Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Bipolar Disorder

Dr. Art Dingley

Bipolar illnesses are cyclical mood disorders. Years ago, they were called “manic depression”. There are three general types of bipolar illness, although there many individual variations.

The first is called Cyclothymia. This is bothersome, but not severe. A person with Cyclothymia has long spells of mild depression and long spells of elevated, expansive, or irritable mood called hypomania. Hypomania is characterized by impulsivity, increased energy, talkativeness, and decreased need for sleep. These moods are lengthy and change slowly.

A second type of bipolar illness is called Bipolar I Disorder. This is characterized by at least one episode of mania. A person with Bipolar I Disorder may, or may not, have episodes of depression. During a manic episode, the individual becomes grandiose, euphoric, or markedly irritable. She may be physically agitated and may not sleep. The individual will talk constantly, jumping from topic to topic, and may be easily distracted. She may become impulsive and behave in uncharacteristic ways, spending money foolishly, taking risks, and engaging in promiscuous sex. Although a manic person may have big ideas, she rarely actually gets anything done, because she is disorganized and distractible. A manic person may become delusional and hallucinated. An episode of mania lasts for at least seven days. This is a very important point: Bipolar disorder has nothing whatsoever to do with “mood swings” or “freaking out”, or “going off on people”. These rapidly shifting, and short-lived, moods are always caused by some other kind of difficulty. The average number of mood episodes experienced by a person with Bipolar I Disorder is four episodes in ten years. Even in “rapid cycling” Bipolar I Disorder, the number of episodes is only about four per year.

Bipolar I Disorder is a severe, persistent, and often disabling mental illness. An episode of mania usually requires hospital care, often involuntarily. Even between episodes of mania and depression, these folks often have great difficulty maintaining employment and getting along with others. Anxiety and substance abuse are common in people with this illness. Ten to fifteen percent of people with Bipolar I Disorder commit suicide.

The onset of Bipolar I Disorder is most often in the third decade (between the ages of 19 and 29). Men and women are affected equally often, although the first episode in men is apt to be mania and the first episode in women is apt to be depression. Only about one percent of the population has Bipolar I Disorder. Genetics plays some role in this illness because we know that an identical twin, raised separately, will have a higher likelihood of bipolar disorder if the other twin has it.

The third type of bipolar illness is called Bipolar II Disorder. This is characterized by episodes of severe depression and episodes of hypomania. The episodes of depression must last for at least two weeks and the hypomania for four days. Again, we are not talking about “mood swings” where people experience sudden sadness, anger, irritability, energy, or euphoria which “come out of the blue” and go away in a few hours. The two weeks of depression consists of sadness (or lack of interest), with interrupted sleep, decreased energy, inability to concentrate, lethargy (or agitation), disrupted appetite, and sometimes thoughts of death. An episode of depression in someone with Bipolar II Disorder may require hospital care to prevent self harm. On the other hand, people with Bipolar II Disorder may enjoy their episodes of hypomania. They can be fun to be around as long as they are not irritable. Their mood is elevated or expansive, they sleep less, experience a surge of energy, and may get a good deal accomplished. Hypomanic people are not disorganized and do not become psychotic.

Bipolar II Disorder is also a severe and potentially disabling mental illness. Although most people with Bipolar II Disorder feel well between mood episodes, about 15 percent continue to have interpersonal and occupational difficulties on a continuous basis. Fortunately, Bipolar II Disorder is very uncommon: only about one half of one percent of the population has this illness. Unlike Bipolar I Disorder, Bipolar II Disorder may be more common in women. This makes sense because depression is the hallmark of Bipolar II Disorder and, as we will see in a future column, depression itself is much more common in women.

There are some things which make bipolar illnesses worse. Taking medicine inconsistently always makes it worse. Bipolar disorders are chronic, relapsing illnesses. Most people with bipolar illness need to take medicine all the time, not just when they feel depressed or manic or irritable. Drugs and alcohol always make bipolar illnesses worse. Stress from poverty, unemployment, loss of relationships, and physical illness also contributes to relapse.

How are bipolar illnesses treated? Recovery from bipolar illness requires giving up drugs and alcohol. Safe, adequate housing is crucial. Next, the bipolar patient must pay careful attention to her sleep cycle and her physical health. Working at least part time is very important to recovery, and this has been convincingly demonstrated by research. As with most mental illnesses, having a supportive family is a big advantage on the road to recovery. Patients must learn to recognize the signs of relapse and take action to head off a mood episode by working with their psychiatrist to keep medicines working properly. Taking medicine consistently is critical to recovery. Very often, people with a bipolar illness need to take more than one medicine. All too often, people with bipolar illnesses stop taking medicine between mood episodes in the mistaken belief that, although they used to be sick, they are “all better” now. Wrong. Once a patient is able to work with her doctor to manage her illness, hospital care is rarely necessary and most people with bipolar illness do very well.

Over the past five or ten years, bipolar disorder has been hugely over-diagnosed in America. This diagnosis du jour phenomenon is nothing new. In the eighties, it was “multiple personality disorder” and “recovered memories”. In the nineties, it was Attention Deficit Disorder. Fortunately, mainstream psychiatry never jumped on any of those bandwagons either. The rush to be diagnosed “bipolar” has been driven by several things. First, the diagnosis may qualify for disability payments. Second, some clinicians have become extremely sloppy about documenting the diagnostic criteria for the bipolar disorders. Third, some drug companies have begun a campaign to convince physicians that bipolar illness is a “spectrum disorder”, that you can have “a mild case of bipolar disorder.” And, you guessed it, their expensive medicine should be prescribed for it. Doctors know that, like all effective medical treatments, medicines for bipolar disorder carry a small, but significant, risk of side effects and should be reserved for people who really need them.

In future columns, we’ll take a look at some psychiatric problems which are easy to confuse with bipolar disorders, but are treated quite differently.

Dr. Art Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He may be contacted at adingley@fchn.org.

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