Bipolar disorder is a serious mental illness marked by extreme fluctuations in mood. There are two types of bipolar disorder, bipolar I and bipolar II, plus a milder form called cyclothymic disorder. More than five million people in the U.S. have bipolar disorder, according to the National Institute of Mental Health.
Bipolar I
Bipolar I disorder is marked by extreme fluctuations in mood. It is defined by the occurance of one or more manic episodes (and may or may not include depressive episodes). Although formerly called manic depressive disorder, bipolar I disorder does not require depressive episodes for a diagnosis. Once someone has ever been diagnosed with a manic episode he technically always has the diagnosis of bipolar I disorder, though he may experience significant relief in symptoms as a result of treatment. Manic episodes consist of a period of at least one week of markedly elevated, expansive and/or irritable mood. Those experiencing manic episodes usually experience a decreased need for sleep, flight of ideas, racing thoughts, increased activity, talkativeness and feelings of grandiosity. They also may experience out-of-control and abnormal behaviors including aggression, sexual acting out, spending sprees and substance abuse. For an episode to qualify as manic, significant disturbance in social, occupational or other important areas of functioning must occur. Manic episodes may include psychosis, or a break with reality.
Bipolar II
Bipolar II disorder presents less disruptive symptomology than bipolar I. One or more hypomanic and one or more major depressive episodes must occur for this diagnosis. A hypomanic episode consists of four or more days of elevated mood and three of the following symptoms: pressured speech, a sense of grandiosity, decreased need for sleep, flight of ideas, racing thoughts, difficulty concentrating, agitation and pleasurable but risky behavior. The symptoms are not significant enough to seriously disrupt social, occupational or educational functioning. In fact, hypomania often appears to be simply high-functioning, extroverted behavior. Major depressive episodes consist of a depressed mood that lasts at least two weeks. Symptoms include loss of pleasure in usual activities, fatigue, agitation, change in sleeping or eating habits, difficulty concentrating and suicidal thoughts.
Cyclothymic Disorder
Cyclothymic disorder exists on the most mild end of the bipolar continuum. Diagnostic criteria include alternating episodes of hypomania and mild depression continuing for at least two years, without a symptom-free period of more than two months. Often symptoms do not markedly disrupt functioning.
Considerations
Many people with bipolar disorder do not seek treatment until either a manic episode has created significant disturbance in their lives or they experience a depressive episode and seek treatment for that. The onset of bipolar disorder usually occurs by age 25, though it often goes undiagnosed for some time, according to the National Institute of Mental Health. Bipolar II disorder and cyclothymic disorder pose particular problems for diagnosis, as symptoms are mild.
Treatment
Treatment for bipolar disorder can include mood-stabilizing medications, antipsychotic medications, anticonvulsants and psychotherapy. Consistent routines in sleep, exercise and work also benefit those with this diagnosis.
