Facts About Bipolar Illness
- More than 2 million Americans have manic-depressive illness. It is extremely distressing and disruptive to their lives.
- Like any serious illness, bipolar disorder also creates problems for spouses, family members, friends, and employers.
- Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.
- Bipolar disorder tends to run in families, and there is strong evidence that it is inherited. However, despite ongoing research efforts, a specific genetic defect associated with the disease has not yet been identified.
- Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. The symptoms can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.
The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes, that is specific to that individual, but predictable once the pattern is identified. Research studies suggest a strong genetic influence in bipolar disorder.
Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment.
Effective treatment is available for bipolar disorder. Without treatment, marital breakups, job loss, alcohol and drug abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance with treatment. Most individuals with bipolar disorder do not perceive their manic episodes as needing treatment, and they resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode, and don't want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance abuse problems.
Bipolar disorder, often referred to as manic depression, is a serious mental illness characterized by severe mood swings. Bipolar individuals frequently have difficulty maintaining interpersonal relationships and may suffer from impaired cognition, decreased ability to function in social settings and exhibit reckless behavior.
The extreme mood swings experienced by people with bipolar disorder are known as mania and depression. During the manic phase, bipolar individuals tend to exhibit an extraordinary amount of energy. They may even experience a state of euphoria, believing themselves to have special powers or abilities; they may also engage in promiscuous behavior or go on extravagant spending binges. In this state, the bipolar person may feel no need to sleep or eat.
The depression phase is just the opposite; the individual may feel a profound sense of sadness or worthlessness and may lose interest in everyday activities. The bipolar patient in the depressive state may be unable to sleep or may sleep too much. Without treatment, it is common for people with bipolar disorder to have suicidal tendencies.
Why is bipolar disorder so often misdiagnosed?
It is not unusual for a person to spend ten years or more seeking treatment for the symptoms of bipolar disorder before the condition is diagnosed; over 70% of bipolar patients are initially diagnosed with some other mental health disorder. The signs of bipolar disorder can be tricky to identify, even for highly-trained mental health professionals because many of the symptoms are consistent with those of other psychiatric disorders.
Diagnosis is especially difficult because the majority of patients who seek treatment only do so when they are in the depressive phase. According to clinical psychiatrist Michael Aronson, MD, a professional consultant for WebMD, individuals who are manic tend to feel exceptionally good during this part of the cycle and do not believe that anything is wrong, and because of this, they do seek treatment unless they are virtually forced to do so by a concerned family member or associate. Unfortunately, clinicians too often rely on the patient’s description of his or her own symptoms to form a diagnosis, often ignoring the peripheral details that may seem irrelevant to the patient, but which may provide a better insight to the true cause of the symptoms.
What can be done to prevent this?
In a study discussed by Michael D. Anestis, M.S., in his article, “Misdiagnosing Bipolar Disorder,” the researchers found that psychotherapists who followed a standardized approach to diagnosing mental health issues were able to more accurately identify the source of the problem.
By conducting a structured interview with the patient and asking a series of directed questions, as outlined in the DSM-IV-TR (the standard diagnostic manual for psychotherapists), a clinician is much more likely to identify the criteria which would lead to a diagnosis of bipolar disorder. The authors of this study conclude that failure to correctly identify bipolar disorder is due in part to insufficient information gathering, and in part to the particular philosophy of the clinician. In order to eliminate this problem, they suggest that a standardized approach to diagnosis be employed using the criteria described in the DSM-IV-TR.
With early and accurate detection of bipolar disorder, the mental health professional is better able to work with the patient to develop an appropriate treatment plan, permitting the bipolar individual to live a much more fulfilling life.
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Bipolar Disorder, (or Manic Depression as it should still be called), has had its share of media attention lately, with stories of Brittney Spears and others. About one in 70 people are affected by Bipolar Disorder and it does not discriminate -- men and women, all races, all socio-economic levels, and even all ages. Most often it first shows up in the late teens or early 20's.
We know from studies of identical twins, that for about 70% of twins, when one is Bipolar, the other also manifests the disorder. What about the other 30%? Bipolar Disorder is a genetic pre-disposition - that is, you are born with the vulnerability - often one or more blood relatives have it -- but you may not show any symptoms until it is triggered by some other factor. Triggering factors can be childhood abuse, a severe emotional or physical trauma at any time of life, a catastrophic loss, a poor diet, exposure to toxins, drug use, ANTIDEPRESSANTS (one of the most common triggering factors), high stress lifestyles, or prolonged lack of sleep. All of these, and more, can kick of the cycle of Bipolar mood swings ranging anywhere from severe debilitating depressions lasting from weeks to months at a time - to hypomanic highs (feeling energized, powerful, creative, needing little sleep, super sexual, productive, talkative and outgoing and fearless) to extreme mania for some (all the symptoms just mentioned, plus lack of judgment, high risk behaviors, delusions, grandiosity, and even paranoia and hallucinations).
As you can see, this is not a light-weight disease. It causes countless suicides, domestic violence, financial ruin, broken homes, and legal problems for people that in their "normal" state of mind are caring, responsible, intelligent members of society, parents, and spouses.
Those who are more fortunate, manage to use the more positive aspects of the Bipolar high (hypomania- or "low level mania") to their advantage. Billionaire Ted Turner is a good example of this.
One of the biggest difficulties lies in the psychological issues that exist, apart from the neurological effects of the disorder. For example, a woman with a childhood history of being sexually abused by a family member, who has never fully resolved that trauma and later develops chronic symptoms of Bipolar Disorder. The latent trauma is a constant, unconscious source of emotional pain, low self-esteem, self-hatred, shame, guilt and anxiety. All of these emotions and negative thoughts contribute a great deal to both the manic and depressive episodes of the disorder.
Both depression and mania can be seen as expressions of deep inner pain, inadequacy and shame. When depressed this is obvious. But when manic, the person with unrsolved self-esteem issues may seem to be confident, powerful, assertive, spiritually tuned-in, artistic, courageous, invulnerable perhaps. And some of these extraordinary qualities may be quite authentic while they last. Nobody would ever guess that at their core, they feel totally inadequate and worthless. And in the hypomanic or manic state the sufferer is also usually completely unaware of their own feelings of emptiness or shame. It has an element of narcissism to it - the grandiose sense of power that comes with mania. It's not the person's fault. By now they are on auto-pilot. The brain has caught fire and is burning out of control. Only medication or plenty of time will bring the person back to earth. Sometimes they may reach a point of total exhaustion before they collapse, and then the depression hits. It's a double wammy. Now they are depressed, feeling deep shame and worthlessness, and have to deal with whatever chaos they may have created while manic. A living hell for many people.
Once a person develops the full blown symptoms of Bipolar Disorder, the medical profession - the mainstream psychiatric view - is that it is a chronic, life-long illness with no cure - and only medication and a healthy lifestyle can help you to manage the symptoms. Resolving the major underlying issues however (such as childhood abuse traumas), low self-esteem, self-defeating or self-critical thoughts, getting out of abusive relationships, and so on, can go a long way towards alleviating many of the severe mood swings of Bipolar Disorder. Medications, at some level, are usually necessary - but I have seen some people learn to thrive without them. In the midst of a crisis however, medications are often the quickest, safest and most effective way to get things back under control. Whatever approach people choose, it is very important to understand the emotional issues both past and present all play a role in creating emotional instability and mood swings.
Psychotherapy (weekly talk-therapy), bipolar support groups, energy psychology techniques such as EFT, and mind-body practices such as yoga, tai chi and meditation, as well as healhty diet, supportive relationships, adequate sleep, exercise and the right nutritional supplements, can all make an enormous difference for those with Bipolar Disorder.
Abstract
BACKGROUND:
Given the observed association between panic disorder and bipolar disorder and the potential negative influence of panic symptoms on the course of bipolar illness, we were interested in the effects of what we have defined as "panic spectrum" conditions on the clinical course and treatment outcome in patients with bipolar I (BPI) disorder. We hypothesized that lifetime panic spectrum features would be associated with higher levels of suicidal ideation and a poorer response to acute treatment of the index mood episode in this patient population.METHODS:
A sample of 66 patients with BPI disorder completed a self-report measure of lifetime panic-agoraphobic spectrum symptoms. Patients falling above and below a predefined clinical threshold for panic spectrum were compared for clinical characteristics, the presence of suicidal ideation during acute treatment, and acute treatment response.RESULTS:
Half of this outpatient sample reported panic spectrum features above the predefined threshold. These lifetime features were associated with more prior depressive episodes, higher levels of depressive symptoms, and greater suicidal ideation during the acute-treatment phase. Patients with BPI disorder who reported high lifetime panic-agoraphobic spectrum symptom scores took 27 weeks longer than those who reported low scores to remit with acute treatment (44 vs 17 weeks, respectively).CONCLUSIONS:
The presence of lifetime panic spectrum symptoms in this sample of patients with BPI disorder was associated with greater levels of depression, more suicidal ideation, and a marked (6-month) delay in time to remission with acute treatment. Alternate treatment strategies are needed for patients with BPI disorder who endorse lifetime panic spectrum features.- Facts about bipolar disorder
- What is a manic episode?
- Descriptions of mood states
- Features of a depressive episode
- Features of a manic episode
- Factors that prevent early intervention
- Treatment of bipolar disorder
- Treatment issues
- Resources for information and support
- Other psychological topics
