Understanding Bipolar Disorder

An estimated 7 million adults in the U.S. live with bipolar disorder, a mental health condition that causes dramatic shifts in a person’s mood, energy and ability to think clearly. Its effects can be disabling; an estimated 83% of people with bipolar disorder had serious impairment, the highest rate among mood disorders. Bipolar disorder is also highly stigmatized, resulting in the spread of misinformation and misconceptions about the condition.

On my journey to recovery from bipolar disorder, I have encountered the condition’s challenges, as well as society’s misperceptions. I have encountered people who believe that all that people with bipolar disorder enjoy manic episodes. I have seen other people who believed mania was an amusing spectacle; instead of helping people during a manic episode, they might stare or laugh, even encouraging the dangerous behaviors. And I have experienced just how harmful the manic and depressive episodes can be.

But I have also learned that it is possible to live in recovery. And, with the right information, we can fight the stigma and help the people we know who live with bipolar disorder.

What Does Bipolar Disorder Look Like?

There are several types of bipolar disorder to be aware of. Bipolar I and II are the most common types; People with bipolar I experience mania while people with bipolar II experience a milder form of mania called hypomania. Less common is schizoaffective disorder bipolar type, which is, as the name suggests, a combination of schizophrenia and bipolar. This comorbidity (the presence of two conditions) is common with bipolar disorder. Over 50% of people with bipolar I and II experience anxiety, and 48% and 61% engage in substance use, respectively. Often, people will choose to self-medicate with substance use — and this can trigger other symptoms.

For bipolar I and II, people experience phases of illness; the main phases are the highs of hypomania/mania and the lows of major depression.

Some common symptoms of hypomania/mania include inflated self-esteem, decreased need for sleep, increased talkativeness and goal-directed activity, racing thoughts and engaging in activities with potentially damaging consequences. Hypomania may not appear to interfere with everyday functioning, and some people may even enjoy being hypomanic, so they may resist treatment during this phase. But both forms of mania can have serious consequences. In addition to hospitalizations, criminal offending and arrests, this symptom can significantly harm people and their relationships.

It’s also important to be able to identify a depressive episode; common symptoms of depression for people with bipolar I and II include low mood, loss of interest in activities, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating and recurrent suicidal ideation.

Some people may also experience a “mixed state” that combines the features of mania and depression.

Approximately 53% of people with bipolar I can experience psychosis, in which a person loses touch with reality, often experiencing hallucinations and delusions. An estimated 40% of people with bipolar experience anosognosia or lack of awareness of symptoms. People with bipolar disorder also face high rates of suicide that exceed those of other major psychiatric disorders — up to 19% die by suicide and up to 50% will make a non-fatal suicide attempt.

The Basics of Diagnosis and Treatment

When learning about bipolar disorder, it’s important to understand the basics.

Risk Factors: Having a close relative with bipolar disorder, experiencing stressful life events and having a history of substance abuse are all risk factors for bipolar disorder.

Onset: The average age of onset is 25 years old, but symptoms also appear in the teen years.

Diagnosis: To be diagnosed with bipolar disorder, a person must have experienced at least one episode of hypomania/mania. Getting a correct diagnosis can take time. Many with bipolar are misdiagnosed with either unipolar depression, which often precedes a manic episode, schizophrenia if the person experiences psychosis or borderline personality disorder if they experience rapid mood cycling.

Treatment: It is important for those experiencing symptoms of bipolar disorder to receive a diagnosis and treatment as soon as possible. Without it, the condition may worsen and become harder to treat. Some people are initially prescribed anti-depressants for unipolar depression, which have not been shown effective to treat bipolar depression and may trigger a manic episode. Further, substance use may complicate the treatment of bipolar disorder.

Medication: There are many medication options for treating bipolar disorder. Typically, patients are prescribed lithium and some anticonvulsants, which can help stabilize mood. They may also be given antipsychotics that mostly treat mania (although few treat depression as well). Antidepressants are also included in many courses of treatment. It is important to ask about common side effects before taking a medication; side effects are a common reason for non-adherence to a medication regimen, which is the leading risk of relapse.

Therapy: Effective types of therapy include Cognitive Behavioral Therapy (CBT), Family-Focused Therapy (FFT) and Interpersonal and Social Rhythm Therapy (IPSRT). CBT seeks to change thinking and behavioral patterns that target problem areas. FFT involves psychoeducation, communication enhancement training and problem-solving skills training. IPSRT helps people improve medication adherence, manage stressful life events and reduce disruptions in “social rhythms” or patterns of daily habits.  

Embracing The Positives

While bipolar disorder can be incredibly harmful if untreated, it can also be accompanied by “positive” attributes, which are a source of pride for many people.

A leading bipolar scholar identified numerous extremely well-known poets, writers, composers and painters who lived or are living with bipolar disorder, including Vincent Van Gogh, Virginia Woolf and Ernest Hemingway. In her 1996 book “Touched with Fire,” she argues that the instability of mood and temperament characteristic of bipolar are integral to their productivity and originality.

People with bipolar disorder are also over-represented among highly successful entrepreneurs. The symptoms and traits of bipolar have been associated with high IQ and perseverance on difficult tasks. Other positive attributes exhibited during a hypomanic state, which may favor entrepreneurial activities,  include high energy levels, extroversion, self-esteem and optimism.

Ultimately, bipolar disorder is complex. It is not easy to treat, nor is it easy to live with. In fact, it may take many years to learn how to manage it, as it did for me. I reached recovery thanks to great treatment and a supportive family, but most of all because of me. Once I realized that I could manage my symptoms, I took responsibility for my illness and did everything I could to get and stay well.

I would like to thank Dr. Joseph Goldberg, a leading mood disorders psychiatrist specializing in bipolar, for being my wonderful doctor and for taking the time to review this blog post.

Katherine Ponte is happily living in recovery from severe bipolar I disorder after first being diagnosed over 20 years ago. She provides bipolar recovery coaching and mentoring services to caregivers and their loved ones with bipolar disorder based on her lived experience. She also provides bipolar caregiver support groups. You can sign up here. Katherine authored ForLikeMinds: Mental Illness Recovery Insights and is on the board of NAMI-NYC.