The National Institute on Health estimates that approximately 5.7 million American adults, or about 2.6 percent of the population age 18 and older in any given year, have bipolar disorder. Although that is a large percentage of the population, in my experience, the disorder is not well understood. And quite often people dealing with this condition do not seek treatment.
What does bipolar look like in a person? The chief characteristic of the disorder is a severe fluctuation in mood, commonly referred to as “mood swings.” Clients have told me that it is as if their mood shifts constantly and frequently. Of course, it is normal to feel different feelings even in a given day. But with bipolar disorder, these shifts are cause of great concern and often impact a person’s overall functioning.
The “polar” ends of the spectrum are, of course, depression and mania (or elevation). Often when depressed, a person will yearn for the more elevated state (it feels better; one has energy, in fact an abundance of energy). In the more depressed state, a person may experience many of the chief characteristics of depression. These include:
- Lasting sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue or of being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can’t sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
- Thoughts of death or suicide, or suicide attempts
On the other extreme, when a person is experiencing mania he or she feels an abundance of energy. Mania includes the following symptoms:
- Increased energy, activity, and restlessness
- Excessively “high,” overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Distractibility, can’t concentrate well
- Little sleep needed
- Unrealistic beliefs in one’s abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
For a person with bipolar disorder, mania – or the less severe case of hypomania – may feel like a welcome relief from depression. After all the person has energy, is able to start (often many) projects (though not necessarily finishing them). Too often a person experiencing these conditions will not seek treatment. Unfortunately, a truly manic episode may result in hospitalization, often following some risky and out-of-control behavior.
In my experience, to manage this disorder takes a combination of psychotherapy and medication management. Usually medications, particular mood stabilizing drugs, are necessary. And so is psychotherapy. Through the psychotherapeutic process, the person can gain better insight into him or herself and obtain help in managing stressors which may trigger an episode. I have seen such clients regain control of their life after a serious manic episode or years of chronic shifting moods and function quite well. A point that I’d like to emphasize, however, is that these clients have remained in treatment – that is a key to successfully managing the condition.