DISCLAIMER
Before reading this article, I would like to clarify that the full range of bipolar disorder, like the symptoms, criteria and diagnosis, are not fully covered; if anything, these are up for a professional to cover.
What is Bipolar Disorder?
Bipolar disorder (BD) is a mental illness that affects how a person acts, as it dramatically makes a huge shift in their mood, energy, and ability to think; 2.4% of the global population get affected by it.(2) Signs of BD usually start showing during a person’s teenage years or early adulthood, and these signs affect a person’s health mentally and physically, their education, how they will perform in their job, and their relationship with their family, friends, and loved ones. (8)
There is a common misconception of the disorder, which is the fact that some people think of it as “mood swings”, but it is a lot more than mood swings; bipolar disorder is characterized by the two polar opposites, which are mania and depressive episodes. (8)
The depressive episodes are almost the same as Major Depressive Disorder, which is defined by its many features, principally a depressed mood and loss of interest in daily activities, with common symptoms like loss of energy, sadness, social withdrawal, hypersomnia, and declining self-esteem. (3)(8) Meanwhile manic episodes are known for their distinct periods of persistently elevated, expansive, or irritable mood, and a persistent increase in energy, which cause hyperactivity, reduced need for sleep, and psychotic symptoms; hypomanic episodes are another form of manic episodes, which are mild and less risky. (5)(8)
How often the symptoms of the mentioned episodes show up differs from person to person; some people’s episodes overlap; some people’s episodes rapidly change; some people could have no symptoms of either episodes for one year, or more; some people could have severe episodes in which both poles are present at the same time. (8)
BD classifications and their differences
Bipolar disorder has four major types, and as mentioned, it differs from one person to another. The four major types are: Bipolar I, Bipolar II, Cyclothymic, and Bipolar Disorder not otherwise specified (NOS).
People diagnosed with Bipolar I had at least one manic episode throughout their life, which lasts from a few days to months; actually depressive episodes are not required, as about 5% of people diagnosed with bipolar I only experience mania episodes. (8)(9)(12) Meanwhile, people diagnosed with Bipolar II had at least one hypomanic episode throughout their life; people diagnosed with bipolar II have long periods of depressive episodes and short periods of hypomanic episodes.(8)(10)(12) People diagnosed with Cyclothymia have unstable moods lasting for less than two years, and not qualifying as either depressive or hypomanic episodes, while also containing symptoms of both.(8)(11)(12) And lastly NOS do not meet any specific criteria for mania, hypomania, or mixed episodes in terms of duration. (6)(8)(12)
Difference between Bipolar Disorder (BD) and Borderline Personality Disorder (BPD)
A lot of people confuse Bipolar Disorder with Borderline Personality Disorder, or vice versa; sometimes professionals misdiagnose both of them.
What’s the difference?
Borderline personality disorder (BPD) is characterized by a person’s unstable mood, their sense of self, their ability to control their impulses, and their interpersonal relationships. Both BD and BPD could be confused due to the mood changes. However, Borderline personality disorder does not have “mood shifts”, but “mood swings” that could only last for a few minutes with moods like sadness, happiness, or anger, while bipolar disorder has shifts that last specific periods of time. (1)(13)
Another key difference is a set of different symptoms from BPD and BD, which are impulsivity and anger, and irritability and aggressiveness, respectively. Some may confuse these two sets of symptoms a lot; what differentiates them is that these BPD symptoms are on a long term basis, as impulsivity is one of the main traits of Borderline Personality Disorder, and are a reaction of relationship issues, and these BD symptoms only happen during manic episodes. And finally, the difference between anger and irritability is that anger is an emotion that does not last for a long time and irritability is a mood, which lasts for a while. (1)(13)
Experiences from members
Three volunteers agreed to explain how they feel during their episodes and how they usually go.
- The first member mentioned that their psychiatrist diagnosed them with Bipolar I, as their manic episodes last for only a month, while their depressive episodes last for seven weeks. They mentioned that their manic episodes are “intense” due to the fact that their depressive episodes last longer.
- The second member mentioned that their psychiatrist diagnosed them with Bipolar II, as their depressive episodes last for months; they said that their depressive episodes affect their daily life, as they feel tired and fatigued, have zero willingness to do anything, and tend to neglect themselves. While their hypomanic episodes last for only a few days; they described their hypomanic episodes as a “weird thing that makes them get off bed suddenly”, which makes them do a lot of things at once. They also said that they cannot focus on anything, that they have racing thoughts, and they tend to make impulsive decisions.
- The third member mentioned that their psychiatrist never specified which type they are diagnosed with. They also said their manic episodes last much longer than their depressive episodes do, although both episodes shift rapidly. When asked how long either of the episodes last, they said that their depressive episodes last for a few days, and they can’t particularly remember how long their manic episodes last. They described their manic episodes as being at a “high point”, and when they get their depressive episodes they feel like they are at their “lowest”. Their manic episodes affect their attitude, which affects their judgment and themselves overall, while their depressive episodes make them lose interest in everything to the point of sleepiness.
How to deal with it?
In terms of treatment, listed below are effective treatments for Bipolar disorder:
- Psychosocial treatments: The main points of psychosocial treatments are learning about the disease and focusing on treatment adherence and self-care, as they are considered an essential part of the treatment of BD. One of the most prominent methods is psychotherapy, which could be done individually or in a group. (4)
- Pharmacotherapy: Medications used to treat BD are mood stabilizers, atypical antipsychotics, and conventional antidepressants. These should be prescribed by a professional. (4)
- Social support network: As BD can cause a lot of strain on relationships; being able to share their experience with others who have common experiences, and being understood can give them hope and motivation to recover. (4)
What if a loved one has bipolar disorder?
If you happen to know someone who is diagnosed with bipolar disorder, here are some tips (14)(15) (some of them are from the three volunteers mentioned above):
- You should read about the disorder and learn a few things from reliable sources and sites to have more knowledge about their experience.
- Learn about their triggers in order to take care of them and to make them avoid their triggers.
- Let them communicate their feelings to understand them better and to avoid any misunderstandings.
- Support them if they mention that they are thinking of getting treatment
- Practice selfcare with them.
- Not to call the state they are in an overreaction.
- Not to tell them to control themselves.
- Be a safe space for them to vent.
Reminders
- Don’t feel ashamed to open up and share your experience when you feel the need to; Our society may not be understanding, but that does not mean you are alone.
- How you feel should not be invalidated since the person in front of you doesn’t get to decide how you feel and doesn’t fully understand what you’re going through.
- Smaller steps towards recovery are worth celebrating.
- Recovery is nonlinear, which is normal.
- Therapy isn’t something to be ashamed of.
References
- Di Giacomo, Ester, et al. “Unblending Borderline Personality and Bipolar Disorders”. Journal of Psychiatric Research, vol 91, Aug 2017, pp. 90-97. ScienceDirect, https://doi.org/10.1016/j.jpsychires.2017.03.006
- Del Mar BonnÍn, Caterina, et al. “Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder”. International Journal of Neuropsychopharmacology, vol 22, issue 8, Aug 2019, pp. 467-477. Oxford Academic, https://academic.oup.com/ijnp/article/22/8/467/5475185
- Giannelli, Frank R. “Major depressive disorder”. Journal of the American Academy of Physician Assistants, vol 33, issue 4, April 202, pp. 19-20. JAPPA, https://journals.lww.com/jaapa/Citation/2020/04000/Major_depressive_disorder.2.aspx
- McCormick, Ursula, et al. “ Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses”. Journal of the American Association of Nurse Practitioners, vol 27, issue 9, Sept 2015, pp. 530-542. Scopus, https://journals.lww.com/jaanp/Abstract/2015/09000/Diagnosis_and_treatment_of_patients_with_bipolar.10.aspx
- Torales, Julio, et al. “Manic Episodes Due to Medical Illnesses: A Literature Review”. The Journal of Nervous and Mental Disease, vol 206, issue 9, Sept 2018, pp. 733-738. Lippincott research,
- Towbin, Kenneth, et al. “Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation”. Journal of The American Academy of Child and Adolescent Psychiatry, vol 52, issue 5, May 2013, pp. 466-481. JAACAP,
https://www.jaacap.org/article/S0890-8567(13)00110-X/pdf
- Vidal-Ribas, et al. “The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review”. Journal of the American Academy of Child & Adolescent Psychiatry, vol 55, no. 7, July 2016, pp. 556-570. National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927461/#:~:text=In%20summary%2C%20irritability%20is%20a,is%20described%20as%20an%20affect.
- Vieta, Edward, et al. “Bipolar disorder”. Nature Reviews | Disease Primer, vol 4, article 18008, Mar 2018, pp. 1-16. PubMed, https://www.nature.com/articles/nrdp20188