Bipolar Disorder

by Aziz Nashef, MA, Doctoral Candidate at the Massachusetts School of Professional Psychology

Bipolar Disorder, formerly known as Manic Depression, is a type of mood disorder that extends beyond the normal ups and downs of life. It is a serious medical condition and an important health concern in the United States. It is characterized by a clearly defined period whereby there is an abnormally and persistently elevated, expansive or irritable mood. This period must persist for at least one week and is called a manic episode, or mania. When mania occurs, it is often, although not always, followed by a depressive episode involving classic depressive symptoms.

Who is affected by it?

Bipolar Disorder affects more than 5.7 million American adults aged 18 and older annually. Twenty to thirty percent of adults diagnosed with Bipolar Disorder report having had their first episode before the age of 20. If symptoms of Bipolar Disorder (see below) are present before the age of 12, they are often confused with symptoms of Attention Deficit-Hyperactivity Disorder, or ADHD. Although Bipolar Disorder affects males and females equally, females are more likely than males to experience a greater number of depressive rather than manic symptoms. The disorder is most often diagnosed in adolescence or early adulthood. However, there is a consensus among researchers in the field that children do experience Bipolar Disorder. Yet clear-cut mania rarely occurs in childhood. Young children can and do experience hypomania—a less severe form of mania in which symptoms are persistently present for at least four days.

Bipolar Disorder is usually diagnosed after a very careful psychiatric and medical examination is conducted by a psychiatrist, psychologist, or primary care physician.

Bipolar Disorder usually runs in families, and is believed to be caused largely by genetic factors. A family history of substance abuse also increases the risk of developing Bipolar Disorder. There may be a gene responsible for the disorder, but researchers are still investigating this possibility.

What are the symptoms of Bipolar Disorder?

 Listed below are the most common symptoms of Bipolar Disorder. However, each individual may experience the symptoms differently for both mania and depression.

 Common Symptoms of Mania

• Very inflated self-esteem
• Severe mood changes including unusually happy or silly, or unusually angry, agitated or aggressive
• Excessively high or euphoric feelings
• Racing thoughts
• Decreased need for rest and sleep
• Increased distractibility and irritability
• Increased talkativeness (may include increased rate of speech, changing topics quickly and not being able to be interrupted)
• Increased energy level
• Uncharacteristically poor judgment
• Increased denial
• Increased sex drive (adolescents and adults)
• Excessive involvement in pleasurable and/or high-risk activities that may result in painful consequences (examples: reckless spending, abuse of alcohol and/or drugs, reckless driving, sexual promiscuity) due to provocative, aggressive, destructive or anti-social behavior

NOTE: Some people in a manic phase experience psychotic symptoms that include hallucinations and/or delusions.

Common Symptoms of Depression

• Persistent feelings of sadness
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate
• Excessive guilt
• Feelings of wanting to die
• Loss of interest in usual activities or activities once enjoyed
• Social withdrawal
• Difficulty with relationships
• Sleep disturbances (i.e., insomnia, hypersomnia: sleeping too much)
• Changes in appetite or weight
• Decreased energy
• Difficulty concentrating
• A decrease in the ability to make decisions
• Suicidal thoughts or attempts
• Frequent physical complaints (i.e., headache, stomach ache, fatigue)
• Running away or threats of running away from home
• Hypersensitivity to failure or rejection
• Irritability, agitation, hostility and/or aggression

Treatment of Bipolar Disorder

Various options are available to treat Bipolar Disorder including some or all of the following:

• medication (i.e., mood-stabilizing medications such as lithium, valproate, or carbamazepine, and/or antidepressants such as Prozac, Zoloft, or Paxil)
• psychotherapy (most often cognitive-behavioral and/or interpersonal therapy)
• family therapy
• consultation with the child's school

The information in the article above was drawn from the following sources:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of    Mental Disorders –Fourth Edition Text Revision: DSM-IV-TR. Arlington:    American Psychiatric Publishing, Inc.

Mash, J.E., & Barkley, E.R. (2003). Bipolar Disorder in Children. Child Psychopathology: Second Edition. (pp. 361-362). New York: The Guilford Press.

Children’s Hospital Boston. Manic Depression or Bipolar Disorder. Retrieved  
April 23, 2009 fromwww.childrenshospital.org/az/Site1273/mainpageS1273P0.html

Additional Sources of Information

• Helping Children and Youth With Bipolar Disorder: Systems of Care, from SAMHSA's National Mental Health Information Center.
• New York Times Health Guides:
  • What to Ask About Bipolar Disorder
  • Expert Q & A: Diagnosing Mood Disorders in a New Generation