Understanding Bipolar Disorder

Are you plagued by significant mood swings that surprise even you? Do you feel as if your emotions have a life of their own, meaning that simple anger can escalate into rage in minutes?  Is it common for you to feel either boundless bursts of energy or debilitating fatigue?  Among my clients, one of the most widely misunderstood and feared diagnoses is Bipolar Disorder.  Let’s understand what it is, its’ symptoms and treatment options. 

Simply put, the definitive feature of Bipolar Disorder is the cycling of polar opposite emotions (think ecstasy/despair or rage/meekness).  Humans experience a broad spectrum of emotions, although individuals with Bipolar Disorder report experiencing cycles of emotional extremes.  Many individuals report feeling “crazy” because, despite their best attempts to balance their thoughts and feelings, their emotions frequently overpower their thoughts and drive unwanted behaviors.  A diagnosis of Bipolar Disorder is not based upon a single snapshot in time but rather, observation of patterns of behaviors characteristic of both depression and mania.  To receive this diagnosis a myriad of diagnostic criteria must be met.  Let’s briefly examine the symptoms of depression and mania.

Depression

I doubt that anyone who has experienced life is unfamiliar with feeling depressed. Today the term depression will be limited to the experience of an overwhelming sadness and even despair regarding the past and present as well as a profound sense of hopelessness regarding the future.  Behaviors associated with depression can include sleep disruption, appetite impairment (too much or too little) and inability to focus and/or concentrate.  Often an individual may question whether life is worth living and possibly become 
actively suicidal.  Emotions may range from irritation to rage, 
increased tearfulness to feeling  “numb.”  Social isolation frequently occurs, as does a noticeable disengagement from  once pleasurable activities.  For example, the avid runner may stop all physical activity.  Physical symptoms like unexplained pain, gastrointestinal distress and migraines may appear without obvious triggers. 

Mania

The polar opposite of depression is mania.  Some hallmarks of mania include: scattered thoughts (so many wonderful ideas that you cannot focus on just one) and heightened creativity (many projects are begun but not completed).  Speech may be pressured (you interrupt others while they are speaking because you have too much to say and no time to waste) and emotions run high (bouts of uncontrollable laughing or crying).  Sleep and appetite may become erratic based upon elevated energy levels.  There is also frequently an increased motivation to engage in reckless behaviors like speeding, daring sports and/or illegal activity without
considering the possible consequences. Physical symptoms may include a sense of restlessness (feels like an engine is running inside of you), irritability (shorter than normal fuse), agitation and increased anxiety (nervousness, racing heart, sweaty palms & pacing).

Cycles

A qualification of Bipolar Disorder is an observed history of both mania and depression. An individual’s transition from depression to mania and vice versa is known as cycling.

While some individuals may experience both mood states at the same time, that is not common. Cycles are directly related to brain chemistry and therefore are specific to each person.  A cycle may occur several times a day to once per year.  Again, this is highly dependent on the individual.  Often my clients will report feeling restless or agitated and/or significantly fatigued prior to the onset of a cycle. An increased vulnerability to self-medicate through alcohol, food, illegal drugs, promiscuity or gambling may occur in an attempt to mask these uncomfortable feelings during a transition.

Origins

Bipolar Disorder is a physiological imbalance within the brain.  Some research suggests that there may also be structural abnormalities within the brain. Research findings also predict a genetic contribution among blood relatives.  There is an equal likelihood of occurrence among males and females.  Stress, significant life events and a history of significant childhood trauma may also contribute to the development of Bipolar Disorder. 

Treatment Options

Clearly Bipolar Disorder is a dis-equilibrium in the naturally occurring neurochemicals within the brain.  Therefore a primary treatment consideration is effective medication management.  Psychiatrists specialize in highly specific medication protocols that are tailored to an individual’s symptom profile.  It is not uncommon to be prescribed a mood stabilizer as well as an antidepressant and perhaps an anti-anxiety medication.  As a patient, it is vital to develop an open and collaborative relationship with your psychiatrist in order to effectively manage your symptoms.
   

Therapy is the second component of treatment. Mood swings can be exhausting not only for the client, but also for those that they love.  Ongoing therapeutic support that combines identifying and then understanding the cycles and the accompanying risky behavioral responses is the first step in mood management.  The next step is learning and then implementing less risky behaviors as alternative coping strategies.  Research indicates exponentially greater success when a team approach to treatment is utilized.

An obstacle to treatment is often a client’s reluctance to forgo the manic cycle.  Although maladaptive, it had often served as motivation for task accomplishment as well as increased feelings of well being. Similar to the patient-psychiatrist relationship, the client-therapist relationship must also feel comfortable and collaborative.  A client’s treatment team often becomes an enduring relationship.

Conclusion

The stigma attached to Bipolar Disorder needs to be eradicated! The fears attached to being labeled “crazy” prevent far too many individuals who would benefit from treatment to seek it out.  Stereotypes of “crazy” within the entertainment industry have reinforced the stigma. Why?  Mania has been sensationalized!

The Oscar award winning film, Silver Linings Playbook has begun to challenge this stigma.  Bradley Cooper, Jennifer Lawrence and Robert DeNiro brought to life the real struggle of Bipolar Disorder within families.  Catherine Zeta-Jones, Robin Williams, Jean-Claude Van Damme and Jane Pauley are celebrities who have publicized their personal challenges in managing their cycles.  Their goal has been to “break down the stigma.” 

The diagnosis itself does not necessarily limit personal growth and success.  Once an individual understands and takes responsibility for their symptoms, effective management begins.  Refusing or halfheartedly following a treatment regime will ultimately impact relationship, professional and personal success. 

If this post has raised questions about yourself or someone you love, don’t delay – schedule an appointment with your physician and/or a licensed psychologist.  NOW is the perfect time!