Bipolar disorders

bipolar disorders

Bipolar disorders involve clinically significant shifts in mood, energy, and activity level. These shifts include episodes of mania or hypomania (elevated or irritable mood with increased energy/activity) and—often, but not always—episodes of depression.

The key feature that distinguishes bipolar disorders from depressive disorders is the presence of mania or hypomania.

bipolar I and bipolar II

Note that here we discuss bipolar disorder in general terms, but that is a distinction between two types:

• Bipolar I disorder, which is characterized by at least one manic episode and often some depression (though not required), and
• Bipolar II disorder, which is characterized by at least one hypomanic (less severe) episode and accompanied by depression.

Mania and hypomania

A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased energy or goal-directed activity, lasting at least 1 week and present most of the day nearly every day (or any duration if hospitalization is necessary). Symptoms often include:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feeling rested after only a few hours)
• More talkative than usual or feeling pressure to keep talking
• Racing thoughts or rapid topic shifting—a “flight of ideas”
• Distractibility
• Increase in goal-directed activity (socially, at work/school, or sexually) or psychomotor agitation
• Risky, high-consequence behavior (e.g., sudden investing sprees, gambling, impulsive travel, reckless driving, risky sex)

For example, a person in mania may suddenly launch a “can’t-fail” business, stay up all night building a new app, impulsively buy expensive items online, or make high-risk financial moves (like day trading or crypto investing) with unrealistic confidence.

Hypomanic episode

A hypomanic episode includes similar symptoms, but is less severe and lasts at least 4 days. Hypomania can still lead to harmful decisions (especially financially or relationally), but it typically does not involve the same degree of impairment as mania and does not require hospitalization on its own.

Risk Factors for Bipolar Disorder

Bipolar disorder is considerably less frequent than major depressive disorder. In the United States, 1 out of every 167 people meets the criteria for bipolar disorder each year, and 1 out of 100 meet the criteria within their lifetime (Merikangas et al., 2011). The rates are higher in men than in women, and about half of those with this disorder report onset before the age of 25 (Merikangas et al., 2011).

Around 90% of those with bipolar disorder have a comorbid disorder, most often an anxiety disorder or a substance abuse problem. Unfortunately, close to half of the people suffering from bipolar disorder do not receive treatment (Merikangas & Tohen, 2011). Suicide rates are extremely high among those with bipolar disorder: around 36% of individuals with this disorder attempt suicide at least once in their lifetime (Novick, Swartz, & Frank, 2010), and between 15%–19% complete suicide (Newman, 2004).