
Mania and hypomania are two terms you’re likely to hear when discussing bipolar disorder. Both describe periods of elevated or irritable mood. Mania is more severe and may be accompanied by psychotic symptoms, unlike hypomania. These episodes are often characterized by goal-directed activity beyond what a person typically exhibits. An individual in a manic episode may start a number of projects, work on them at all hours with little thought to sleep, and then never finish them after the manic episode ends.
By definition, a manic episode must last for at least a week. A hypomanic episode must last at least four days. In either case, the individual’s manic behavior should be observable by others. The moods experienced should be so severe that they interfere with the individual’s work, schooling, or relationships. Finally, these symptoms must not be the result of substance abuse or medication.
Of the following symptoms, a patient must show three or more to diagnose a manic or hypomanic episode:
- Increased self-esteem
- Feeling rested after little sleep
- Talking more than usual
- Racing thoughts
- Becoming easily distracted
- Becoming more goal-oriented or agitated
- Unusual activity with a high chance of painful consequences - shopping sprees, foolish investments, unwise sexual encounters, etc.
Major Depressive Episodes
Many people think depression is just feeling sad, but clinically, depression is a condition often caused by changes in brain structure and chemistry. The changes are likely to cause depressed mood, reduced interest in everyday tasks, and other symptoms that go beyond feeling blue. If these signs persist for weeks, it is called a major depressive episode.
Over the course of a two-week period, a major depressive episode must feature five or more of the following symptoms, including either depressed mood or reduced interest:
- Depressed mood most days for most of the day - feeling sad, hopeless, etc.
- Reduced interest or loss of joy in daily activities
- Significant weight loss or weight gain or increased or decreased appetite
- Insomnia or excessive sleeping
- Restlessness or slowed activity noticed by others
- Feelings of guilt or worthlessness
- Inability to concentrate or make decisions
- Recurring suicidal thoughts, or planning or attempting suicide
Forms of Bipolar Disorder
In addition to manifesting through a variety of symptoms and states, are several forms of bipolar and related disorders that differ based on severity and frequency of symptoms:
● Bipolar I disorder is also known as manic-depressive disorder or manic depression. It is characterized by at least one manic episode that may or may not be preceded by hypomanic or major depressive episodes.
● Bipolar II disorder is like bipolar I, but the “highs” never reach true mania, instead remaining hypomanic. Bipolar II is signaled by at least one major depressive episode and at least one hypomanic episode, but not by a manic episode.
● Cyclothymic disorder causes similar, but less severe, cycles of highs and lows. It can be identified if you’ve had at least two years with periods of hypomanic symptoms and periods with depressive symptoms, but no full hypomanic or major depressive episodes.
Between 10% and 20% of people with bipolar have “rapid cycling” bipolar - experiencing four or more mood episodes in a year. Women and those with bipolar II are more likely to have rapid cycling bipolar. Even though they experience multiple episodes a year, a patient with rapid cycling bipolar spends more of their time depressed, and this type of bipolar can be easily misdiagnosed as depression.
What You Can Do About Bipolar Disorder
It’s important to note that in isolation, many of the symptoms of mania, hypomania, or depression do not indicate bipolar disorder. But some symptoms are always concerning, and a misdiagnosis can make life unnecessarily difficult for someone struggling to manage their health. Dickinson Center, Inc. strongly encourages community members to reach out if they have any concerns about their risk of suffering from this illness; our team is here to ensure that you receive any care you need and you can live your life like any other individual. Please contact us today with your questions, and let us help you address your concerns!