What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive disorder or manic depression, is a mental health condition defined by extreme mood swings with episodes of mania, hypomania, and depression. While mania and hypomania are two types of “mood episodes” differing in severity, both feature the same symptoms. There are different types of bipolar disorder including bipolar I, bipolar II, and cyclothymia identified by patterns of mania and depressive episodes.
- Bipolar 1 disorder: Bipolar 1 is defined by at least one manic episode that lasts a minimum of seven days, or by severe manic symptoms that require immediate care.
- Bipolar 2 disorder: Bipolar 2 includes at least one hypomanic episode and one major depressive episode. It does not include severe manic episodes found in Bipolar 1.
- Cyclothymic disorder: Cyclothymic disorder (also called Cyclothymia) is a milder form of bipolar consisting of mild hypomanic symptoms and periods of depressive symptoms that last for days or even weeks.
Bipolar symptoms in men may vary with those found in women. Those with bipolar may also have another co-occurring disorder, including bipolar depression, major depression, or anxiety, which can worsen symptoms.
What Are the Signs and Symptoms of Bipolar Disorder?
Bipolar disorder includes high periods of mania (commonly thought of as “highs”) and low periods of a depressed mood (the “lows” that many people will feel). If you’re asking yourself, “how do I know if I have bipolar disorder,” there are several signs and symptoms to be aware of and to look out for. Most importantly, you should know that there’s help available.
So, how do you know if you have bipolar disorder? Of all the bipolar symptoms, the first to be aware of is that you’ll typically go through periods of mania and depression. These periods are more than just mood changes. A bipolar episode of mania (extreme highs) and depression (dark lows) can last 7 days or longer, with people having symptoms of either every day. Both bipolar 1 disorder and bipolar 2 disorders consist of shifts in mood, energy, and behavior, but symptoms can vary depending on the type of bipolar dealt with.
If you want to learn how to know if you have bipolar disorder, look for any of the following signs of mania and bipolar depression.
Mania and hypomania
Manic episodes in bipolar disorder can include 3 or more of the following bipolar disorder symptoms:
- Uncontrollable racing thoughts
- Feeling oddly or unusually upbeat
- Insomnia or feeling like you don’t need sleep
- Impulsivity and restlessness
- Overconfidence
- Enhanced sense of well-being
- Poor decision making
- Grandiose thinking
- Risk-taking behaviors
- Being distracted/unable to focus
Major depressive episode
Major depressive episodes in bipolar disorder can include five or more of the following symptoms:
- Low energy
- Having suicidal thoughts
- Thoughts about hurting yourself
- Low or no appetite
- Noticeable weight loss or weight gain
- Crying episodes
- Withdrawal from friends/family
- Lack of interest in former hobbies
- Fatigue
- Feeling overly guilty
- Feeling worthless
“Signs and symptoms are not always black and white, which can add undue stress and anxiety. If possible, take time to connect with a provider who can help you understand the difference between mood and relational issues. Often overlooked is the tenant of relationships, that can drive patterned behavior in personality disorders versus aspects of mood in depression for example.”
- Ashley Ertel, Licensed Clinical Social Worker (LCSW), BCD, C-DBT
Given that there is often overlap in different mental health conditions and their symptoms, it is important to understand the difference between borderline personality disorder vs bipolar disorder, as well as bipolar vs depression.
How To Know If You Have Bipolar Disorder
If you think you may have bipolar disorder, it’s important to look at how this mental health condition might be impacting your daily life. While getting a professional diagnosis is the best way to truly determine if you do have bipolar disorder, there are some things you can look for on your own.
In bipolar disorder, mania and depression can act together to create a constant rollercoaster of emotions that most people (those who are bipolar, as well as the friends and family members who love them) find difficult to deal with.
To find out how to know if you are bipolar, you can first ask yourself the following questions:
- Do you have symptoms of mania and/or symptoms of depression?
- Do you experience episodes of psychosis that are related to another illness?
- Does your depression and/or mania frequently occur in cycles?
- Does your depression and/or mania affect your daily life?
These questions can help to differentiate whether your symptoms are more aligned with bipolar vs. depression on its own. It’s important to remember that depression and sadness are two different emotions, and mania and happiness are different as well.
Symptoms of bipolar disorder can often mimic other illnesses like ADHD , major depressive disorder, and schizophrenia. Perhaps surprisingly, they can also mimic non-psychiatric diseases such as syphilis, HIV, and lupus.
These are all reasons that seeking professional help is so essential in getting a diagnosis. Talk to your doctor or a mental health care professional for more about how to know if you are bipolar.
“Trying to understand new symptoms can feel emotionally uncertain. If you can simplify your routine to alleviate stress, you can make more room for support and a space for psycho-education. Both can help establish stability and maintain important relationships when navigating a new diagnosis.”
- Ashley Ertel, Licensed Clinical Social Worker (LCSW), BCD, C-DBT
Discover Bipolar Disorder Signs
How do you know if you have bipolar disorder? The first step is reaching out for professional help, especially if you’re having thoughts of suicide.
When you talk to a doctor or mental health professional, be sure that you’re honest about your bipolar symptoms and feelings. There are a number of things you can do to monitor and track feelings and symptoms leading up to and during the mood episode. Some tactics that have been known to help include:
- Keeping a journal
- Writing down or logging moods
- Identifying risk factors like family history and genetics
- Being honest about stressful life events that might be a trigger
Remember, it’s okay to ask for help. Finding out if you have bipolar disorder is crucial. Only then can you seek early intervention, which is the single best thing you can do to learn to live a fulfilling life after a bipolar disorder diagnosis. Ready to explore your symptoms and learn more about online bipolar treatment? Take our bipolar disorder test today.
What Causes Bipolar Disorder?
What are the causes of bipolar disorder? There’s no single known cause of bipolar disorder, but most experts agree that genetics are the primary causal factor. That said, chromosomes and DNA aren’t the only probable causes to consider. The full picture is complicated, and likely involves multiple factors.
Genetic Factors
Researchers have found that there’s overwhelming evidence to support the idea that bipolar disorder is often inherited. In fact, there’s a high likelihood that genetic vulnerability is a big contributor to someone’s risk in developing the condition.
Having first relatives with Bipolar Disorder
According to researchers at the National Institutes of Health (NIH), bipolar disorder is an extremely heritable mental condition — perhaps one of the most — but it’s been incredibly difficult to fully understand in what capacity genetic influence plays a role.
That means people with children, siblings, or parents who have bipolar disorder are more likely to develop it themselves. The same is true with twins. Despite our clear understanding that heredity is involved, scientists haven’t yet been able to discover any specific genetic code that could be responsible for bipolar disorder.
Having another condition that mimics Bipolar Disorder
It’s estimated that 50 million people globally might be affected by bipolar disorder. While we don’t know exactly how heredity plays a role, we do know that it’s polygenic, with incredible potential for overlap in symptoms, with other conditions.
It’s quite clear that bipolar affective disorder is common, and that it shares certain symptoms with other mental health conditions, which can make an accurate diagnosis more challenging. Some other conditions that can present similarly to bipolar disorder include:
- Schizoaffective disorder
- Major depressive disorder
- Borderline personality disorder
- Premenstrual dysphoric disorder
- Attention deficit hyperactivity disorder
Now, let’s look at some of the biological factors that may contribute to or exacerbate bipolar disorder.
Biological Factors
Research from the National Institute of Mental Health (NIMH) focuses on the neurobiological factors that could potentially cause or worsen symptoms of bipolar disorder. Much of this research is focused on neurotransmitters in the brain, which are chemical messengers that transmit messages from neurons to muscles or between neurons.
Neurotransmitter imbalance
Multiple brain and body chemicals affect mood regulation, and thereby are thought to potentially cause or worsen BD symptoms. Some of these might include:
- Glutamate
- Dopamine
- Serotonin
- Estrogen
- Thyroid hormone
- Testosterone
- Progesterone
In many cases, pharmaceuticals are used to slightly alter these neurotransmitters with hopes of improving bipolar symptoms. However, the mechanisms of action of these medications are not well understood.
Sometimes, they can do more damage than good, exacerbating pre-existing bipolar disorder symptoms, or causing new symptoms all together. Unfortunately, there hasn’t been enough research done for us to fully understand these concepts. Needless to say, much more research is needed in large-scale, randomized human trials.
HPA-axis hyperactivity
So, what causes bipolar disorder? How is HPA-axis hyperactivity connected? According to researchers, depression in bipolar disorder is likely linked, at least in part, to hyperactivity in the hypothalamic-pituitary-adrenal-axis (HPA-axis). Some research has targeted the effects of chronic stress and elevated cortisol on unipolar and bipolar disorders.
This is a novel area of research, and much more research is needed if we’re to truly understand how the HPA-axis may cause and/or affect BD.
Environmental Factors
Various environmental factors can cause or worsen BD symptoms. Some are more likely to cause depression relative to mania, and others act the opposite way.
“Environmental factors such as life changes, stressful events, homelessness, or where and how a person grows up can trigger or exacerbate this disorder. Although environmental factors are not considered the sole cause of BD, they contribute to it.”
- Cynthia Catchings, Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR
Depression triggers
Some common stressors that might trigger depressive mood episodes in someone who has bipolar disorder could include:
- Sleep interruptions
- Everyday stress
- Illness or injury
- Sedentary lifestyle
- Menstruation
Mania and hypomania triggers
Some of the triggers for a depressive episode can also cause a hypomanic or manic episode. However, certain triggers seem unique in their ability to cause mood episodes marked by mania, but not depression, including:
- Staying up all night
- Using recreational drugs
- Listening to loud music
- Expressing creativity
- Romantic interludes
- Going on vacation
Further, use of antidepressants after giving birth may also trigger a hypomanic episode or manic episode.
Societal Factors
“Societal factors can accelerate the onset or increase the symptoms. Fortunately, these factors can be prevented or eliminated. Therapy can help to accomplish that so the person lives a better life. These societal factors may include adverse life events such as family difficulties, domestic violence, abandonment, or sexual assault.”
— Cynthia Catchings, Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR
Unmanaged stress
Not all mood swings in bipolar disorder are caused by stressful events, but many are. Scientists don’t yet totally understand how stress triggers bipolar episodes, but most believe a stress hormone called cortisol is at least partially to blame.
When we get stressed out, our bodies release more cortisol, which is a steroid hormone produced in the adrenal glands, that alters how the brain communicates and functions.
High cortisol levels
According to researchers, cortisol plays many different roles. It’s important in stress response, inflammatory response, metabolism regulation, and immune function. In small doses, cortisol affects different brain areas — like the amygdala — that control fear, mood, and motivation to protect us. It’s like an internal, autonomic alarm system, and its effects are often referred to as “fight-or-flight” responses to danger.
Periodic small doses of cortisol are natural and healthy, and can, in fact, save our lives. However, when cortisol levels remain elevated, it can cause an array of adverse effects, including:
- Inability to focus
- Poor memory
- Poor digestion
- Weight gain
- Depression
- Headache
- Anxiety
Stressful events in life and high cortisol levels may contribute to the onset of bipolar disorder symptoms. Once the symptoms are triggered, they may progress. If the bipolar cycle is initiated, then certain biological or psychological processes might act to keep the condition in an active state.
Research about stress and cortisol, and other environmental, social, and societal factors that may cause or exacerbate bipolar disorder symptoms continues.
Types of Bipolar Disorder
Each type of bipolar disorder is identified by the pattern of mania and depressive episodes. The treatment that is best for you may differ depending on the bipolar disorder type.
Common symptoms of a manic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Distractibility
- Impulsive decision-making
Common symptoms that occur in a major depressive episode include:
- Insomnia or hypersomnia
- Unexplained or uncontrollable crying
- Severe fatigue
- Loss of interest in activities that the person typically enjoys
- Recurring thoughts of death or suicide
Bipolar I disorder
Bipolar I is defined by at least one manic episode that lasts a minimum of seven days, or by manic symptoms that are severe enough to require immediate hospital care. In Bipolar I disorder, depressive episodes might occur as well and typically last at least two weeks. It is also possible for someone struggling with Bipolar I disorder to have manic episodes with some depressive features or depressive episodes with some manic symptoms.
Bipolar II disorder
Bipolar II disorder consists of depressive episodes and hypomanic episodes, but doesn’t include the severe manic episodes that can inhibit functioning that is characteristic of bipolar I disorder. People who have bipolar II disorder have experienced at least one hypomanic episode and one major depressive episode in their lifetime. Bipolar II disorder typically causes individuals to experience multiple major depressive episodes, unlike bipolar I disorder where major depressive episodes aren’t required.
Between experiencing periods of hypomanic and depressive episodes, the individual with bipolar II disorder is typically able to live life normally.
Bipolar I Vs. Bipolar II Disorder
Understanding the similarities and differences between bipolar I and II disorders might be confusing, but the core differences lie in the intensity of manic episodes and the amount of major depressive episodes experienced. In bipolar I disorder, severe mania is experienced for at least one week, but in bipolar II, the less intense hypomania is experienced for at least four days.
Both emotional highs of mania and hypomania might consist of abnormally high levels of energy, inflated self esteem, racing thoughts, impulsive behavior, a decreased need for sleep, and excessive talkativeness, among other things. However, while severe mania might come with psychotic symptoms, impairment in functioning, and often requires psychiatric hospitalization, hypomania does not.
Both bipolar I and bipolar II disorders consist of shifts in mood, energy, and concentration. Other signs of these disorders might include: experiencing anxious distress, melancholy emotions, and psychosis. Depending on the timing of these bipolar symptoms, a person may be diagnosed with mixed episodes or rapid cycling.
Cyclothymic disorder (also called Cyclothymia)
This bipolar disorder type is a milder form of bipolar disorder which consists of cyclical periods of hypomanic symptoms as well as periods of depressive symptoms that last for days or even weeks. The highs and lows of cyclothymic disorder, however, are not severe enough to qualify as hypomanic or depressive episodes according to the bipolar test requirements.
Cyclothymic disorder, also known as cyclothymia, usually develops in adolescence. People with the condition often appear to function normally, although they may seem “moody” or “difficult” to others. Those struggling with this condition will often not seek treatment because their mood swings do not seem severe, but if left untreated, cyclothymia can increase the risk of developing bipolar disorder.
Bipolar disorder due to another medical or substance abuse disorder (unspecified bipolar disorder)
Some bipolar disorders don’t have a specific pattern or don’t match the three categories of disorders listed above and yet, they still align with the criteria for abnormal mood changes. For example, a person may experience mild depressive or hypomanic symptoms that last less than the specified amount for cyclothymia. Additionally, a person might experience depressive episodes, but have symptoms of mood elevation that are too mild or brief to be diagnosed as mania or hypomania.
These instances can be determined to be characteristic of bipolar disorder, but aren’t classified under the aforementioned types of bipolar disorder.
Help is Available for All Types of Bipolar Disorder
Treatment is available for all types of bipolar disorder. When it comes to how to treat bipolar disorder, the first step to recovery is to seek help from a medical doctor or licensed mental health care provider such as a psychiatrist. The professional will likely provide you with a psychological assessment for bipolar disorder and work with you to create a bipolar disorder treatment plan specifically for you. You might also be asked to monitor your daily mood changes and sleep patterns through a mood chart to help with diagnosis.
Treatment for this disorder usually includes a variety of strategies to manage the condition over the long term such as therapy for bipolar disorder and medication. Since bipolar disorder is a chronic illness, treatment must be ongoing.
Medications are typically an important part of treatment and might include mood stabilizers, antipsychotic medications, or antidepressants. Such medications for bipolar disorder usually need to be taken regularly to be effective. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right medication or combination of medications for your unique needs. As everyone responds to medication differently, you may have to try several different medications before you find one that relieves your bipolar disorder symptoms.
With treatment and through an individual’s own efforts, people with all types of bipolar disorder can live rich, rewarding lives.
