Okay—So, Am I Bipolar or Something?

“Bipolar” is one of those terms that gets thrown around a lot in pop culture.  Ever had a cousin, friend, or colleague say to you: “Whew--that girl is something else!  She is so ‘bipolar!’” or “Man, this weather is so ‘bipolar’ lately!”  

Well, as a mental health provider, when I overhear something like this, I get this feeling inside of me—the same kind of feeling that people often get when they hear someone scrape their nails on a chalkboard.   A lot of times, when people describe a person or something like the weather as “bipolar,” they really might mean temperamental, unpredictable, and erratic in behavior or nature.  However, when the term “bipolar” is incorrectly used, I believe it contributes to confusion and trivializes a serious mental disorder. 

So, hey!  I’m Dr. K, a psychiatrist in the Southeast, and I’ve been posting content to help provide education about mental health and mental illness.  Today, I want to focus on trying to increase understanding about a mental health condition called Bipolar Disorder which about 4-5% of American adults and about 3% of children and adolescents experience at some point in their lives.  I specifically want to focus on describing the manic or hypomanic phase of the condition so that the general public can understand what criteria we as mental health providers use to diagnose the disorder. 

So, if a person has bipolar disorder, then a person has a pattern of dramatic shifts in mood, energy, and activity that clearly demonstrates two poles—or distinct extremes. Now, let me help you understand—these shifts in mood are far more severe than the normal ups and downs everyone experiences as a result of just living life.  No—these mood shifts are so significant that they affect a person’s ability to carry out their day-to-day activities.  Now, one extreme or “pole” is depressed mood.  This can last for days to months and is accompanied by a host of other changes in appetite, sleep, energy, and behavior.  The other extreme or “pole” is manic or hypomanic mood that can also last for days to months and is also accompanied by a host of changes in appetite, sleep, energy, and behavior.  

A person must demonstrate a pattern of extreme mood swings involving both manic episodes and depressive episodes to meet the criteria for a bipolar diagnosis.  Also, in order to meet the criteria for diagnosis, the mood swings must be troubling the person significantly and clearly interfering with their day-to-day functioning.  It’s also important to keep in mind that when we mental health providers diagnose a person as having bipolar disorder, the changes in mood and behavior cannot stem from the direct effects of illegal drug use. 

In my experience, many people generally have a pretty reasonable understanding of what a depressive episode may look like, but they really don’t know what a true manic episode looks like.  So, let me go through the list of criteria that are required for diagnosis of a manic or hypomanic episode. 

First and foremost, when a person experiences a manic or hypomanic episode, people around them notice a clear shift in that person’s mood.  They do not act like themselves.  They become unusually energized and may be extremely happy and hyper or extremely irritable.  Now, let’s take a look at the full list of symptoms that characterize mania or hypomania. 

*Inflated self-esteem or grandiosity.  Let me translate this—people--during manic episodes--believe they are larger than life.  They may believe that they are invincible--ten feet tall and  bullet proof.  Some may believe that they are gods or divine creatures.  I once had a patient in the middle of a manic episode explain to me his belief that he was simultaneously a member of the CIA, the FBI, the US Marshalls, and a local police department. 

*Decreased need for sleep.  Now let me clarify—it doesn’t just mean a person cannot sleep.  No, that’s just insomnia.  With bipolar disorder, a person does not feel like they NEED to sleep as much or really at all.  Oftentimes, patients with the disorder may go for days and even months will very little sleep—a few hours here and there.  And they don’t feel bothered by this lack of sleep.  In fact, oftentimes, they simply don’t see a need to sleep.  For less severe episodes, patients may still be able to sleep, but instead of sleeping for 6 to 8 hours, they sleep for 2-5 hours or so and don’t complain about feeling tired or sleepy.  They just don’t perceive the need for much sleep.    

*Increased talkativeness—and what I mean is that words just seem to pour out of a person    who is experiencing mania or hypomania.  They talk continuously and may be hard to    interrupt.  It may seem that they cannot release the words from their mouths fast enough.   

*Racing thoughts—patients who are in a manic phase of illness feel as though their minds are all over the place and that the wheels are constantly turning in their minds and that their minds jump from subject to subject to subject and cannot continue with a single train of thought. 

 *Distractibility—patients experiencing mania or hypomania have real difficulty staying focused on what’s most relevant.  This is usually quite evident in conversations, as they often get into rabbit trails and discuss one irrelevant and unrelated topic after another. 

*Significant increase in activity levels—patients may start multiple new projects at one time, clean the entire house in one night, attempt to start new organizations or hashtags, and make countless and unusual posts on social media, etc.  I’ve had patients spend night after night filling one notebook after another with writing, but the majority of what they’ve written is nonsensical or gibberish. 

*Impulsive, over-the-top and excessive involvement in activities that are high risk or can result in painful consequences.  For example, patients in a manic phase may make multiple large purchases with their credit cards. I had a patient who once attempted to charge two motorcycles to his credit card. Patients may also become hypersexual and engage in reckless sexual activity.  

Now, in order for this to be considered a true manic episode, a person must experience or display 3-4 of these symptoms and they must last for at least a week or result in hospitalization because of the severity of symptoms. It’s not uncommon for people experiencing mania to require hospitalization because their behavior can be impulsive and reckless to the extent that it endangers themselves or others. Hypomania is defined as a less severe version of mania. Those who experience hypomania may experience the same symptoms as I described earlier, but hypomania usually lasts for shorter periods of time and does not require hospitalization. People experiencing hypomania are not as impaired in their functioning as those experiencing mania. Also, in my clinical experience, people with hypomania have more insight. And by insight, I mean understanding and awareness of what’s going on with them while it’s happening. However, people experiencing true mania have little to no understanding or awareness that they are experiencing a manic episode and may have very little remembrance--if any—of events that occurred during the episode. During such episodes, people are truly not themselves, and after the episode they may feel embarrassed or ashamed of what they did during the episode. 

Alright, guys--that’s the end of the session for today.  I hope this content has shed some light on things you may not have fully understood or appreciated about the manic phase of bipolar disorder. I hoped I’ve helped you understand that Bipolar Disorder is considered a serious mental illness. I really believe that those people who struggle against this illness and still find ways to thrive are truly courageous and heroic individuals.   

Folks, let’s make it our business to understand mental illness and those who struggle against mental illness.  I’m Dr. K, and this has been Mental Health | Plain Speak.  And remember, “Be kind, for everyone you meet is fighting a hard battle.”