Bipolar Disorder

The Ultimate Guide (Revised Edition)

Sarah Owen, Amanda Saunders

• Publisher: Oneworld Publications
• Year: 2019
• ISBN:
  9781780747309
• Edition: 2
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Written in a highly-accessible question and answer format, this comprehensive and compassionate guide draws on the latest research, a broad range of expert opinion, numerous real-life voices and personal experiences from people with bipolar. With a list of useful resources, it is both the perfect first port of call and a reference bible you can refer to time and time again.From how to recognize the symptoms to how to explain to a child that their parent has been diagnosed, first cousins Amanda and Sarah – who have four close family members diagnosed with the condition – explore and explain absolutely everything that someone with bipolar disorder (and those who live with and love them) needs to know.

‌Chapter One

Causes, Symptoms and Diagnosis

‌Q1. What is bipolar disorder?

Bipolar disorder is a serious mental illness that’s thought to be caused by an imbalance in the way brain cells communicate with each other. This imbalance causes extreme mood swings that go way beyond the normal ‘ups and downs’ of everyday life, wildly exaggerating the mood changes that everyone has. Someone with bipolar can have long or short periods of stability, but then tends to go ‘low’ (into deep depression) or ‘high’ (experiencing mania or psychosis). They can go into a ‘mixed state’ too, where symptoms of depression and mania occur at the same time.

According to a World Mental Health survey by the World Health Organization (WHO), bipolar disorder affects a total of 2.4% of the world’s population. The survey found that the US has the highest rate of bipolar spectrum disorders (4.4%), while India has the lowest rate (0.1%). In the UK, the mental health charity Bipolar UK estimates that 1% to 2% of the country’s population experience a lifetime prevalence of bipolar disorder.

‌Q2. Why was manic depression renamed bipolar disorder?

‘Bipolar disorder’ has now replaced ‘manic depression’ as the official name for this condition. The term ‘manic depression’ was first coined in 1896 by Emil Kraepelin, a German doctor, and was widely used in the psychiatric world throughout the twentieth century, until the American Psychiatric Association renamed it in 1980 as ‘bipolar disorder’ – to reflect what it called the ‘bi-polarity’, or dual nature, of the illness (the highs and lows).

‘I prefer the term ‘bipolar’ to ‘manic depression’ as bipolar sounds more medical and less scary. Manic depression seems to carry an undeserved stigma. I was speaking to someone I used to work with when I said my daughter had bipolar – she asked what that meant and I was able to explain. On a separate occasion that same day, I used the term ‘manic depressive’ to see if that was understood, and the reaction I received was of shock.’

(Alison)

However, not everyone is as enthusiastic, including actor and writer Stephen Fry who presented two BBC documentaries about bipolar disorder in 2006 – The Secret Life of the Manic Depressive – in which he openly talked about his own bipolarity. In the foreword to the book You Don’t Have to be Famous to Have Manic Depression, which was published at the same time, he comments:

‘Bipolar isn’t quite right – the condition isn’t really just about two poles, there are mixed states in between. Besides, why not give it a title that names the effects?’

Another writer with a bipolar diagnosis, Julie A. Fast, also dislikes the term bipolar disorder and suggests an alternative in her book Loving Someone with Bipolar Disorder:

‘Bi-polar disorder is a bit of a misnomer. Yes, people with the illness do go up and down, but doesn’t it seem as if they also go sideways or do little corkscrews as well? Maybe if it were called MULTI-polar disorder, people would understand the illness a little bit more.’

We agree that the term ‘multipolar disorder’ describes the condition more accurately because there’s so much more to bipolar than simply being up or down, at one pole or the other. In fact, the psychiatric world recognizes that the current labels used (such as Bipolar I and II) don’t always reflect the wide range of bipolar symptoms. But the answer lies not in dispensing with the labels, but using them as a starting point to decide how people are treated. We might move towards talking, for example, about ‘bipolar spectrum disorder’ or a ‘continuum of bipolarity’. In other words, experts will be less likely to focus on a concrete diagnosis in the future (‘let’s forget what the illness is called’) and concentrate more on an individual’s unique set of symptoms.

‌Q3. What is the difference between Bipolar I, II and III?

There are ‘types’ of bipolarity, known as Bipolar I, Bipolar II and Bipolar III.

To be diagnosed with Bipolar I, a person will have experienced at least one full manic episode in their lifetime, along with at least one major episode of depression. Around 1% of the general population is thought to develop Bipolar I at some point during their lives.

Bipolar II is diagnosed when someone’s mood swings between major episodes of depression and periods of hypomania rather than manic episodes. The incidence of Bipolar II is estimated to be about 4–5% of the general population.

According to the latest Diagnostic and Statistical Manual of Mental Disorders or DSM-5 (the fifth version of a manual published by the American Psychiatric Association, which is used in the UK and US for categorizing and diagnosing mental health problems), the main difference between Bipolar I and Bipolar II is full mania for seven days versus hypomania for four days. Once a person experiences a full manic episode, they will receive a Bipolar I diagnosis.

Bipolar III is not in the official handbook, but is used by some mood experts in the United States to refer to hypomania that emerges only when a patient has been given an antidepressant (known by doctors as treatment-emergent mania/hypomania or TEMH). There is more about this in question 34.

In the US, Bipolar II and III are sometimes referred to as ‘soft’ bipolar.

‌Q4. What is cyclothymia?

If a person’s depressive and manic symptoms last for two years but are not severe enough to qualify as bipolar disorder, they may instead be diagnosed with ‘cyclothymia’, which is a milder form of bipolar. According to UK charity Bipolar UK, ‘Individuals experience mood swings but at a much lower level. Symptoms must last for a period of at least two years, with no period longer than two months in which there has been a stable state and no mixed episodes.’ However, a strong family history of bipolar, as in Amanda’s case, can lead to a much quicker diagnosis.

There is evidence that for some people with cyclothymia, the mood swings will worsen over time until they develop Bipolar II or Bipolar I. Confusingly, cyclothymia is also sometimes referred to as Bipolar III.

In terms of diagnosis, this is a tricky area, because where do you draw the line between sad or irritable behaviour that’s considered ‘normal’ and the kind of ups and downs that warrant a diagnosis of cyclothymia? Even the world’s leading experts on mental health can’t agree and probably never will. After all, what is normality?

‌Q5. Is there an age or gender profile for people with bipolar disorder?

Gender

Bipolar disorder tends to affect equal numbers of men and women overall, although research carried out at the Institute of Psychiatry at King’s College in London does show gender differences in the way bipolar tends to run its course:

• The researchers found that in early adult life (defined as 16–25), there were higher rates of bipolar disorder in men ...

Table of contents

• Contents
• With thanks …
• A word from Paul Abbott
• A word from Jo Crocker
• A word from Professor Steven Jones
• Introduction • Is This Book for You?
• Chapter One • Causes, Symptoms and Diagnosis
• Chapter Two • Treatment
• Chapter Three • Support
• Chapter Four • Hospital Care
• Chapter Five • Lifestyle Choices
• Chapter Six • Living with Bipolar
• Extra resources
• Glossary