“It’s hard to let go of the demons inside. They were holding you when no-one else would.”
First things first, I can tell you what Bipolar Disorder is not - it is not a character flaw, nor is it a sign of personal weakness. If your preconceived opinion of bipolar is somewhere along these lines then I wouldn’t blame you: the conversations about this disorder all too often will focus on the severity of it, its debilitating nature and how destructive it can be for those who suffer from it (and their loved ones).
Now let me tell you what it is: a mental condition, that with proper understanding and empathy can be treated and managed.
What is Bipolar Disorder?
Presenting as extreme changes in mood, thought, energy and behaviour, bipolar disorder is a mental condition where a person’s psychological state alternatives between mania (highs) and depression (lows) lasting for hours, days, weeks or even months.
In order to fully understand the complexities of this condition we first need to look at the condition itself and why it takes so long to make an accurate diagnosis.
Causes
The actual cause behind bipolar is not clear however research suggests that it is more likely to be a combination of factors, rather than just one single trigger.
Genetic Inheritance
Bipolar disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition. This doesn’t necessarily mean though that there is a ‘bipolar gene’ and that all family members will be affected.
Brain Chemistry
Symptoms are often treated with certain psychiatric medications which are known to act on the neurotransmitters (messenger chemicals) in the brain. As a result it is thought that bipolar disorder might be related to problems with the function of these neurotransmitters. Some research does support this theory however it is not known for certain what these problems are or what causes them.
Childhood Trauma
By the time we reach adulthood the majority of us have learned to regulate our emotions. If severe emotional stress however is experienced as a child, this can greatly affect and stunt a person’s ability to carry out this regulation. Neglect, sexual or physical abuse and traumatic events (like the loss of a loved one) may be the culprit behind an adult’s onset of bipolar.
Depression and Low Self-Esteem
During the mania phase of bipolar, researchers believe that this could be a way to escape from feelings of depression and low self-esteem. Again, there is little research that has been undertaken to support the theory, though it can act as a contributing factor when paired with other possible causes.
Seasonal Factors
Spring for most of us is the time of year we look forward to; those longer hours of sunshine are like a tonic after the gloom of winter. Interestingly though, research suggests that spring is thought to play a crucial role in the onset of bipolar. Rather than aid to alleviate low moods and thoughts, increased hours of bright sunshine can act as a trigger for depression and mania in bipolar-predisposed individuals by affecting the pineal gland (which is responsible for the release of melatonin).
As you can see, diagnosing bipolar disorder can be extremely difficult and it may take years before a person finally has an official name for what they’re suffering.
Symptoms
How severe the symptoms of bipolar disorder are can vary from individual to individual. A person may have distinct mania or depressed states but may also have extended periods (months or even years) without any symptoms at all. During these severe mania and depressed states, symptoms can range from hallucinations and delusions to suicidal thoughts and an inability to function with day-to-day life. It is because of these psychotic symptoms that bipolar is often wrongly misdiagnosed as schizophrenia.
Mania
Being full of new and exciting ideas
Shifting quickly from one thought/idea to the other
Hearing voices
Behaving out of character (spending large sums of money, using drugs or alcohol, gambling or engaging in casual sex)
Depression
Low mood
Loss of energy
Feeling negative and hopeless
Difficulty concentrating
Just to further complicate matters, there are different types of bipolar disorder.
Types
Bipolar I Disorder: in order to be diagnosed you will have had at least one manic, mixed and major depressive episode. These episodes last for at least one week, but may continue for months. Bipolar I Disorder is the most severe form of the illness.
Bipolar II Disorder: is characterised by predominately depressive episodes accompanied by occasional hypomanic episodes. These hypomanic episodes are milder than manic episodes although they can still impair functioning. Between episodes there may be periods of normal functioning. The risk of suicide is higher in type II than it is in type I.
Bipolar I or Bipolar II Disorder with Mixed Symptoms: you will experience symptoms of mania and depression at the same time. This can be referred to as a “Mixed Bipolar State” where you may feel sad and hopeless while simultaneously experiencing restlessness and high energy. This mixed bipolar state is a lethal combination with a very real risk of suicide.
Bipolar I or Bipolar II Disorder with Rapid Cycling: rapid cycling means you will have had four or more depressive manic episodes in a twelve month period.
Bipolar I or Bipolar II Disorder with Seasonal Pattern: where depressive mania is regularly affected in the same way by seasons. This can mean that you might have a depressive episode each winter but your mania does not regularly follow a pattern.
Cyclothymic Disorder: is characterised by chronic fluctuating moods involving periods of hypomania and depression. Even though these mood swings are shorter, less severe and separated by periods of normal mood, they can create havoc in your life. Some people with Cyclothymia develop a more severe form of bipolar, while for others it continues as a chronic (ongoing) condition.
Once diagnosed, the search for the correct treatment begins. Even though treatment is tailored for the individual and their particular set of symptoms, what works for one person may not for another. Becoming accustomed to the medication itself and their effect on your mind and body takes time and perseverance.
Treatments
Drug Therapy is the core treatment and involves a combination of mood stabilisers, antipsychotic drugs and anticonvulsants. Antidepressants are sometimes used in conjunction but never alone.
Counselling and Psychotherapy are used alongside medication. They help you learn ways to manage your illness and prevent relapse.
Cognitive Behavioural Therapy involves changing how you about and evaluate situations around you and your reactions to them.
Interpersonal and Social Rhythm Therapy helps you to establish healthy daily routines, especially regarding sleep. Disruptions to a routine can potentially trigger mania so it is important to stick to them as much as possible.
Family Focused Therapy focuses on strengthening communication skills. It is vital that family members and other support networks educate themselves on the complexities of this mental illness. It also teaches the development of problem solving strategies which reduces the risk of relapse.
It takes monumental courage and strength to live life battling bipolar disorder. It is worth knowing that those who love you are not fooled by the dark images you hold about yourself. They remember your beauty when you feel ugly, your strength when you are broken and your purpose when you are confused.