If you go on the internet you will get a list of signs and symptoms of bipolar disorder, but to me these are cold and rigid and far from expressing the reality. I will go into them here, but hopefully, add in some insights which are not in the lists as I am someone diagnosed with bipolar disorder.
There are typically noted to be 3 main types:
Bipolar 1, Bipolar 2 and Cyclothymia.
Commonly, it is assumed that bipolar 1 is more serious than bipolar 2, but in fact this is misleading. Statistically, people diagnosed with bipolar 2 have a very high suicide rate compared with those with bipolar 1 and the general population. However, the diagnosis is based on the manic episodes not the depression, and these are more serious in people diagnosed with bipolar 1. Technically, you only need to have one episode of mania to be diagnosed, but in reality, it is something that often occurs more often than once.
People with bipolar 1 are typically described as having severe mania, with euphoria (not just very happy), speediness in thoughts, words and actions, and often “delusions of grandeur” – as they are called. These are often episodes of beliefs that they are very important, can do almost impossible (or actually impossible) things, and will act on these beliefs. Less commonly, but relevant are episodes of hallucinations. The thoughts are so fast that the person themselves can find it impossible to keep up and speech becomes like a rapid firing machine gun. Often the thoughts are so fast, the person can’t finish sentences, only speaks in words and will jump from subject to subject rapidly. Anything and everything will distract the person.
Unfortunately, people in this state can get utterly frustrated with all around them who aren’t following their thoughts, aren’t believing their beliefs, and this can turn into rages against others. This anger can lead to terrible problems with those around them, long after the mania has stopped, obviously, as family and friends can be utterly devastated. Telling a person to calm down is probably the one things NOT to do. It is best to try to avoid reacting – but that is very, very hard.
Along with these problems, a person can also spend money like water, landing themselves and their families into debt and surrounded with a random array of objects, or investments which are rarely going to be of any use. My husband would take away all my cards, despite my anger at this, and limit the amount of access to money I had.
Hypersexuality is arguably one of the worst aspects of bipolar. A person who in an ordinary state would never think of indulging in sex with strangers or anyone outside of their relationships, suddenly finds they have had sex in all kinds of places and ways which can be highly dangerous and/or unbelievably upsetting and embarrassing afterwards.
Sometimes, people in mania do things which sound very amusing to others – but often they are not like that to the person with bipolar, once they come back down. Events can be embarrassing and cause people to withdraw in shame afterwards. It is wise, if possible, not to laugh in front of the person at these events or be very sensitive to their feelings once the mania has passed.
Typically in this state, people sleep very little for days on end and the text books talk of having to have this state for 2 weeks non stop to be called mania. However in my experience, it can last for shorter periods, having just as devastating an effect on the person and the relatives/friends. This lack of sleep acts like a motor driving the mania on, causing more and more psychotic symptoms.
Eventually, the Crash will happen. Exhaustion, lack of sleep, and sudden awareness of all that has happened will occur. The swing into depression can be sudden and dramatic. Most depression occurs as a gradual process, a person getting lower and lower. In bipolar, it can be like that, but often is a rapid descent. For many of the above reasons, this depression is very dangerous, as shame, anxiety and despair hit hard. It is at this time that suicidal thoughts can occur strongly and self harm is fairly common.
People with bipolar 2 have much of the above, but its called hypomania, which means lower level mania. During this time they can be more productive and have lots of good ideas, but often this period doesn’t last and the more destructive aspects can assert.
There is a state called a Mixed State, and this is very dangerous. The high mood in this case can lead to lack of inhibition of mania, but with all the feelings of depression. This can lead to an impulsive suicide attempt, and any suspicion that a person is like this should be taken seriously.
As I said before, the depression in bipolar 2 is often more frequent and severe. Some people with bipolar 1 never experience depression at all, but all people with bipolar 2 do. There is a commonly stated aspect of bipolar 2 that they can’t get psychotic symptoms but this just isn’t true. Hallucinations and delusions can happen, almost always in the depressive aspect.
Cyclothymia, is milder than the above symptoms but is still debilitating to the individual, causing a sense of being out of control of their lives and the swings can still be dangerous, especially the depressions.
Treatments usually start with medications. Mood stabilisers, sometimes antidepressants and anti psychotics. Anti psychotics aren’t only used for psychosis, but as they are major tranquilisers, they are used to calm the person. Antidepressants should never be used alone as they can easily precipitate a manic episode. Hospital admissions are common, at least once, but with help, these can be minimised.
However, it is not commonly known that many people with diagnosed with this condition can respond to talking therapies, and /or the behavioural types eg CBT or DBT, psychodynamic and others. DBT (Dialectical Behavioural Therapy) was created originally for people with another condition, but the emphasis on behavioural changes and validation of emotions and sense of self, can be highly effective.
Some people with bipolar have found that a structured life of Mindfulness and careful diet can mean they can live on no medications or lower dosages. But this takes a lot of discipline and commitment. I have found medications debilitating at times as do many people diagnosed with bipolar, so I am trying DBT to help me have the skills to manage my condition. Understanding is needed with people not taking medications as medication can lead to a person not feeling alive and feeling worse. Relatives and friends tend to concentrate on the person taking meds non stop and nag them, and its understandable given the extremes of reactions of bipolar. But, some antidepressants and most anti psychotics cause a lot of weight gain and diabetes as well as feeling like a zombie, so that is also to be taken into account.
A lot of understanding and love is required in helping a person who is diagnosed with this form of mental distress. Learn about and encourage Mindfulness and sometimes it can help for all people in a family to manage better. Mood diaries are also something often used and encouraging the person to monitor their moods can give clues when they are beginning to tip over.
But a very positive thing is to try to identify triggers and validate the early signs in the person, so something which might not bother you, might be the trigger for a person to become stressed. Stressful events are often a trigger.
It is not all doom and gloom. Some manage med free, some manage with meds and therapy and more are learning to manage more with Mindfulness. It is not true that a person is necessarily bipolar for life. There may be very long times, even years, when a person has no signs or reactions. All the above list of signs sounds terrible, but most people don’t have all those reactions to distress.
- Bipolar Disorder for Dummies – Reasonable start but be critical in reading it.
- Bipolar Disorder, the ultimate Guide by Sarah Owen and Amanda Saunders – really good insights and written by women who have both had family members living with bipolar.
- Mindfulness for Dummies – another good starter book.
- Mindfulness in Plain English by Bhante Gunaratana – Don’t get hung up on the long Indian words, he is brilliant at explaining it!