B ipolar Disorder is a type of mood disorder. However, unlike in Depression, the problem in Bipolar Disorder is in the brain’s regulation of the usual ups and downs of normal mood. In Bipolar Disorder, people cycle between periods of Mania (i.e., feeling really elevated or irritable) and periods of either normal mood or Depression (i.e., feeling really sad and low). These cycles (sometimes called episodes) of Depression and Mania may be frequent (daily) or infrequent (years apart). Although adults in a manic episode can act euphoric and grandiose, young people in a manic episode can sometimes appear more irritable and grandiose.
Someone with Bipolar Disorder will usually experience a depressive episode before experiencing a manic episode, and may even have several depressive episodes prior to a manic episode. This is why some people with Bipolar Disorder are originally diagnosed with Depression.
Less than 2 percent of people have Bipolar Disorder (any type) and it is almost equally as prevalent among women and men. It usually begins in the late teens to early twenties. The symptoms of Bipolar Disorder can be subtle or extreme. Mild Bipolar symptoms may sometimes be confused with “being a teenager”. Typical teenage strife does not cause Bipolar Disorder or any mental illness. Bipolar Disorder is a disorder of mood control in the brain that is thought to be caused by a combination of genetics and the environment. Because Bipolar Disorder has a large genetic component, immediate family members of someone with Bipolar Disorder are at a much higher risk of also developing the disorder than people without Bipolar Disorder in their family.
Bipolar Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
There are different types of bipolar disorder depending on the severity of the symptoms and how long a person’s mood swings last:
- Bipolar I Disorder: The person must experience at least one manic episode, although they will likely also experience depressive episodes.
- Bipolar II Disorder: The person must experience at least one depressive episode and one hypomanic episode. A hypomanic episode is a less-severe version of a manic episode. See below for further details.
- Cyclothymic Disorder: The person’s mood changes quickly between hypomania and depression and is rarely in a “normal” mood. Usually begins early in life, and it may eventually develop into a more severe form of bipolar disorder for some people.
Depressive Episodes
These look similar to the depressive episodes experienced when someone has Depression. They occur nearly every day for at least two weeks and can include:
- Feeling sad and low most of the day
- Losing interest and pleasure in most activities
- Losing or gaining a considerable amount of weight
- Eating a lot more or a lot less than usual
- Difficulty sleeping or sleeping all the time
- Restlessness or a sense of moving in slow motion that is noticeable to others
- Fatigue or lack of energy
- Feeling worthless or guilty for no reason
- Difficulty thinking or concentrating
- Recurrent thoughts of death or suicide
Manic Episodes
These occur most of the day, nearly every day for at least one week. They can include:
- Inflated self-esteem or grandiosity (e.g., acting like they are superior to others)
- Little need for sleep (e.g., feeling rested after only 3 hours of sleep)
- Need to continue talking – rapid and sometimes confused speech
- Having too many thoughts at once, feeling a pressure of thoughts in their head
- Acting distracted or unable to focus
- Increase in goal-directed activity (e.g. either socially, at school or work) or restlessness, although the goal they are working toward may not make sense or be logical
- Excessive involvement in risky activities with painful consequences (e.g., expensive shopping sprees, foolish business investments, drug use, sexual promiscuity)
- In severe cases, people can experience hallucinations (i.e., hearing or seeing something that isn’t actually there) or delusions (i.e., believing something that isn’t true even when confronted with proof)
Hypomanic Episodes
These are similar to manic episodes and last for four consecutive days or longer, but don’t significantly interfere with the person’s ability to live their life. Because hypomanic symptoms are less severe, they don’t always seem problematic to the person, even though they’re an obvious departure from their usual behaviour. Although a person may be very productive and accomplish many tasks when experiencing Hypomania, they also may become involved in risky behaviour or activities that result in painful consequences.
These symptoms are much more severe and last longer than the regular ups and downs of life. Although most people’s moods change when they experience positive or negative events, the moods swings of someone with Bipolar Disorder occur without any external provocation and are not easily controlled by the person. Some individuals will experience a ‘mixed state’, which is Mania and Depression at the same time.
For many people with Bipolar Disorder, there may be periods of time (lasting from days to years) where the mood is under better control and more likely to stay within “usual” limits. This is especially true if the person is being successfully treated for the illness.
*Statistics are sourced from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Remember, you cannot diagnose someone with Bipolar Disorder without a proper mental health assessment conducted by a properly trained health provider.
Although the core feature of Mania is an extreme sense of euphoria, it is actually quite different from just feeling really happy. The emotion is extreme and intense, often uncomfortably so. Irritability is often mixed with the euphoria and this mood state develops in its own accord, not as a response to a positive event. Someone in a manic episode is likely to act unrealistically, like they are out of touch with reality. To someone experiencing Mania, impossible tasks will seem entirely feasible. Self-esteem will be so high that the person appears arrogant or conceited. They will be constantly moving, talking, and changing direction (both physically and in conversation). Most concerning, someone experiencing Mania will take dangerous and unnecessary risks without any awareness of the potential consequences. In a manic episode, the person could bet their entire life savings on black, take their toddler hang-gliding, max out their credit card at a luxury store, or have unprotected sex with a stranger. Mania is very different from feeling really happy.
The exact relationship between deliberate self-injury, such as cutting, and Bipolar Disorder is not well understood. Most people with Bipolar Disorder do not self-injure and many people who self-injure do not have Bipolar Disorder. Self-injury happens for many reasons, including to numb emotional pain. For some people, the act of cutting releases a chemical that can temporarily help them to feel better. However, over time, just like an addiction, the person often has to inflict more and more pain to produce the same effect. Although self-injury happens more often in girls than in boys, it is seen in both genders.
- Encourage the person to seek help (or take them to a trained health professional yourself, if appropriate).
- Ask the person a few questions to get a better sense of what is going on:
- Do people ever tell you that you seem really agitated, talkative or easily distracted?
- Do you have periods of time when you feel like you could do absolutely anything, no matter how difficult or unlikely it might be?
- Do you have periods of time where you do things that other people consider to be really risky, like unprotected sex, drug use, gambling or expensive shopping sprees?
- Do you have periods of time where you feel really low, sad or depressed?
- Do you have periods of time where you lose interest in the things you usually enjoy?
- Do you have periods of time where you sleep much more or much less than usual?
- Do you have periods of time where you have difficulty thinking or concentrating?
- Do you ever think about committing suicide?
If someone in your life has been diagnosed with Bipolar Disorder, here’s what you can do:
- Be well-informed. Learn about Bipolar Disorder and the treatment options available. Read books, trusted websites and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- Help the person track their moods and other symptoms after the diagnosis and during the treatment. Use a calendar, journal or something you design together with the treatment team to keep track of what is happening and when. The journal can include: how they feel, if there are changes throughout the day and how strong the feelings are. Sharing this information with the mental health team can them improve and modify the treatment plan.
- Help the person identify when they are acting irrationally or engaging in risky behaviour. Share this information (or encourage the person to share) with their health care provider. If their moods aren’t levelling out while on medication, it is important for the health care provider to know so that the treatment program can be adjusted accordingly.
- Encourage the person to avoid drugs or alcohol. Taking drugs or drinking alcohol can be highly toxic to someone with Bipolar Disorder. These substances can make it harder to treat the illness or even cause it to come back when it has been successfully treated.
- Ensure the person is getting enough sleep every night (8-9 hours). Sleep is restorative and lack of sleep can trigger an episode of Mania. For tips on healthy sleeping, check out: Healthy Sleeping
- Listen. When you listen to and acknowledge their feelings, it sends the message that you care. Knowing that you have people who care about you is an important part of coping with a mental disorder.
- Be patient. Sometimes it can be frustrating when the person you care about acts differently than they used to. Take a deep breath and remember that Bipolar Disorder is making them feel this way. They can’t just “snap out of it.” Getting impatient will only make the situation worse. Stay positive and be patient.
- Be aware of the warning of suicide and keep a careful eye on the person. People with Bipolar Disorder are at a higher risk of committing suicide than other young people. Check out our section on suicide for more information.
Psychological Treatments:
- Psychotherapy, or “talk therapy”, can be helpful for dealing with the associated stress of Bipolar Disorder. Therapy may be done individually (just the individual and the therapist) or in groups (a group of people with Bipolar Disorder and Effective types of psychotherapy that are commonly recommended by health care providers include:
- Cognitive Behavior Therapy (CBT): helps the person learn to problem solve and change negative thoughts and behaviours to positive.
- Family-Focused Therapy: helps the entire family better understand Bipolar Disorder and learn more effective coping strategies.
- Psychoeducation: helps the person better understand Bipolar Disorder and how to effectively manage symptoms.
- Sometimes these therapies are provided in groups
Support:
- School supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing their symptoms.
- Community supports: Community supports can include peer support groups for teenagers, support groups for families, and other helpful resources.
- Regular routine: Maintaining a healthy, regular daily routine is very important for a person with Bipolar Disorder. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for Bipolar Disorder, check out Taking Charge of Your Health.
The usual course of treatment for someone with Bipolar Disorder is a combination of medication and psychotherapy. Although psychotherapy is not usually needed long-term, there is a good chance that the person will always need to be on medication to level their moods. Remember that treatment is different for everyone, so often trials of various combinations of medication and therapy will be used until the right combination is found. This may also change over time if new symptoms develop or if symptoms are not responding as well as expected.
Sometimes, during a manic or depressive episode, a person with Bipolar Disorder will need to be hospitalized until their condition improves
Remember, all treatments have the same goals: decrease symptoms and improve functionality; decrease risk of relapse; and promote recover. Think about it this way: Get well; Stay well; Be well.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders with Bipolar Disorder (also called comorbid disorders) include:
- Anxiety (e.g., panic attacks, Social Anxiety Disorder, specific phobias)
- ADHD or other disruptive, impulse-control disorders
- Conduct Disorder
- Alcohol or Drug Use Disorders (Substance Use Disorders)
People with Bipolar Disorder are at increased risk for suicide, especially if left untreated. Pay attention to the person’s behavior and be aware of the warning signs that they may be contemplating suicide:
- Intense hopelessness or sadness
- Preoccupation with death
- Loss of interest in regular activities
- Withdrawal from family and friends
- Talking about what it will be like when they are gone
- Giving away valued possessions
If you suspect that someone is thinking about suicide, ask them about it and let them know you are concerned. Asking about suicide will not put the idea in their head. Suicidal thoughts must be taken seriously and should never be ignored. Take the person to the hospital immediately or call 911. Suicide risk is serious and there are professionals who can help.
Click here to find more information on youth suicide, or here for a list of crisis hotline numbers available throughout Canada.
