Bipolar Disorder generally sets in during adolescence or early adulthood though it may also occur late in one's life or during childhood. It results in terrible mood swings ranging from mania and euphoria to depression and suicidal tendencies. The earlier a person is diagnosed with bipolar disorder the better. Medication is available for bipolar disorder, which helps control the mood swings and even treats the condition. Diagnosis of bipolar disorders can be done only by specialized psychiatrists and is done according to the criteria established by the American Psychiatric Association in the Diagnostic and Statistic Manual of Mental Disorders.
Bipolar disorder, more commonly known as manic depression, is a major mood disorder that is distinguished by behavior that fluctuates from extreme highs (mania) to serious lows (depression) interspersed with periods of "normal" mood. This change in mood or "mood swing" can last for hours, days weeks or months. Persons suffering from this condition are unable to keep a sense of calm about their lives. It is not a character flaw or a sign of personal weakness.
Although "mania" is used freely in speech to refer to any type of passion or obsession, like soccer mania, in medicine, mania refers to behavior that includes profuse and rapidly changing ideas, exaggerated sexuality, extreme gaiety, intense irritability, and decreased sleep. Though "depression" is used to describe a feeling of sadness, in cases of bipolar disorder, the lows of depression are characterized by extreme hopelessness and a feeling of worthlessness accompanied often by thoughts of suicide. (David Guiness, 1998)
Manic depression typically begins in adolescence or early adulthood and continues throughout life. After pooling the data from 22 studies reporting average onset age in bipolar affective illness, the weighted mean was found to be 28.1 years. (Goodwin and Jamison, 1990)
Because manic and depressive episodes may be less extreme in the early stages, or if a person has periods of mild mania, the disorder, unfortunately, is often not recognized for years or even decades. Bipolar disorder affects women and men almost equally and tends to be genetic and can be inherited. Effective treatments exist to greatly alleviate the suffering and minimize the mood swings caused by manic depression. Left untreated, major mood disorders often lead to social and personal problems such as loneliness, divorce, job loss, substance abuse, and suicide. (Mark Halebsky, 1997)
Causes of Bipolar Disorder
Bipolar disorder does not seem to have any single clear cut cause but is rather a combination of factors. According to Durand and Barlow, most scientists believe in "an approach to the study of psychopathology that holds that psychological disorders are always the products of multiple interacting causal factors," which would mean physical, mental, environmental and emotional causes are involved. (Durand & Barlow, 2000)
Bipolar disorder has been found to be genetic and is inherited from family members. It has been found that In families of persons with bipolar disorder, first-degree relatives (parents, children, siblings) are more likely to have a mood disorder than the relatives of those who do not have bipolar disorder. (Davis & Palladino, 2000)
Twin studies indicate that "if one twin presents with a mood disorder, an identical twin is approximately three times more likely than a fraternal twin to have a mood disorder." (Durand & Barlow, 2000)
In considering bipolar disorder specifically, the concordance rate (when both twins have the disorder) is 80% for identical twins as compared to only 16% for fraternal twins. (Durand & Barlow, 2000) "Overwhelming evidence suggests that such disorders are familial and almost certainly reflect an underlying genetic vulnerability." (Durand & Barlow, 2000)
Some researchers believe that bipolar disorder is caused by biochemical instability in the transmission of nerve impulses in the brain triggered by an upsetting life experience, substance abuse, lack of sleep, or other excessive or extreme stimulation. It is possible that this neurotransmitter system may be inherited. Researchers have known for decades that a link exists between neurotransmitters and mood disorders, because drugs which alter these transmitters also relieve mood disorders. (Bernstein et al., 2000)
Some studies hypothesize that a low or high level of a specific neurotransmitter such as serotonin, norepinephrine or dopamine is the cause. Others indicate that an imbalance of these substances is the problem - i.e., that a specific level of a neurotransmitter is not as important as its amount in relation to the other neurotransmitters. (Durand & Barlow, 2000)
Still other studies have found evidence that a change in the sensitivity of the receptors on nerve cells may be the issue. (Bernstein et al., 2000)
In short, researchers are quite certain that the neurotransmitter system is at least part of the cause of bipolar disorder, but further research is still needed to define its exact role.
Findings suggest that bipolar disorder affect persons with an inborn vulnerability when they come into interaction with an environmental trigger. This idea is similar to theories about cause of other medical conditions such as cancer or heart disease. Here, the cause of bipolar disorder is psychological - mental, emotional or environmental. A "stressful life event" can range from a death in the family to the loss of a job, from the birth of a child to a move. It can be pretty much anything, but it cannot be precisely defined. Research has found that stressful life events can lead to the onset of symptoms in bipolar disorder. However, once the disorder is triggered and progresses, "it seems to develop a life of its own. Once the cycle begins, a psychological or pathophysiological process takes over and ensures that the disorder will continue." (Durand & Barlow, 2000)
This cause of bipolar disorder has been termed the "Diathesis-Stress Model." The word diathesis means, in simplified terms, a bodily condition that make a person more than usually susceptible to certain diseases. Thus the Diathesis-Stress Model says that "each person inherits certain physical predisposition that leave him or her vulnerable to problems that may or may not appear, depending on what kinds of situations that person confronts." (Bernstein et al., 2000)
Durand and Barlow define this model as a "hypothesis that both an inherited tendency and specific stressful conditions are required to produce a disorder." (Durand & Barlow, 2000)
Symptoms of Bipolar Disorder
The mood swings of manic depression are alternating cycles of depression and mania ranging from elation or irritability to sadness and hopelessness, and back again. The periods of highs and lows are called episodes, with each rotation from one extreme to the other called a cycle.
Cycles can be widely spaced, with long episodes of depression followed by long episodes of mania. Or each cycle can be very short. Cycles can include long or short periods of wellness or normality in which no symptoms are experienced. In some cases, bipolars experience both depressive and manic symptoms of bipolar disorder at the same time in what is called a "mixed state." (Goodwin and Jamison, 1990)
Although many of the indicators of manic episodes appear to be pleasant, they are actually so exaggerated as to be inappropriate and leave one, feeling out of control and even desperate. In addition to typical bipolar disorder symptoms, hallucinations or delusions may accompany severe episodes.
The Highs: In bipolar disorder, a manic episode is indicated by an elevated mood or an irritable mood accompanied by restlessness - high energy and activity levels, racing thoughts and rapid talking, decreased need for sleep, euphoria, distractibility, agitation, grandiosity - inflated self-esteem, recklessness and increased interest in goal-oriented activities. The severity of these symptoms or conditions may vary from person to person. Although most people would have experienced most of these symptoms at one time or another, someone having manic depression is likely to experience a number of these symptoms over a significant period of time and with significant intensity. (David Guiness, 1998)
The Lows: The occurrence of a depressed mood or a loss of interest or pleasure indicates a depressive episode. This is accompanied by symptoms of hopelessness or pessimism, guilt, worthlessness, helplessness, fatigue, insomnia or hypersomnia (inability to stay awake), decreased concentration levels, restlessness and irritability, loss of appetite and weight or weight gain, chronic pain not caused by physical disease (hypochondria) and recurring thoughts of death and suicide. All these symptoms, as in the case of the highs, are not indicative of manic depression but occur with persistence and severity in people having manic depression. (David Guiness, 1998); (Ronald R. Fieve, 1997)
Hypomania: Hypomania literally means "low/mild mania." It is often one of the first bipolar disorder symptoms and has all the characteristics of mania, but is usually not so problematic or severe as to interfere with a person's work or social life. Because hypomania instills positive feelings, individuals often insist that they are fine when family and friends recognize the mood swings. Many bipolars often go off medication in an attempt to induce a hypomanic episode. Unfortunately this often results in severe mania or can swing into depression. (David Guiness, 1998)