Bipolar disorder includes a variety of mood disorders involving periods of depression and periods of mania, or intense excitement or high energy, usually in a cycling pattern. There are several types of bipolar disorder. Though they share characteristics, they require slightly different approaches to treatment.
- Bipolar I Disorder: This type of bipolar is defined by manic episodes lasting at least one week or mania serious enough to require hospitalization so patients do not harm themselves or others. The intense mania is followed by depression, lasting about two weeks. People with bipolar I disorder may also experience depression with anxiety or manic symptoms.
- Bipolar II Disorder: Manic episodes are actually hypomanic, meaning they do not last as long or they are much less severe. These intersperse longer periods of depression.
- Cyclothymic Disorder or Cyclothymia: This disorder includes short, rapid cycles of hypomania with mild depression for at least two years, without characteristics clearly defining either bipolar I or II.
- Other Specified and Unspecified Bipolar Disorder: This disorder is signified by symptoms that are distressing or disturbing that fit some criteria for bipolar disorder, but not all of them.
People who struggle with bipolar disorder are at a great risk of developing substance abuse problems, often as a method of self-medicating their intense changes in mood. It is important to diagnose bipolar disorder as early as possible in order to treat or prevent substance abuse and other problems associated with mental health disorders.
Generally, bipolar disorder is diagnosed using the following process:
Step 1: A therapist examines symptoms.
Many people with undiagnosed bipolar disorder may end up in the hospital during a manic episode. Once the patient has stabilized, they may be sent to a psychologist for a diagnosis. The therapist will ask about symptoms the person has suffered, including how long symptoms last. In some cases, a person with bipolar disorder is initially misdiagnosed with depression or anxiety, which are common mood disorders, and begins to receive treatment for those issues. If treatment does not work or it triggers a manic episode, then the therapist will try a different approach.
Step 2: The individual undergoes a physical exam.
A physician will perform a thorough physical exam, including bloodwork and potentially brain scans. This helps to rule out other causes of bipolar symptoms, such as hormonal conditions, tumors, or toxins. For example, underactive or overactive thyroid conditions may produce symptoms similar to bipolar disorder. Physical conditions require different treatment than mental health conditions like bipolar disorder, so it is important to rule out physical issues.
Step 3: The individual begins therapy.
Once underlying conditions and other mental health conditions have been ruled out, the therapist will use scales or tests, including information in the DSM-5, to determine what type of bipolar disorder is present.
Symptoms of mania include:
- High self-esteem
- Less need for sleep
- Speaking faster than normal
- Ideas coming and going rapidly
- Being easily distracted
- Very goal- or activity-focused
- Physical agitation, like pacing, hand-wringing, etc.
- Pursuit of dangerous activities
Symptoms of depression in bipolar disorder include:
- Low physical energy
- Increased sleeping and overall fatigue
- Trouble with cognition, memory, and focus
- Changes in appetite
- Moving or speaking more slowly
- Low motivation levels and poor self-esteem
- Thoughts of suicide
How frequently these symptoms occur, and how intensely they are experienced will help to determine the type of bipolar disorder that is present.
Step 4: The individual will be encouraged to chart moods or journal.
In order to properly track mood shifts, the therapist may ask their client to journal or use a mood tracking app. This can illuminate how often mood cycles and if the cycling may be related to a different mental health condition. It also helps the therapist to further refine the diagnosis, identifying the specific type of bipolar disorder the individual has.