Bipolar Disorder: Managing Extreme Highs and Lows

Bipolar and related disorders now have a chapter of their own in the updated American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5): ‘Bipolar and Related Disorders’.

An estimated 1 in 50 (1.8%) Australian adults experience a bipolar disorder each year (Black Dog Institute 2018).

The exact causes of bipolar disorders are not yet clear. However, there is evidence to suggest that some people have a genetic disposition to developing bipolar disorder (Sane Australia 2016).

What is Bipolar?

In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorders are defined as a group of brain disorders that cause extreme fluctuations in a person’s mood, energy, and ability to function (DSM-5 quoted by Truschel 2019).

People with bipolar disorder will experience periods of mania and depression.

During mania, feelings of excitement, overactivity, delusions and euphoria will be present. In depressive periods, a person will feel sad and hopeless (Truschel 2019).

The term bipolar reflects the nature of the condition: a fluctuation between extreme highs and lows. These extreme emotional states may occur at distinct times or periods, categorised as manic, hypomanic, or depressive (Truschel 2019; APA 2017).

People with bipolar disorders will have periods of regular moods as well. There are treatments available for bipolar disorders; people with these conditions are still able to lead full and productive lives (APA 2017).

Types of Bipolar Disorder

Bipolar I Disorder

• A manic-depressive disorder;
• It can exist both with and without psychotic episodes.

(Truschel 2019)

Bipolar II Disorder

• Consists of both depressive and manic episodes, which will:
  • Alternate between states;
  • Are typically less severe; and
  • Generally, do not inhibit a person’s ability to function.
• It is not unusual for people who have bipolar II disorder to have co-occurring mental health conditions such as anxiety disorder.

(Truschel 2019; APA 2017)

Cyclothymic Disorder

• Is milder, consisting of mood swings;
• Cyclical;
• Causes brief but frequently occurring episodes of hypomania and depression.

(Truschel 2019; APA 2017)

As per the DSM-5, there are five possible diagnoses for adult bipolar disorder:

• Bipolar I disorder;
• Bipolar II disorder;
• Cyclothymic disorder;
• Substance-induced bipolar disorder;
• Bipolar disorder associated with another medical condition;
• Bipolar disorder not elsewhere classified.

(DSM-5 quoted by Purse 2019)

Bipolar Disorder DSM-5 Diagnostic Criteria

The first step to diagnosing bipolar disorder is to seek the opinion of a mental health professional.

To be considered as ‘manic’, the elevated, expansive or irritable mood alongside increased activity and energy must last for at least one week and be present most of the day, nearly every day (DSM-5 quoted by Black Dog Institute 2018).

Mania will be severe enough to disrupt work, family life, social life, and daily responsibilities (APA 2017).

Manic Period

During mania, three or more of the following must be present:

• Increased self-esteem or grandiosity;
• Decreased need for sleep;
• Increased talkativeness;
• Having racing thoughts;
• Being very easily distracted;
• Increased goal-directed activity;
• Increased psychomotor agitation;
• Engaging in risky activities that may have the potential for painful consequences.

(DSM-5 quoted by Truschel 2019)

A hypomanic episode is quite similar to a manic episode. However, the symptoms will be less severe. Symptoms only need to last four days to be considered a hypomanic episode.

Hypomanic symptoms do not lead to the major problems that mania is associated with. Generally, a person will still be able to function (APA 2017).

Depressive Period

A depressive period is a period of two weeks in which a person presents at least five of the following:

• A depressed mood during the day, nearly every day;
• A loss of interest or pleasure in activities;
• Significant weight loss or change in appetite;
• Carrying out purposeless movements, such as pacing or tapping;
• Being fatigued or showing a loss of energy;
• Feelings of guilt or worthlessness;
• Having a reduced ability to concentrate;
• Indecisiveness; and
• Suicidal ideation, plan or attempt.

(DSM-5 quoted by Truschel 2019)

Bipolar Disorder Treatment

Bipolar requires long-term management. It is generally treated with a combination of medications - such as mood stabilisers, antidepressants or antipsychotics - as well as counselling, psychotherapy or community support (Healthy WA n.d.; Beyond Blue n.d.; Smith 2019).

The impact bipolar disorder can have on a person’s life should not be underestimated. Suicide risk is significantly higher among people who are living with bipolar disorder (APA 2017). Thankfully, there are treatments widely available for people who have bipolar disorders.

If you or someone you know needs help now, call Lifeline on 13 11 14. If someone is in immediate danger, call Triple Zero (000).

Additional Resources

• DSM 5 Fact Sheets, https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-fact-sheets
• Sane Australia, https://www.sane.org/information-stories/facts-and-guides/bipolar-disorder
• Black Dog Institute, https://www.blackdoginstitute.org.au/clinical-resources/bipolar-disorder/what-is-bipolar-disorder

References

• American Psychiatric Association 2017, What Are Bipolar Disorders?, APA, viewed 5 December 2019, https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
• Beyond Blue n.d., Bipolar Disorder, Beyond Blue, viewed 5 December 2019, https://www.beyondblue.org.au/the-facts/bipolar-disorder
• Black Dog Institute 2018, What is Bipolar Disorder?, Black Dog Institute, viewed 5 December 2019, https://www.blackdoginstitute.org.au/clinical-resources/bipolar-disorder/what-is-bipolar-disorder
• Diagnostic and Statistical Manual of Mental Disorders: DSM-5, Arlington, VA, American Psychiatric Association.
• Healthy WA n.d., Bipolar Disorder, Healthy WA, viewed 5 December 2019, https://healthywa.wa.gov.au/Articles/A_E/Bipolar-disorder
• Purse, M 2019, ‘Changes in the DSM-5 on Bipolar Disorder’, Very Well Mind, viewed 5 December 2019, https://www.verywellmind.com/what-is-the-dsm-5-379955
• Sane Australia 2016, Bipolar Disorder, Sane Australia, viewed 5 December 2019, https://www.sane.org/information-stories/facts-and-guides/bipolar-disorder
• Smith 2019, 'Bipolar Disorder Treatment', Psycom, viewed 5 December 2019, https://www.psycom.net/bipolar-disorder-treatment
• Truschel 2019, ‘Bipolar Definition and DSM-5 Diagnostic Criteria’, Psycom, viewed 5 December 2019, https://www.psycom.net/bipolar-definition-dsm-5/