Understanding Bipolar Disorder

By Jane Farrell

Editor’s Note: Bipolar disorder is often talked about, but sometimes misunderstood. The story of days-long manic episodes followed by prolonged depressed periods is a familiar one. But that isn’t the only form this disorder takes. And if someone you love has a variation on classic bipolar disorder, it’s important to recognize the condition and seek diagnosis and treatment. The experts at the National Institute of Mental Health offer the distinctions between the different types of bipolar disorder:

Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior for bipolar I to be diagnosed.

Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown episodes.

Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.

Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people, the NIMH experts say, may also be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.  Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age.

But no matter what type of bipolar disorder a person suffers from, the NIMH says, it tends to worsen if it isn’t treated. And delays in getting the correct diagnosis and treatment make a person likelier to experience social, personal and work problems.

Substance abuse is also an issue: Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms. Other disorders commonly occurring in conjunction with bipolar disorders include post-traumatic stress disorder and attention deficit hyperactivity disorder. Physical illnesses linked to bipolar disorder include  diabetes, heart disease, migraines and obesity.

To date, the NIMH experts say, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy, as well as steady self-monitoring of physical and mental health.

Adapted from materials published by the National Institute of Mental Health. For more information on bipolar disorder, click here.