Bipolar disorder is one of the most common mental health conditions that is characterised by extreme mood swings and unusual shifts in energy, activity levels, concentration, and the ability to carry out day-to-day tasks. It includes emotional highs, which are called mania or hypomania, and emotional lows, which are called depression.
There are three types of bipolar disorder according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). These are bipolar I, bipolar II, and cyclothymic disorder (also known as cyclothymia).
Bipolar I (mania) is characterised by manic episodes that last for at least seven days. A manic episode is an emotional state characterised by a period where an elevated or unusually irritable mood exists. It’s common to experience feelings of euphoria, heightened energy, and creativity.
People experiencing this episode may sleep very little, be very hyperactive, talk unusually fast, and have racing thoughts – jumping quickly from one idea to the next. They are impulsive and act recklessly without thinking about the consequences of their actions. They may also feel like they are powerful and destined for greatness.
People with this type of disorder usually experience mixed episodes of depression and manic symptoms.
If bipolar I involves classic manic-depressive episodes, bipolar II is much less severe and involves hypomania and severe depression.
Hypomania is a condition similar to mania but is less severe. It is a mood state or energy level that is elevated above normal but not so extreme as to cause impairment. In simple words, hypomania does not cause significant distress to the family, work, or social life while mania does.
People experiencing this kind of episode may tend to be unusually cheerful, have more than ample energy, and need little sleep. They may also experience a heightened sense of creativity and power and an impairment on their judgements.
Hypomania can be difficult to diagnose because it may masquerade as mere happiness. It is important to diagnose hypomania because, as an expression of bipolar disorder, it can cycle into depression and carry an increased risk of suicide.
Cyclothymic disorder (cyclothymia)
The third type of bipolar disorder is cyclothymic disorder also known as cyclothymia. It is a rare disorder and a milder form of bipolar disorder. It is characterised by cyclical mood swings for over a two-year period. It still causes emotional ups and downs but not as severe as bipolar I or bipolar II.
People with this kind of disorder experience episodes of hypomanic and depressive experiences but do not meet the full diagnostic criteria for hypomania or major depressive disorder. These may be episodes of pain when they experience flooding of painful memories, of feeling great, of deep, unexplainable depression, of shame, of loneliness, and of self-doubt.
People experiencing these kinds of episodes can have difficulty maintaining employment due to absenteeism, poor performance, or erratic behaviour in the workplace. Their social functioning may also be affected by weird and inappropriate behaviour.
Causes of bipolar disorders
While there is no known exact cause of bipolar disorders, most studies suggest that there are factors that may increase the risk of developing these disorders. These risk factors are genetics (heredity), stress, substance abuse, and gender.
- Heredity. If a person has an immediate relative diagnosed with bipolar disorder, such as a parent or a sibling, then that person is at risk for having bipolar disorder as well. Studies show that about half the people with bipolar disorder have a family member with a mood disorder. For example, if one parent has bipolar disorder, there is a 10–15% greater chance of their child developing this condition. The risk in a child jumps to a 30–40% chance if both parents have bipolar disorder. There is also research conducted on identical twins that shows that if one twin is diagnosed with bipolar disorder, it increases the risk between 40–70% for the other twin to also be diagnosed. This data may be intriguing; however, this is not conclusive of bipolar disorder’s genetic roots. More research is needed to better understand the genetic factors at play for this condition.
- Stress. Studies show that people who experience high levels of stress or traumatic events have a higher risk of developing bipolar disorder. Traumatic events can increase the risk of having bipolar disorder later in life and these may originate from their childhood, such as physical or sexual abuse, neglect, death of a parent, etc. Highly stressful events such as burnout, losing a job, moving to a new place, or experiencing a death in the family can also trigger manic or depressive episodes. Lack of sleep can also increase the risk of a manic episode – that’s why it is important to strengthen a person’s immune system and to have complete sleep.
- Substance abuse. Substance abuse is not considered a cause of bipolar disorder; however, it can worsen the illness by interfering with its recovery because it can make mood episodes worse or hasten the onset of symptoms. For example, the use of alcohol and drugs may induce a more severe depressive phase. Sometimes medications can also trigger the onset of a manic or depressive episode. However, because substance use can trigger psychosis, a person may have to detox from substances before a doctor can give them a diagnosis of bipolar disorder.
- Gender. Though both men and women can have bipolar disorder, according to a study in 2015, women are at a higher risk of developing it than men. In fact, women are three times more likely to experience rapid cycling of mood episodes. They are also more likely to experience depressive and mixed episodes of the disorder compared to men. According to the DSM-5, a woman with bipolar disorder II is more likely to alternate rapidly between episodes. DSM-5 also notes that women with bipolar disorder are more likely to have a higher genetic risk of alcohol use disorder and a higher rate of lifetime eating disorders. There are also some studies that show menstrual dysfunction for women with bipolar disorder and this is more common to women experiencing Bipolar I disorder than those diagnosed with Bipolar II disorder. Based also on research published by the Indian Journal of Psychiatry in 2015, women with bipolar disorder attempted suicide more often than men with the same condition and two to three times more often than men in the general population. This means that women are at a higher risk of attempting suicide.