Bipolar Disorder: What It Is and How It Manifests

The word "bipolar" often comes up in conversation about a mood that swings from one side to the other. Behind it is a specific psychiatric diagnosis, and it differs from ordinary ups and downs. Below is what is known about it.

What bipolar affective disorder is and what it is called

Bipolar disorder is a mood disorder with pronounced ups and downs. In psychiatry, one speaks of episodes: manic and hypomanic, depressive and mixed. The phases replace one another almost without the influence of external circumstances — directly or through lucid intervals, remissions, in which the person's psyche and personality traits recover.

• Type I — manic episodes lasting at least seven days or so severe that immediate hospital care is needed.
• Type II — depressive episodes and hypomania, a milder form of mania, without full manic episodes.
• Cyclothymia — hypomanic and depressive symptoms are milder and shorter; in adults they persist for at least two years, in children and adolescents — one year.
• Rapid cycling — four or more episodes of mania or depression per year.

Manic-depressive psychosis, BD, "bipolar": are they the same thing

For a century and a half the same illness has been called by different names: "circular psychosis," "madness in two forms," and later "manic-depressive psychosis." This term was introduced by the German psychiatrist E. Kraepelin. The name was recognized as not entirely accurate: psychotic disturbances occur in only a few, both types of phases are not always present, and the term itself is stigmatizing. Now people say "bipolar disorder," BD; in ICD-10 this is category F31. "Bipolar" is a colloquial abbreviation, "manic depression" is the old English-language name.

How manic and depressive episodes manifest

With elevated mood, a person feels very happy and excited or irritable and aggressive. There is a lot of energy, the need for sleep decreases, thoughts race, it is hard to concentrate, speech is fast and abundant. Self-confidence and a craving for risk grow, impulsive spending and actions unusual for the person occur. In severe cases there are hallucinations, delusions, a sense of threat.

With low mood — sadness, loss of interest in usual activities, loss of energy. Sleep and appetite are disturbed, concentration drops, feelings of worthlessness and hopelessness come, avoidance of people, thoughts of death or of harming oneself. Episodes last from several days to weeks; symptoms occur almost daily and for most of the day.

Why bipolar disorder occurs

The exact cause is unknown. The likelihood is higher if a parent, brother or sister has such a disorder. Among the factors cited are trauma or abuse in childhood, severe events — relationship problems, loss of a loved one, financial difficulties — use of drugs such as cannabis and cocaine, infection with the parasite Toxoplasma, and the structure and function of the brain. Heredity and environment are also discussed.

How bipolar disorder differs from personality disorder and ordinary mood swings

Bipolar disorder is classified as a mood (affective) disorder, not a personality disorder: during remissions the person's personality traits fully recover. It differs from ordinary mood fluctuations in duration and structure. An episode lasts days or weeks, symptoms occur almost daily, and between episodes there are periods of stability — weeks, months, years. The swings noticeably affect daily life. The picture resembles other mental conditions, so the diagnosis is sometimes not made immediately.

How the diagnosis is made and when to see a psychiatrist

The diagnosis is made by a psychiatrist, to whom a family doctor refers. The specialist asks about mood, behavior, health and family history, assesses mental state and, if necessary, orders examinations to rule out other causes. The reason for a conversation is extreme mood changes that persist for a long time or interfere with life. If help does not help, this is discussed with the psychiatrist.

Bipolar disorder in itself is not a reason to call an ambulance. Numbers 103 and 112 — if a person talks about suicide or about the intention to harm themselves, if there is a threat to harm another, if the condition is so severe that immediate hospital care is needed.

This material is for reference: it explains general concepts and does not replace consultation with a doctor, with whom a specific situation is discussed.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer