The Bipolar Disorder Answer Book: Professional Answers to More than 275 Top Questions

What is bipolar disorder?
Bipolar disorder, which until the 1980s was called manic-depression, is a diagnostic term used to describe patterns of abnormal and severe mood swings, ranging from disabling depression to mania. For the sake of clarity, we're using the term "mood" to describe a sustained or prevailing emotional state. The term "bipolar" refers to extreme moods, from depressed on one pole to manic on the other.

There are four variants of bipolar disorder included in the current psychiatric diagnostic manual (the DSM-IV-TR), a book medical professionals use to diagnose patients.
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
- Bipolar disorder NOS (not otherwise specified)

These will be described in detail, along with their variants, in Chapter 2.

In the real world, what we find is that while these diagnoses are useful and provide a common language with which behavioral health professionals (psychiatrists, psychologists, social workers, counselors, therapists, and others) can communicate, the reality is that bipolar disorder represents a complex spectrum. Each person with bipolar disorder will have an array of symptoms unique to them and to their changing lives, circumstances, and moods. The range is vast, from people who will have multiple mood swings in a year to some who may go for years or even decades with the disorder lying dormant.

There is no one face to bipolar disorder, and because we're discussing moods-something everyone has-we'll need to define where normal ends and a disordered state begins.

What are mood disorders?
Mood disorders, also referred to as affective disorders, include the full range of depressive disorders (major depression, dysthymia, etc.) as well as the bipolar spectrum (bipolar I, bipolar II, cyclothymia, bipolar disorder NOS, and some would also include schizoaffective disorder). All of these are discussed and defined in Chapter 2. In practical terms, mood disorders are where sustained emotional states (days, weeks, months, or years as opposed to minutes and hours) are so extreme that they are out of proportion to the situation and cause impairment in major areas of a person's life (work, relationships, health).

When does a mood state become a disorder?
This is a fundamental question: when does a mood cross some imaginary line from normal to abnormal? Probably the best way to approach this is to look at disruptions and overall functioning in the individual's life. If someone gets by with four hours of sleep a night, has tons of energy, is extremely productive, feels rested, is getting on well with family, friends, and co-workers, does this make them hypomanic, or are they just energetic and happy? In this example you could argue that we're in the realm of normal, because there's no disruption being caused by the good mood and revved up personality; it's just the person's natural way of being.

In order for a mood state to cross the line into a disorder there must be-in addition to various symptoms and durations of symptoms that we will outline for each of the mood states (mania, mixed and depressed)-a significant disruption in overall functioning, at work, home, or in other settings.

Additionally, as is seen in depressed and mixed states, the presence of significant to severe and disabling emotional distress is what pushes a case of the everyday blues and occasional irritability that we all get into something that is a disorder.

Is there a cure for bipolar disorder?
Bipolar disorder, like many medical conditions, is treatable, although there is no known cure. People do recover, however, and by learning to manage their symptoms can have lives that are highly productive, rich, and meaningful.

How long has bipolar disorder been around?
The first recorded mention of mental illness of any sort dates back to Egyptian hieroglyphs. The ancient Greeks conceptualized various moods through the balance of four humors or biles (black, green, yellow, and red), which included melancholia or black bile to describe a depressed state. Mentions of a connection between depressed and manic states can be found in Roman writings of the second century.

The modern conceptualization of bipolar disorder/manic-depression is credited to the psychiatrist Emil Kraepelin (1856—1926), who coined the term "manic-depressive insanity." His careful descriptions of the natural course of the illness (before medications were around) still read true and laid much of the groundwork for current diagnostic thinking.

How many people have bipolar disorder?
According to the National Institute of Mental Health (NIMH), 2.6 percent of Americans age eighteen or older (5.7 million Americans) have bipolar spectrum disorder. Other sources place the incidence between 1 and 1.6 percent.

The broad discrepancy in reporting has a lot to do with how different researchers have looked at the disorder. Some include just bipolar I, while others include bipolar II, cyclothymia, and bipolar disorder NOS (not otherwise specified).

Has there been a rise in the disorder in the last few years?
The answer is both yes and no. The number of people with bipolar I-people who get both depressed and manic or mixed episodes- has remained relatively stable. But as the concept of a bipolar spectrum has expanded to include people who never become fully manic (bipolar II and cyclothymia-see Chapter 2), the actual number of individuals with bipolar diagnoses has increased.

What is a manic episode?
A manic episode is a sustained period of abnormally elevated mood. This can range from a glowing sense of euphoria to a pressured and agitated state, in which people feel as though they could jump out of their skin. When someone is manic he has seemingly boundless energy, and in the early phases may be quite productive. His speech becomes too rapid and the normal give-and-take of conversation is lost-you can't get a word in edgewise. The person with mania may become easily distracted and will describe his thoughts as having a racing quality. When listening to a person who is manic, the ideas that fly from his mouth seem to blossom one on top of the other (flight of ideas). Elaborate-and sometimes unrealistic and grandiose-plans are laid out. These take many forms, such as get-rich-quick schemes or religious revelations that he, and he alone, has discovered. If you attempt to reason with a person who is manic, he may become agitated, condescending, and openly hostile.