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Understanding Bipolar Disorder


Bipolar Disorder

When you hear the words "bipolar disorder", do you understand what they mean? We hear it in passing, usually from people who don't really know what it is, when describing someone who might act like two different people at times. It seems to be used interchangeably with schizophrenia or having multiple personalities, but the three are not the same thing.

Schizophrenia is a condition characterized by delusional thinking and hallucinations. Multiple personality disorder is an illness that makes a person think there is more than one defined identity within his or her being, and those identities coexist to take on different character traits and behaviors. Bipolar is the most common of the three, but it is widely misunderstood.

Bipolar disorder is a serious health concern and a major challenge for anyone who has it. Review the information below to understand what it is, the behaviors associated with it, and how it is treated.

What Is Bipolar Disorder: Diagnosis by the DSM

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a person with bipolar disorder experiences clinically significant episodes of depression and mania. To diagnose someone as bipolar, he or she must have specific symptoms for a designated period of time. Those symptoms, or mood episodes, include the following:

  • Major depressive episodes
  • Manic episodes
  • Mixed episodes
  • Hypomanic episodes

These episodes are categorized by specific characteristics.

Major Depressive Episode

Bipolar Disorder Depressive Episode

A major depressive episode begins with constant depression or a complete lack of interest or pleasure in normal daily activities, almost every day for a two-week period. In addition to one of these two scenarios, at least four more of the following symptoms must be present every day over the same period to categorize an episode as major depressive:

  • A significant change in weight or appetite
  • Thoughts of death or suicide or an attempt
  • Slowed speech, thinking or movement, or heightened activity (pacing, problems sitting still, etc.)
  • Feeling worthless or intensely guilty
  • Inability to sleep or inability to stay awake
  • Difficulty concentrating or making decisions
  • Overwhelming fatigue

Manic Episode

Bipolar Disorder Manic Episode

When someone experiences a manic episode, he or she is unnaturally euphoric or persistently irritable for a period of at least one week. This person may also go from one feeling to the other, but to be considered a manic episode, it must include three to four of the following symptoms:

  • Exaggerated self-esteem or confidence
  • Partaking in risky activities because they are pleasurable
  • Inability to focus on one thing, even if it is important
  • Diminished need for sleep
  • Excessive pursuance of a goal or trouble sitting still
  • Racing thoughts
  • Loud and theatrical speech for own self amusement or random fuming rants

Hypomanic Episode

Bipolar Disorder Hypomanic Episode

A person is having a hypomanic episode if they are experiencing the symptoms of a less extreme manic one. These indicators only need to be present for four days in this type of episode, but have to be noticeable by others as a change from the norm and evident that they affect normal functioning.

Mixed Episode

In simple terms, a mixed episode is when a person experiences both a major depressive and manic episode for a duration of one week.

Definition of Bipolar Disorder I and II

The DSM notes there are multiple types of bipolar disorder, but all include the principal symptom of mania. The exact diagnosis is determined by how often these episodes are present, their history and the order in which they happen.

  • Bipolar Disorder I: When a person has had a full manic episode, which means they had mania for at least seven days, and a two-week depressive episode.
  • Bipolar Disorder II: When a person has at least one major depressive and one hypomanic episode.

What Causes Bipolar Disorder?

Researchers don't know what causes bipolar disorder, but most agree it is not caused by one single source. According to the National Institute for Mental Health, several factors may contribute to heightened risk and the development of the disorder. Studies have shown any combination of the following factors may cause the problem:

  • Biochemical Brain Function: A chemical imbalance related to norepinephrine, dopamine and serotonin levels
  • Genetics: The presence of particular genes that make it more probable you will experience the disorder
  • Family History: Someone else in your family is or was bipolar
  • Age: You are between 15 and 30 years old

Those predisposed to bipolar disorder because of genes or brain chemistry are more likely to have environmental factors, such as excessive stress or trauma, spark symptoms. Pregnancy is also a factor that can trigger the disorder. According to the National Alliance on Mental Illness, some research has found that many women first experience symptoms of the disorder during or just after pregnancy, most likely because of hormonal changes, limited sleep and extra stress.

How Is Bipolar Disorder Treated?

Once diagnosed, bipolar disorder can be treated using a combination of methods, including medication, psychotherapy and electro conclusive therapy (ECT). Treatment should be continuous and consistent for maximum results, as bipolar disorder is a lifelong condition.


Most bipolar patients will take some form of medication to treat the symptoms, and often a combination of drugs. The most commonly used medications are antidepressants, mood stabilizers and atypical antipsychotics. When taking these prescriptions, keep in close contact with your doctor, as some may have negative effects for certain people. Don't abruptly stop taking a medication, however, as that could potentially increase your bipolar symptoms.


Bipolar Disorder Family Therapy

Therapy is a key part of treatment for bipolar disorder and should be done in conjunction with medication. Not only can it help patients cope with the symptoms of their illness, it's a way to provide education, support and guidance for both the bipolar individuals and their families. There are four main options when it comes to psychotherapy:

  1. Cognitive Behavioral Therapy (CBT): Designed to help patients learn how to recognize negative thinking patterns and false beliefs so they can change their behaviors and focus on solutions. For bipolar disorder, CBT can help patients learn to identify when a mood swing is about to happen and how to manage it.
  2. Family-Focused Therapy: Includes family members in treatment to increase the patient's support system and improve relationships. Therapists will educate the family and uncover problems within the unit that could contribute to bipolar symptoms, and then teach appropriate communication that leads to resolving those issues as a group.
  3. Interpersonal and Social Rhythm Therapy (IPSRT): Teaching patients how to increase awareness of their mood and activities so they can recognize problematic behavior. The goal of IPSRT is to create standard routines that keep social rhythms consistent, while formulating plans to avoid instances that could interrupt the stability of the schedule.

Electroconvulsive Therapy (ECT)

If other treatments have been tried with little success, ECT is an option for those with severe cases of bipolar disorder. ECT sends an electric current to the patient's brain to cause a minor seizure. This is achieved by carefully placing electrodes around the head. It is recommended electroconvulsive treatment is administered three times a week until symptoms start to improve, then reduced to maintenance treatments based on the individual person.

Getting Treatment

Getting the right treatment for your disorder is crucial to adequate coping. If you think you or someone you know may have bipolar disorder, it's important to schedule a mental health consultation with a professional right away. At San Antonio Behavioral Hospital, we offer free, confidential consultations 24 hours a day, 7 days a week. Our assessment is designed to evaluate your current symptoms and determine the best course of action for treatment. Contact San Antonio Behavioral or call our admissions clinicians directly at 210-541-5350 to take the first step toward managing your bipolar disorder.