Bipolar Disorder & mood swings

Within the broad diagnostic umbrella called Bipolar Disorder there is in fact a lot of variation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides the basis of various formal diagnoses that you can receive. These diagnoses attempt to capture the differences that individuals can experience in terms of the type of symptoms, the intensity or duration of symptoms, and the timing of symptoms in relation to each other. It can also be helpful to see these symptoms dimensionally with increasing distress and impairment as one moves from cyclothymia to bipolar I disorder. One commonality across all subtypes is the cyclical nature of symptoms. Bipolar Disorder is characterised by experiencing episodes of hypomania or mania and episodes of depression. While hypomanic or manic people describe feeling high or euphoric or even irritable, having extreme self-confidence, sleep disturbances, being talkative and a sense that you can’t get your words out fast enough, having great ideas and feeling more inspired, racing thoughts and getting very busy. If you are experiencing a (hypo)manic episode, you may also engage in activities that are harmful for yourself and your family. Examples of such behaviour may include excessive and impulsive spending, reckless driving and risky sexual behaviour.

It is also possible to experience mixed episodes. A mixed episode is a manic or hypomanic state where you also experience depressive symptoms. In essence this is likely to be intense fluctuations of mood that can vary from one moment to the next.

You do not have to have all of the above symptoms to have Bipolar Disorder (there are various decision rules that clinicians use). Additionally, even if you do not tick all the boxes for a formal diagnosis, if your symptoms are interfering with your life you can benefit from psychological treatment. The reality is that symptoms do not necessarily fit the diagnostic box and less severe symptoms of (hypo)mania and depression can also be very distressing. The experience of bipolar disorder is unique for each sufferer and the frequency, nature and duration of episodes vary markedly. For example, some people report very few hypomanic or manic episodes but many depressive episodes. The reverse can also be true. Some individuals experience repeated episodes cycling rapidly from one mood state to the next while others experience periods of relative wellness in between episodes.

The difference between Bipolar I Disorder and Bipolar II Disorder is the experience of mania and hypomania. If you meet criteria for Bipolar I Disorder you have experienced at least one manic episode in your lifetime. For Bipolar II Disorder you have experienced at least one hypomanic episode in your lifetime. The difference between mania and hypomania is the intensity of the symptoms. If you experience a hospitalisation, a mixed episode, experienced delusions or hallucinations, or engaged in behaviours that have harmful consequences for yourself or your family you have experienced a manic episode. Hypomania is a less severe form of mania. You are likely to still be able to work and function OK. You may even enjoy these periods as you may feel productive and experience great creativity. It is easy to overlook hypomanic episodes as many patients with Bipolar II Disorder only present for help when they are depressed. However, from a psychological perspective, it is important that both hypomania and depression are addressed. This is because the same psychological vulnerabilities that make you susceptible to hypomania or mania also render you vulnerable to depression. Additionally, there is some evidence to suggest that those with Bipolar II Disorder have a shorter time to relapse compared to people who experience depressive episodes only and the degree of depression they experience is more severe.

Many people with bipolar disorder also describe symptoms of anxiety. In fact, studies have shown that up to 80% of those with bipolar disorder also suffer from an anxiety disorder. Anxiety disorders predict a worse course for those with bipolar disorder with those with both conditions experience more episodes, more hospitalisations, and more time symptomatic than those without anxiety disorders. Particular anxiety disorders such as social phobia and generalised anxiety may have a special relationship with bipolar disorder and predicts a worse outcome. Unfortunately, in clinical practice anxiety disorders are under-recognised and rarely diagnosed but they can have a real impact on the severity and frequency of your symptoms. Therefore, psychological treatment must also target these symptoms to reduce risk of relapse. Psychological therapy is the treatment of choice for anxiety disorders and symptoms and you can get real relief from getting treatment.