Bipolar Affective Disorder (BPAD) is when a person experiences periods of extreme mood changes that range from manic (emotional highs) to depression (emotional lows). These mood swings can impact a persons behaviours and thinking on a daily basis. BPAD can be a chronic condition and it can develop during adolescents or early adulthood. In some cases those affected can experience psychosis.
BPAD is a very challenging set of symptoms to live with. While typically people experience mood shifts as a result of identifiable triggers, with bipolar the shifts can instead be cyclical, triggered by risk factors such as sleep deprivation, poor intake, and stress. This can lead the individual to feel extremely disoriented and out of control, and essentially at the mercy of their brain chemistry. Individuals around them can become frustrated or frightened by these unpredictable shifts.
Mood Swings vs Bipolar
What makes Bipolar different from labile mood (mood swings), is that although the mood can shift rapidly, the low mood or the higher mood is sustained for days. When someone’s mood makes multiple shifts within the same day, it is considered labile mood or emotion dysregulation. Individuals can have both bipolar and labile mood.
Bipolar I vs II
Bipolar I is the classic type of Bipolar depicted in popular culture and is characterised by periods of severe depression and periods of mania. Bipolar II is when the individual experiences a milder form of mania known as hypomania.
Another note on Bipolar representation in popular culture - While the representation of Bipolar in popular culture is of mixed accuracy, it is worth noting that even accurate representations can lead individuals with BPAD to feel misrepresented due to the vast individual differences in individuals experiences of BPAD.
Mania vs Hypomania
While mania lasts for at least one week with severe symptoms, hypomania usually lasts for at least 4 days and the symptoms are mild to moderate. Individuals with hypomania can usually function as per usual, whereas in mania, work and social relationships are significantly impacted.
What are the symptoms of BPAD?
Often individuals experience episodes of elation/mania followed by depression/low mood. These episodes vary in duration and frequency for each individual and they can experience a state of balance (symptom free) between episodes. In addition, manic episodes can be likened to feeling invincible during this period followed by a crashing down sensation to despair and hopelessness in the depressive phase.
Manic/Hypomanic episodes are characterised by:
· Intense energy, hyperactivity
· Elevated mood - euphoric, irritable, or agitated
· Taking on too much physically, mentally and emotionally.
· Overcommitting with activities and unable to follow through
· Increase in creativity
· Setting unrealistic plans
· Over spending
· Poor judgement
· Poor sleep- reduced desire to sleep as a result of wanting to complete tasks set and engaging in creativity
· Grandiosity/ poor self-awareness and inflated self-esteem
· Easily overstimulated
· Easily distracted, poor memory and concentration
· Pressured speech, talking loudly, interrupting others
· Racing thoughts, flight of ideas and derailing conversations
· Unpredictable emotional states
· Displays poor boundaries and can be taken advantage of
· Increase in risk taking and reckless behaviour without regard to self or others
· Increase in sex drive
· Delusions or hallucinations
Depressive Episodes:
· Decrease in self-esteem
· Ruminate on perceived failures and inadequacies
· Feelings of guilt and shame
· Sleeping more frequently to avoid existing
· Loss of interest and pleasure with day to day actives such as work, recreational activities, family and friends.
· Crying more frequently
· Numb and disconnectedness
· Decrease is sexual drive
· Withdraw and isolate from people and commitments
· Suicidal thoughts
· Change in appetite
· Lack of energy
Mixed Episodes
A mixed episode is when an individual experiences the racing thoughts, flight of ideas (mind jumps from topic to topic), and pressured speech of mania, but rather than accompanied with a feeling of elevation it is accompanied by a feeling of depression and despair. Mixed episodes are extremely frightening for individuals, especially if they do not know what is happening.
There is some controversy around the term mixed episode, with some health professionals arguing that the phenomena is better understood as a form of agitated depression. Regardless, it is an extremely uncomfortable and frightening experience.
What Causes Bipolar Affective Disorder?
Research indicates a few contributing factors to BPAD, however, like other mental health conditions there is no definite cause. Genetics, chemical imbalance, and environmental such as significant life events/trauma all contribute to BPAD.
Can BPAD coexist with other mental health disorders?
BPAD can coexist with other conditions such as personality disorders, anxiety disorders, substance abuse disorders, eating disorders, and ADHD, PTSD and cPTSD.
What is the treatment of BPAD?
A combination of treatment is required to support those with BPAD. There are different treatments for manic, depressive and rapid cycling episodes. The treatments utilised for BPAD are;
· Medication - these will vary depending on manic, depressive, or rapid cycling episodes.
· Talk therapy utilising; Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (CBT), Acceptance Commitment Therapy (ACT), Psychotherapy etc. - the skills used will depend on the individuals needs.
· Electroconvulsive Therapy (ECT)
It is important to note that while there is no cure for BPAD, with the right therapy and medication, BPAD can be extremely well managed and individuals can live a rich and fulfilling life.
