Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
There are three main types of bipolar disorder: bipolar I, bipolar II, and cyclothymia.
Bipolar I is defined by the appearance of at least one manic episode. You may experience hypomanic episodes, which are less severe than manic episodes, or major depressive episodes before and after the manic episode. This type of bipolar disorder affects people of all sexes equally.
People with bipolar II experience one major depressive episode that lasts at least 2 weeks. They also have at least 1 hypomanic episode that lasts about 4 days. According to a review, this type of bipolar disorder may be more common in women.
People with cyclothymia have episodes of hypomania and depression. These episodes involve symptoms that are shorter and less severe than the mania and depression caused by bipolar I or bipolar II disorder. Most people with this condition only experience no mood symptoms for 1 or 2 months at a time.
Your doctor can explain more about what kind of bipolar disorder you have when discussing your diagnosis.
Some people experience distinct mood symptoms that resemble but don’t quite align with these three types. If that’s the case for you, you might get a diagnosis of:
Rapid cycling is not a type of bipolar disorder, but a term used to describe the course of illness in people with bipolar I or II disorder. It applies when mood episodes occur four or more times over a 1-year period. Women are more likely to have this type of illness course than men, and it can come and go at any time in the course of bipolar disorder. Rapid cycling is driven largely by depression and carries an increased risk for suicidal thoughts or behaviors.
With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues.
Scientists don’t yet know the exact cause of bipolar disorder. But they do believe there’s a strong genetic (inherited) component. Bipolar disorder is considered one of the most heritable psychiatric conditions — more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesn’t necessarily mean you’ll also develop it.
Other factors that scientists think contribute to the development of bipolar disorder include:
Changes in your brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition.
Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.
To receive a diagnosis of bipolar disorder, you must experience at least one period of mania or hypomania. These both involve feelings of excitement, impulsivity, and high energy, but hypomania is considered less severe than mania. Mania symptoms can affect your day-to-day life, leading to problems at work or home. Hypomania symptoms typically don’t. Some people with bipolar disorder also experience major depressive episodes, or “down” moods. These three main symptoms — mania, hypomania, and depression — are the main features of bipolar disorder. Different types of bipolar disorder involve different combinations of these symptoms.
Bipolar I symptoms
A diagnosis of bipolar I disorder requires:
Bipolar II symptoms
A diagnosis of bipolar II requires:
A diagnosis of cyclothymia requires:
If you do ever experience enough symptoms to meet the criteria for a hypomanic or depressive episode, your diagnosis will likely change to another type of bipolar disorder or major depression, depending on your symptoms.
To diagnose bipolar disorder, your healthcare provider may use many tools, including:
Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for health care providers to properly diagnose people with bipolar disorder.
People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD).
Because of this, it’s important to be honest and thorough when explaining all of your symptoms and experiences when talking with your health care provider. It can also be helpful to include a loved one who may be able to provide additional details about your mental health history in your discussions with your provider.
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