DEAR DR. GOTT: What are your feelings about bipolar disorder? It is being diagnosed all too frequently these days. In some cases it appears to be just an excuse for bad behavior.
What are the criteria for a legitimate diagnosis? I know there is the manic phase and the depressed phase but it doesn’t explain some of the behavior of some people I’ve known who supposedly suffer from it.
DEAR READER: Initially, I must say it is sometimes impossible to even attempt to explain or understand the behavior of some of the people around us, whether they suffer from bipolar disorder or not. I guess that is a puzzling fact over which we will never have control.
Having said that, bipolar disorder, otherwise known as manic-depressive disorder, is associated with mood swings that range from depression to euphoria. These swings may occur as seldom as a few times a year, or as frequently as several times each day. The confusing thing is that there are instances when the extremes occur at the same time.
There are several types of the disorder, each having its own varying pattern of symptoms. For example, bipolar I has swings that can be extremely severe. The highs and lows can cause difficulties in every phase of life, whether at work or at home. Type II is less severe, with the individual generally able to function rather normally on a day-to-day basis most of the time. Finally, there is cyclothymic disorder or cyclothymia, the mildest form of a bipolar condition. The highs and lows can be rather disruptive for the individual as well as those nearby; however they are not as severe as they are with types I and II.
As with almost any condition, symptoms vary from person to person. For some, depression is extremely difficult and of great concern. This phase is linked with feelings of hopelessness, sadness, a lack of interest in things once enjoyed, irritability, suicidal thoughts, fatigue, loss of appetite, and more. For others, just the opposite holds true. The manic phase can reveal irritation or agitation, rapid speech, poor judgment, euphoria, a lack of interest in sleeping, aggressive behavior, and more.
Diagnosis often begins with a medical examination by a personal physician that likely includes laboratory testing of blood and urine that may shed some light on other possible medical issues. A psychological evaluation might be performed, with the person in question discussing various thoughts or feelings regarding specific situations. Other specialists may even be called in to provide an opinion.
In order to be diagnosed with bipolar disorder, a person must meet criteria specifically outlined in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. For example, bipolar I states that a person has at least one manic or one mixed episode. Type II mandates a person has at least one major depressive episode and at least one hypomanic (not fully manic or mixed) episode with episodes of difficulties coping in the work place or at home. With the cyclothymic disorder, an individual must have had several hypomanic episodes and periods of depression over a two year period (less time for children and adolescents) or even longer. There are additional but extremely specific related actions that must occur for each event, as outlined by the manual that must occur prior to any diagnosis being made.
The exact cause of bipolar disorder remains elusive. It is believed that a hormonal imbalance, stress, trauma, inherited traits, and additional factors play a role. Things that increase the risk of the disorder include a family history, drug and/or alcohol abuse, high stress levels, and major life modifications such as the loss of a loved one. Bipolar disorder is disruptive — both for the individual and for those who come into contact with that individual. Left untreated, serious problems can occur. Fortunately, in most instances, medication such as lithium, anti-psychotics or anti-depressants and psychotherapy can help keep things in check. Treatment will likely be lifelong and might include a social worker, psychologist and support groups.
On the home front, those diagnosed with bipolar disorder should get adequate sleep, eat well-balanced meals, and discontinue alcohol. There are a number of over-the-counter supplements; however, additional research is necessary before they can be endorsed. Massage therapy might assist in reducing stress levels and yoga or tai chi can often help level mood swings.
In summary, I am sure you feel there are instances of bad behavior blamed incorrectly on bipolar disorders. However, for the individual so diagnosed, the condition is real and often overwhelming consuming, for which we all need a better education for understanding.