Bipolar mood disorder

Misdiagnosed and misunderstood

Bipolar mood disorder is most probably the most misdiagnosed and misunderstood challenge of all psychological disorders.  Bipolar disorder can strike without warning.

Bipolar mood disorder can be compared to a surfer going out to sea.  Sometimes the surfer reaches the crest of the wave and rides the wave with sheer excitement and ecstasy.  You might from time to time ride the wave so high that you are being lifted into the air.  Ecstatic, yet frightening. The high wave may knock you off your surfboard, leaving you feeling as if you are busy drowning. Only to experience the same highs and lows next time.

Sandy* is living with Bipolar mood disorder.  In her own words: every day you second-guess everything. You ask yourself: Am I happy for a reason? Is there a reason I’m down? and you have to be constantly aware of what the illness is, and what not. She is living with the sudden mood swings intrinsic to this condition.

You may shift from happiness to total despair in a flash.

High stress is a common trigger for Bipolar mood disorder.  You may become a bit manic.  You may start to stop sleeping, becoming less patient and impulsive.

Bipolar mood disorder is often referred to as manic depression or a manic-depressive disorder.   These terms are outdated and not used anymore.

At its worst, I have hallucinations and psychosis, a complete detachment from reality, and I interpret the world as no one else can.  I see things that are quite dangerous and do not know who I am, says a 52-year-old person.  It is a very scary place.

Sleeplessness, impulsivity, high energy, racing thoughts and speech, distractibility euphoria, hyper sexuality, and poor decision-making are among the symptoms of a mania, which can also trigger psychosis.

You need help but at this point, you are not willing to accept help.  Bipolar disorder usually appears without warning in the late teens to early 20s, though it tends to run in families and can be triggered by trauma.

Bipolar disorder – DSM 5 Diagnostic Criteria

Talking with a doctor or mental health professional is the first step in identifying Bipolar disorder. Firstly, a doctor may perform a physical evaluation to rule out any other conditions that may be causing symptoms. If no other illnesses are present, the doctor will conduct a comprehensive mental health evaluation to assess the patient’s symptoms in accordance with the specific criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with Bipolar disorder, a person must have experienced at least one episode of mania or hypomania.

One of the most misunderstood thoughts about Bipolar mood disorder is that the shifts between emotions, between mania, the elevated, expansive, or irritable mood, and depression, listlessness, and depression may appear suddenly. 

To be diagnosed with Bipolar mood disorder, you will have to meet the criteria of depression (please see my article on Depression on this website), alternated with the criteria of a manic or hypomanic episode as explained below. This manic or hypomanic mood must last at least four consecutive days and be present most of the day, almost every day.

Manic or hypomanic episodes:

• During this period, three or more of the following symptoms must be present and represent a significant change from usual behaviour;

–  inflated self-esteem or grandiosity

–  decreased need for sleep

–  increased talkativeness

–  racing thoughts

–  distracted easily

–  increase in goal-directed activity or psychomotor agitation

–  engaging in activities that hold the potential for painful consequences, e.g., unrestrained buying sprees, sexual indiscretions, or foolish investments.

• Mania does not mean happiness

We might even be envious of individuals with Bipolar disorder when they exhibit endless energy and creativity and lack inhibitions during a manic episode, but they report that it does not feel like fun.

It is important for people to know mania is not like happiness, says mental health activist Lindi*, who is diagnosed with Bipolar and has attempted suicide.  You stop sleeping, are incredibly busy, can’t sit still and it is difficult to go through, especially psychosis.

During such a mania, you stop sleeping, are incredibly busy, cannot sit still, have endless energy without any inhibitions with tremendous creativity.

• Episodes of anger

You might not even realise getting angry and going off on a tangent.  I don’t remember a lot of the fights.  It was not normal irritation.  I was so excited and talked so much, says Heather.

• Depressive episodes

The depressive side of Bipolar disorder is characterised by a Major depressive episode resulting in a depressed mood or loss of interest or pleasure in life. The DSM 5 states that a person must experience five or more of the following symptoms in two weeks to be diagnosed with a Major Depressive episode:

–  depressed mood most of the day, nearly every day

–  loss of interest or pleasure in all, or almost all, activities

–  significant weight loss or decrease or increase in appetite

–  engaging in purposeless movements, such as pacing the room

–  fatigue or loss of energy

–  feelings of worthlessness or guilt

–  diminished ability to think or concentrate, or indecisiveness

–  recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt.

Different types of Bipolar mood disorder

Many people don’t know that there are different types of Bipolar disorder; all characterised by their own symptoms. Although they are similar, it is important to know what type of Bipolar disorder you have so that you can receive the treatment that will work best for you.

• Bipolar 1 or Bipolar 2

In the past, a distinction has been made between Bipolar 1 and Bipolar 2.  Bipolar 1 was seen as a much worse form of Bipolar than Bipolar 2, also called Soft Bipolar.  With the advent of the DSM 5, this distinction fell away, and it is of no value anymore.

• Cyclothymia

Cyclothymia is a type of Bipolar disorder in which the person will go through episodes of hypomania and depression, however, they will be much less severe and for shorter periods. These periods will come between months of their mood being stable. The symptoms of cyclothymia are not severe enough to be classified as Bipolar disorder.

• Rapid cycling

Rapid cycling is a severe form of Bipolar disorder that is diagnosed when a person experiences more than four manic, or depressive episodes within a year, meaning they will go from high to low and back to high again with no break.

• Not otherwise specified (NOS)

Bipolar disorder NOS is classified as a Bipolar disorder that doesn’t follow a pattern. An example of this is having multiple episodes of hypomania but with no depressive symptoms following.

Could my mood swings be Bipolar disorder?

We all have good and bad days – sometimes we feel on top of the world and other days, if we lose a job, go through a bad break-up, or fallout with a friend, we may be down in the dumps. Have you ever gone to bed one night feeling euphoric and woken up the next morning to find yourself feeling empty and hopeless? Have you ever noticed your high-energy levels and racing thoughts suddenly turn to feelings of worthlessness and an inability to experience pleasure doing the same things you once enjoyed? If not, it’s unlikely that you have Bipolar disorder.

Several important features of Bipolar disorder allow us to distinguish between Bipolar disorder and the occasional mood swing:

• the fluctuations in mood are caused by a situation, person, or event, or appear without cause. People with Bipolar disorder also frequently become manic or depressed for no apparent reason. In comparison, for most people, moodiness is tied to a situational event, particularly a stressful period, or even hormonal changes in the body;
• unlike occasional mood swings – a manic or hypomanic episode should last for at least four consecutive days, while depressive episodes last for at least two weeks at a time;
• moodiness and the intensity of the moods you are experiencing are likely significantly higher on the intensity scale than those of people with Bipolar disorder;
• At its worst, one may have hallucinations and psychosis – a complete detachment from reality. However, sleeplessness, impulsivity, high energy, racing thoughts and speech, distractibility euphoria, hyper sexuality, and poor decision-making are among the symptoms of an episode of mania, which can also trigger psychosis.

Thandi* says: Initially my mother was diagnosed as schizophrenic, and in the early 2000s the diagnosis changed to Bipolar disorder.  In certain cultural groups, mental illness is extremely misunderstood.  If you act differently, you can be seen as possessed, so you can imagine the stigma.

Psychologists and therapists suggest that you keep track of the events or situations in your life that cause your mood swings or if they appear seemingly without cause.

A greater suicide risk

People with Bipolar are at greater suicide risk at both ends of their mood spectrum.  When they are manic, they have the energy, guts, motivation, and drive to carry it out, and at the other end, they might feel too hopeless, incompetent or powerless to follow through on the suicide threats leaving them more depressed and hopeless.

Depression is often the result of a mania when someone has done extravagant things, which they regret and feel guilty about, even if it was beyond their control.

Untreated Bipolar tends to shatter the relationships, finances, careers, and families of those who live with this challenge.

Final ideas

• Avoiding triggers, particularly sleep deprivation and stress, is critical to people managing Bipolar. To make matters worse for people trying to cope, since we’re living in a high-stress society.
• Bipolar disorder always goes hand in hand with previous trauma. It is possible to overcome Bipolar disorder when you work through your trauma of the past.
• Although I believe that you can overcome this challenge by working through trauma, it is advised to continue taking your medication while processing your trauma. Afterwards, you can be weaned off your medication.
• Ensure you get your eight hours’ sleep, exercise, healthy food, enough sunshine, and hydration to cope.
• Stop drinking certain liquids may also help – many people with Bipolar say they must avoid coffee, alcohol, cannabis, and other drugs.
• Don’t take your diagnosis and life too seriously. You may even joke about this. Some people say Bipolar means split personalities, borderline personalities, or a crazy person who is a danger to others, but Bipolar does not meet any of these.
• Keep in the back of your mind that the death of loved ones and relationship stress are the biggest triggers for relapses.
• I firmly believe that medication is important to manage Bipolar, but people do better with a combination of medication and therapy. Even on treatment, they can still have episodes.
• However, psychotherapies for Bipolar have been neglected. Everybody can benefit from episodic and maintenance medical treatment.
• Social support is extremely important. When somebody is in the grip of an episode, let them know that you are there for them. They need to know that they are not alone in the world.
• You will not stay like this; these feelings are not permanent.
• Bipolar is not something that needs to be feared if you approach it systematically and with an open mind. But if you ignore it and pretend it is not there, it will create chaos.

In conclusion

Bipolar mood disorder need not be as severe as the disorder is currently viewed in clinical circles.  Take your medication, but also realise that you don’t necessarily have to take it forever.  It is entirely possible to overcome this challenge with psychotherapy. Bipolar mood disorder is indeed just a mood disorder and not a personality disorder.  It is possible to ride the crest of the wave, without being overwhelmed or drowning.

Ride the wave, and don’t allow the wave to ride you!

Bipolar Self-Assessment

This Self-assessment comprises three initial questions followed by a checklist of 27 items.  Only if you answer yes to the first three questions should you continue with the checklist.  At the end of the test, you will be given your results.

Question 1:   Have you had episodes of clinical depression – involving a period of at least five of the following? 

• Feeling depressed, sad, hopeless, or down
• Loss of interest and pleasure in most things
• Appetite or weight change
• Sleep disturbance
• Physical slowing or agitation
• Fatigue or low energy
• Irritability
• Poor concentration
• Suicidal thoughts

If YES to five or more, please proceed to Question 2.

If NO, stop the test. You don’t meet the criteria for Bipolar mood disorder.

Question 2:   Do you have times when your mood cycles, that is, do you experience ups as well as depressive episodes?

If YES, proceed.

If NO, stop.

Question 3:   During the ups do you feel more wired and hyper than you would experience during times of normal happiness? 

If YES, proceed by completing the checklist below.

If No, stop the test.  You do not meet the criteria of Bipolar mood disorder.

Please find the questionnaire below. Allocate a rating of the extent to which each item applies to you in your experience in the now.

Scoring instructions items are scored as follows:

Much more than usual               = 2

Somewhat more than usual   = 1

No more than usual                    = 0

Please score one score per item.  Either a 2, 1, or a 0.