Lots of people have ups and downs and are familiar with the experience of mood swings. Bipolar disorder (also known as manic depression or bipolar affective disorder) is characterised by periods, or 'episodes', of unusually high and low levels of mood, energy, and activity.1 Between these episodes, mood is generally what is considered 'normal' for the individual.
The central defining feature of bipolar disorder is periods of high mood, which at the most severe are referred to as mania, and when milder are referred to as hypomania. Individuals with bipolar disorder generally also experience periods of persistent low mood and depression. Mood episodes can also be 'mixed', when symptoms of mania and depression are experienced at the same time. In fact, low mood, anxiety, and guilt are often experienced during mania.
Each person with bipolar disorder is different, and experiences vary widely from person to person. For example, during times of depression, one individual may feel sluggish and tired all the time, another individual may feel agitated and physically restless. Some people feel extremely happy and cheerful when they are manic, while others feel irritable and even confrontational.
A period of elated or irritable and agitated mood lasting at least a week, along with coinciding symptoms experienced for most of the day, nearly every day, such as:
- Exaggerated or unrealistic beliefs about talents and abilities
- Becoming more talkative and speaking faster
- Racing thoughts and ideas
- Reduced need for sleep
- Over-involvement in work, hobbies, and new projects
- Becoming easily distracted
- Being more impulsive and carefree
- Disinhibited, risky behaviour, such as reckless driving, promiscuity, over-spending, and taking drugs
A period of low mood and/or loss of interest and pleasure for at least 2 weeks. Further symptoms are also experienced for most of the day, nearly every day, including:
- Significant changes to sleep patterns and appetite
- Crying more often
- Loss of interest in sex
- Feeling tired and 'slowed down', or agitated and 'keyed up'
- Loss of energy
- Feeling worthless
- Feeling guilty and self-critical
- Difficulty with concentration and making decisions
- Thoughts of death and harming oneself, or even attempting to take one's life
Psychosis is sometimes experienced as part of an episode of mania or depression. Psychotic experiences include:
- Hallucinations, where the individual can see, hear, taste, smell or touch something that is not actually there
- Delusions, which are strong yet untrue beliefs the individual has
- Disturbed or confused thoughts and speech
- Unusual behaviour
- A lack of self-awareness
Hypomania is characterised by the same symptoms as mania, such as over-confidence, sociability, and risky behaviour. However, the changes are not as severe, and there are no psychotic features. Close friends and family would notice a change in the person, which must last for 4 or more days.
Some people have reported that they view their periods of hypomania positively and negatively. Positive aspects of hypomania include feelings of increased creativity and productivity during these times. However, hypomania can lead to an upward or downward spiral into mania or depression. For this reason, people with bipolar disorder can report mixed feeling about their highs.
About 1% of the population have a diagnosis of bipolar disorder, although it has been suggested that bipolar disorder falls on a spectrum or continuum with 'normal' mood swings. Taking into account the 'bipolar spectrum', prevalence thus becomes as high as 6%.2 In its most severe form, bipolar disorder can be extremely debilitating, and can cause difficulties with work, education, relationships and family life.3 Individuals with bipolar disorder often experience further problems, such as anxiety and substance use. The age at which bipolar disorder usually manifests is late teens or early twenties, although this varies.4
Some people have reported positive aspects of experiences relevant to bipolar disorder, such as creativity, drive, and high achievements. Many people with artistic temperaments and creative abilities are considered to have experienced bipolar disorder, and the recent BBC documentaries presented by Stephen Fry, 'The Secret Life of a Manic Depressive,' explored these aspects of the condition.
While it is recognised that genes may play a role in the development of bipolar disorder, research has identified a number of contributory psychosocial factors, such as:
Evidence has suggested that these factors can combine over time to exacerbate mood swings, sometimes leading to the mood episodes associated with bipolar disorder.
The majority of people with bipolar disorder are treated with medication, such as mood stabilisers, anti-depressants, and anti-psychotics. A recent report by the British Psychological Society's Division of Clinical Psychology5 recommends that mental health services should be respectful and allow individuals to make informed choices about their own treatment. In order to improve, service delivery needs to recognise that each individual is unique, and draw on service users' own expertise about what they have found helpful in their experience. Research has found that 'talking treatments', such as psychosocial interventions, can be effective and should be more widely accessible. These include:
The National Institute of Clinical Excellence (NICE) guidelines6 have also recommended that individuals with bipolar disorder should receive evidence-based psychosocial interventions, with greater involvement of service users in their own support. The Spectrum Centre aims to improve our understanding of the psychosocial factors underlying bipolar disorder and related conditions,in order to inform and improve psychosocial interventions and support for individuals with mental health problems. For further information, visit our Spectrum research projects.