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What is Bipolar Disorder?

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by Mary Moonen, LCSW, CAP

This disorder was formerly called Manic Depression, but is now referred to as Bipolar Disorder. Bipolar Disorder is a mood disorder that describes a person who is suffering from severe mood swings; usually alternating between episodes of feeling depression and then having an extreme shift in their mood called “manic” episodes. This is believed to be caused, at least in part, to a chemical imbalance of the neurotransmitters in the brain. The term bipolar can be thought of “polar opposites” in the generic sense, although some people have what is called “Unipolar”. These different names can be confusing for lay people as well as professionals, so I have laid out some basic concepts.

Most of the symptoms described are from what clinicians refer to as the “DSMIV”. This was developed by The American Psychiatric Association: Diagnostic and Statistical Manual of Mental Health Disorders, Fourth edition, Text Revision, 2000. This manual is meant for all clinicians to use as a tool to classify various disorders, help clinicians be articulate when talking about conditions, and keep consistency with vocabulary. It also helps determine what, if any, treatment is needed. These categories and codes are also used in getting reimbursement for services when they are medically necessary. It is important to keep in mind that this is a tool and not the only means to diagnose conditions.

According to the DSM, there are different types of mood disorders which are classified as Bipolar Disorders:

  • Bipolar I
  • Bipolar II
  • Mixed episodes, with and without psychotic features
  • Cyclothymia

Among mood disorders, there is also depression, anxiety, and what is referred to as “Unipolar” disorders. Unipolar means that a person only experiences symptoms that do not alternate, or “cycle.”

Part of the challenges of making a diagnosis is that many symptoms overlap. It takes some time and a thorough assessment to help “tease out” the diagnosis. I explain it to people as the equivalent of figuring out whether they may have the common cold or the flu? It often takes a psychiatrist, as well as a therapist, and input from important sources to piece it all together.

Bipolar I – This is what one may typically see in a movie or receives actual media attention by someone who has ended up having some type of “outburst or has done something bizarre or illegal.” When a person is in a full blown manic state, they may feel completely invincible. They are elated, grandiose, and feel on top of the world. Sometimes they think they are much smarter than their actual IQ. They may act silly or laugh inappropriately.

The person experiences many more “manic states” and the manic symptoms can get so severe that the person has grossly inappropriate behavior, delusions and, in some cases, can even develop a full blown psychotic disorder. For example, they may have delusions that are religious in nature and become convinced they have special powers. They may become so paranoid that they think the phone wires are tapped. They may go on incredible spending sprees that can lead them to financial ruin. Some may be hyper sexual and engage in high risk activities; such as, having affairs or unprotected sex. Their behavior can cause them to be arrested or admitted to the psychiatric unit.

Bipolar II – is a type of bipolar that is characterized by the person experiencing many more depressive states. When they cycle into a manic state, it is not to the same degree of intensity as Bipolar I.

They experience “hypomanic” episodes that are often not seen as a problem for themselves or others. They have feelings of being elated, very driven, perhaps hyper verbal, gregarious, etc., but again, not to the point where others feel there is any problem. This is a most tempting place for a person with this disorder as they may feel extremely well and healthy. They are having fun, perhaps exercising, excelling in their studies or work, and are enjoying a social life.

However, when they get into a depressive cycle, it is generally much deeper than the person who has Bipolar I. They often become despondent and filled with excessive guilt for things they imagine they have done to others. They may feel as though they are a burden to others and their self talk is extremely negative and self-berating. They often feel suicidal and may actually get to the point where they make plans, have a method, and carry out their plans tragically.

Mixed Episodes – classifies a person who experiences a cluster of symptoms from both depression and manic simultaneously. This is a very dangerous state since the person is at higher risk for self harm or suicide. It is perplexing to the individual who has the disorder.

When someone is in a manic state, they often describe feelings of being elated, grandiose, or invincible. They may feel as though they do not need to sleep, or sleep very little, yet still feel refreshed. Sometimes, they can get so wrapped up into projects, whether in school, work, or creative arts, that it feels as though they can’t stop. Some report they can’t contain their energy or enthusiasm. Some people make statements such as, “I feel like my brain is going 100 miles per hour”. They love this feeling as it can be quite exhilarating. This is one of the reasons that people don’t seek help. They may think, “I feel great! I don’t have a problem! Why are people concerned about me?”

People that have bipolar disorder are often gregarious and creative. They are multi-talented individuals who enjoy trying new things and aren’t afraid to take chances. This can be a double-edged sword because during this cycle they may be able to accomplish many things and receive accolades for their ability to go the extra mile. People are often attracted to their outgoing, gregarious, and adventurous personalities. They often hold positions of leadership because they are driven to complete a project. The major problem with these symptoms is that they can include high risk activities since they feel invincible. They talk too much and at a rapid pace. They do not have the ability to filter this. Others who may not know they have bipolar may see them as arrogant, haughty, and flat out annoying. These types of inappropriate behaviors can lead them to get fired from a job or have relationships that are strained. This is especially true for family members and close friends.

As the cycle continues, the person may experience days of having only a few hours sleep. This may lead to feelings of irritability. The person may seem to be snappy or have a reduced capacity to deal with stressors. In some cases, if there is not any intervention to these feelings of irritability, this can escalate to feelings of rage and wanting to hurt others or themselves.

In contrast, when a person experiences a depressive state, they may show total apathy for doing basic activities of daily life including self-care. They may sleep excessively, overeat, under eat, appear to be extremely unmotivated for any activities, even those that have given them pleasure in the past. Their grooming habits may become impaired and disheveled. They may have difficulty even showering or brushing their teeth. They are likely to isolate themselves and not contact friends, family, or people in the community. They report thoughts of wanting to hurt themselves. They will say things such as, “I wish I just wouldn’t wake up” or “if I were to get hit by a car, I wouldn’t care”. Some people get so desperate that they make an attempt to kill themselves. Some carry the plans through resulting in death by suicide.

ONE VERY IMPORTANT NOTE – Sometimes when people are coming out of a very depressed state they are actually at higher risk for suicide. The person has a higher level of energy; therefore, having the actual energy to follow through on plans including self-harm. Another potential factor is that they are feeling as though they can finally decide what to do. They may appear happier, calmer, etc. This is NOT always a sign of improvement. It could mean that they have made their decision to complete the act.

Some Suicide Warning Signs
Have you ever heard someone say two or more of the following?

  • Life isn’t worth living
  • My family (or friends or girlfriend/boyfriend) would be better off without me
  • Next time I’ll take enough pills to do the job right
  • Take my prized collection or valuables — I don’t need this stuff anymore
  • Don’t worry, I won’t be around to deal with that
  • You’ll be sorry when I’m gone
  • I won’t be in your way much longer
  • I just can’t deal with everything — life’s too hard
  • I won’t be a burden much longer
  • Nobody understands me — nobody feels the way I do
  • There’s nothing I can do to make it better
  • I’d be better off dead
  • I feel like there is no way out
  • You’d be better off without me

Have you noticed them doing one or more of the following activities?

  • Getting affairs in order (paying off debts, changing a will)
  • Giving away articles of either personal or monetary value
  • Signs of planning a suicide, such as, obtaining a weapon or writing a suicide note

This following citation was found on the blog, The World of Psychology, by Dr. John Grohol. (Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues — as well as the intersection of technology and human behavior — since 1992. Dr. Grohol sits on the editorial board of the journal, Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine).

I think I may have bipolar, what should I do? First, I recommend that you see a doctor that specializes in mental health, such as a psychiatrist. They have the most extensive training in diagnosing this disorder and other mental health issues as well as the most up to date information on what medications can be potentially helpful.

Learning about the disorder is most important. This does not mean you are crazy! It means you have an actual medical situation which may be due to an imbalance in the brain chemistry. Medication can help restore that balance and help you improve your abilities to function. Seeing a therapist can be beneficial. You can learn to monitor symptoms as well as develop healthy ways of coping and managing the disorder. It is very important to note that many people have a full recovery/remission of their symptoms by following and maintaining a plan of action. There are many famous, intelligent, creative people who have openly admitted to having this disorder or other mental health issues and have lived very successful lives. With the right interventions and treatment, you can get well!

If you are feeling suicidal – There is a hotline that is free of charge, is available 24/7, and is staffed by trained counselors who can help. Even if you are NOT at the stage where you have planned any specific actions, they will be happy to listen and support you as a way of preventing your thoughts/moods from getting worse.

1-800 273 TALK(8255)

What can I do for my loved ones? – Safety First!! If your loved one states they are feeling suicidal, ask them if they would be willing to go get an evaluation at a one of the local crisis centers or the ER. If they are willing, and you feel safe for both of you, you could offer to drive them and stay with them. If there is any doubt, whatsoever, that you cannot safely transport, call 9-1-1.  When someone is agitated, they may try to jump out of a moving vehicle, run away, grab the steering wheel, endanger both of you as well as others on the road.

Family members have told me they don’t want to call 911. They say “They don’t want to make a scene” or “They don’t want to embarrass the person”. “I would be afraid of what the neighbors would think” or “My loved one will never forgive me”.

Here is my take on it… I would rather have a loved one ALIVE, even if they are mad at me forever. If the neighbors learn there is an issue, instead of trying to hide it or feel shame, you can always say the truth: “We are having some issues with our loved one; please keep them in your thoughts and prayers. We had an intervention to get them to a safe place.”  This is usually sufficient and stops any rumors or prodding. You have shown a calm demeanor and not one of shame. I would much rather be able to look at myself in the mirror and feel that I have done my best to help someone get the help they need, and NOT take their life, than allowing my ego, shame, or embarrassment to get in the way.  Not assisting a loved one, who ends up taking their life, is a burden I pray to never have to live with.

Loving someone with a mental health disorder can be tricky. On one hand, you want to be supportive.  At other times, you may feel exasperated because the “experts” in the field dismiss their willingness to get help for themselves or, when you are concerned for the loved one’s safety, you are told “Your loved one said they were OK and they are not suicidal at this very moment, so we cannot take them into treatment”. At other times, the loved one may be very resistant, resentful of your attempts to intervene, and in rare cases, combative. You may want to be their cheerleader and help them stay out of depression, but to no avail. You may become frustrated with your efforts to help, feel unappreciated, and angry because the loved one isn’t doing all that he or she could be doing to help themselves.

You can ask to be a part of their treatment plan/ care team. If the person agrees, you can accompany them to a doctor’s appointment and allow the doctor to discuss treatment methods, medications, and their specific recommendations with both of you. Keep in mind though, that the most important thing is for the client/patient to feel completely empowered. Do not try to control or take over the situation. The more the patient can understand they have a disease, admit it, and accept treatment, the better their chances of recovery. Hand holding, care giving, or enabling means doing for the person what they can and should be doing for themselves unless, of course, they are so grossly impaired they need an intervention for their safety or the safety of others.

There are many positive things you can do to help yourself. Reading up on Bipolar Disorder is most helpful. Learning what other families and friends have experienced can make you feel less alone and isolated. Gaining knowledge can help us educate people that we are talking about a real medical disease. We can also remove the stigma of the diagnosis.

Most of all, take excellent care of you. Do not let yourself get burnt out or depleted. Make sure you are getting plenty of sleep, eating well, and exercising. Self care puts you in a position where you can help. Not only is it important to take care of you, this is also great modeling for wellness.

The following links are available for further reading:

About the Author: Mary Moonen is a Licensed Clinical Social Worker and Certified Addiction Professional. For the past 20 years, she has served in the Human Services field working in a wide variety of settings: homeless shelters, alcohol and drug rehabilitation, nursing homes, and assisting people with disabilities or victims of trauma. She is passionate about our first responders including 911 operators, firefighters, paramedics, and law enforcement officers to ensure they have access to Critical Incident Stress Management.

In 1989, her dear friend, who had been a victim of abuse for several years, tragically ended her life. As a survivor of a close friend’s suicide, Mary is acutely aware that many people struggle with depression and abuse issues and has been a strong advocate for suicide prevention and awareness. In the past two years, she has sat on the Board of Directors for her local chapter of American Foundation for Suicide Prevention. She became a singer/songwriter in her teenage years, playing guitar, piano, and vocals. Mary wrote “Crying in the Night” in memory of this friend who died by suicide.

Mary is proficient in American Sign Language and has held a position of Deaf Services Coordinator for five years. She conducts workshops on the American Disabilities Act, was a clinician for First Step of Sarasota, Inc., a drug and alcohol rehabilitation center, and has earned a Brown belt in Shaolin Kempo Karate. She has taught many self-defense workshops in her community and tailors her presentations for people with disabilities, teaching the many ways people can prevent crime or protect themselves regardless of physical limitations.

For more information or to book her for your next conference or workshop, contact Mary Moonen

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