Despite being a relatively common mood disorder, bipolar disorder is highly misunderstood and often confused with other mood disorders such as
major depressive disorder (MDD) and schizophrenia. While this disorder is a
lifelong condition, proper education and treatment can help manage the
condition and allow the diagnosed individual to better function.
اضافة اعلان
Today, we will
be covering some basic criteria and statistics to show the nature of bipolar
disorder medically.
Exact reports on
the prevalence of bipolar disorder internationally vary and are likely an
underestimate of the true prevalence. In the
US, bipolar disorder affects 4.5
percent of the population.
In Jordan, there
are no reports on the prevalence of bipolar disorder, but it is nonetheless
present.
What is bipolar disorder?
Bipolar disorder is a common, chronic, and often severe mood disorder
characterized by fluctuations in mood, energy, and behavior. Bipolar disorder
tends to present around late adolescence or early adulthood, although the
majority (over two-thirds) develop symptoms before the age of 18.
The main
features of bipolar disorder are episodes of depression, mania, or hypomania.
Due to the fact that bipolar disorder is a cyclic disorder, an individual will
routinely cycle between these features and may or may not have periods of
normal mood, also known as euthymia, between episodes.
These
fluctuations in mood may also be sporadic. Fluctuations may occur and continue
for months, or after one episode, symptoms can disappear for years without any
recurrence.
Diagnosing bipolar
disorder
Under the
Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), to be diagnosed with bipolar, fluctuations in mood cannot be
attributed to other medical conditions, substance use or abuse, or a separate
psychiatric disorder.
Three main
defining features must be present for a bipolar disorder diagnosis: depression,
hypomania, and mania. Their presentation dictates the subtype. Each feature is
further defined by the DSM-5 as follows:
Depression: The features of
depression in bipolar disorder follow the same criteria as MDD. Symptoms of
depression must be present for at least two weeks on most days and must be
associated with depressed mood or loss of interest or pleasure in normal
activities. Additionally, there must be at least five of the following
symptoms:
• Depressed, sad mood in adults or an irritable
mood in children.
• Decreased interest and pleasure in normal
activities.
• Decreased or increased appetite; weight loss or
weight gain.
• Insomnia (lack of sleep) or hypersomnia
(excessive sleeping)
• Psychomotor impairment (slow thinking or
moving) or agitation (restlessness)
• Decreased energy or fatigue
• Feelings of excessive guilt or worthlessness
• Impaired concentration or indecisiveness
• Recurrent thoughts of death, suicidal thoughts,
or attempts
Hypomania and mania: The
criteria between hypomania and mania are similar and largely overlap. The main
difference is the duration of the episode. However, mania may be more
associated with violent tendencies, both to the individual and to others, in
comparison to hypomania.
To be diagnosed with bipolar, fluctuations in mood cannot be attributed to other medical conditions, substance use or abuse, or a separate psychiatric disorder.
Both are
described as abnormally and persistently elevated mood (described as expansive
or irritable) and energy. In mania, symptoms must be present for at least one
week, whereas symptoms for hypomania need to be only present for at least four
days. In order to fit the criteria of hypomania or mania, an individual must
have three of the following symptoms or four if the mood is only irritable:
• Grandiosity or inflated self-esteem
• Decreased need for sleep
• Increased talking
• Racing thoughts or flight of ideas
• Getting easily distracted or having poor
attention
• Increased goal-directed activity or psychomotor
agitation
• Excessive involvement in activities that are pleasurable
but have a high risk for serious consequences
When discussing
activities that are pleasurable but have a high risk for consequences, this can
look like spending sprees, sexual indiscretions, or poor judgment in
business ventures. This risky behavior can be self-destructive and negatively impact
those around the individual.
Generally, the
length and severity of a mood episode, as well as the interval between
episodes, vary from individual to individual. Manic episodes tend to be shorter
and end more abruptly than depressive episodes.
Different mood
episodes can occur regularly at similar times every year.
Classifying bipolar
disorder
There are two main subtypes of bipolar disorder: bipolar I and bipolar
II. There are also subtypes designated for those who do not quite meet the
threshold for bipolar disorder. More people tend to be classified as bipolar II
than bipolar I.
Bipolar I is
defined as manic episodes with or without major depressive or hypomanic
episodes.
Bipolar II is defined as major depressive episodes with or without
hypomanic episodes.
Cyclothymic disorder is defined as chronic fluctuations between depression-like symptoms.
Although bipolar II is slightly more common, roughly
5–15 percent of those with bipolar II will develop a manic episode within five
years. Once there has been a single instance of mania, the diagnosis changes
from bipolar II to bipolar I.
The two main
subtypes for those who do not meet the criteria for bipolar I or II are:
cyclothymic disorder and unspecified bipolar and related disorder.
Cyclothymic
disorder is defined as chronic fluctuations between depression-like symptoms.
This means depressive episodes that do not meet the criteria for major
depression and hypomania. For adults, these fluctuations must be present for at
least two years, and in children and adolescents, symptoms must be present for
at least one year.
Although
cyclothymic disorder does not meet the threshold for bipolar disorder,
individuals with this disorder have a 15–50 percent risk of developing bipolar
I or II later in life. Unspecified bipolar and related disorders are mood
states that do not meet the full criteria for any specific disorder in the
bipolar and related disorders class.
Conditions similar to bipolar disorder
In order to be diagnosed with bipolar disorder, the fluctuations in
mood can not be related to any other cause. Unfortunately, there are many
medical conditions, medications, and substances that can cause symptoms of
depression and mania.
Abuse and use of certain drugs such as hallucinogens, alcohol, marijuana, and withdrawals from substances such as alcohol, opioids, or benzodiazepines can cause manic episodes.
Brain tumors, strokes, infections, electrolyte
abnormalities, and hormonal conditions such as Addison’s disease, Cushing
disease, or hyper/hypothyroidism can cause manic episodes.
Additionally,
medications such as antidepressants, steroids, certain decongestants, and
herbal products can also cause manic episodes.
Abuse and use of
certain drugs such as hallucinogens, alcohol, marijuana, and withdrawals from
substances such as alcohol, opioids, or benzodiazepines can cause manic
episodes.
There is also a
similar psychiatric disorder that shares many similarities to bipolar disorder,
Schizoaffective disorder. This disorder, in short, is a mix between
schizophrenia and bipolar disorder and is likely the reason why the two
conditions are often confused.
Those with
schizoaffective disorder experience mood episodes similar to those with
bipolar, but they will also experience psychosis or dissociation from reality
between episodes.
Due to the vast
number of factors that can influence mood, diagnosing bipolar disorder can be
difficult. However, we hope that with today’s article, you can better
understand the disorder.
Stay on the lookout for
our next article where we will be covering the impacts, treatments, and other
aspects of living with bipolar.
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