Bipolar Disorder

Bipolar disorders typically feature episodes of major depression interspersed with periods of mania or hypomania (an abnormally elevated or expansive mood that does not impair reality testing). A manic episode must meet the following criteria:

A. A discrete period of abnormal, persistently elevated, expansive, or irritable mood

B. At least three of the following in the same period:

1. Inflated self-esteem/grandiosity
2. Marked decrease in need for sleep
3. Pressured speech
4. Racing thoughts
5. Marked distractibility
6. Increased goal-directed activity or psychomotor agitation
7. Excessive involvement in pleasurable activities without regard for negative consequences

C. Symptoms must be severe enough to cause marked impairment in functioning or place self or others in danger

D. Not be caused by schizophrenia or substance abuse

Walt, a big man, a truck driver, who seems pleasant and good natured in his normal state, has bipolar disorder. He has had trouble holding down a job for the past few years because of his erratic behavior. Sometimes he becomes sexually obsessed. He can't get sex off his mind. If an attractive woman is anywhere near, he can't concentrate on anything but his sexual fantasies. Sometimes he loses touch with reality enough to start believing that she returns his fantasies. When he's in this state, he'll spend money he doesn't have on prostitutes, on gambling, on anything to impress women. He believes he's attractive, powerful, and charmed, and he feels he can do now wrong. Nothing seems to bother him. He can stay up for days, talking nonstop.

But at other times, Walt is severely depressed. He doesn't believe he's capable of anything. He hardly has the energy to get out of bed. He tries to go to work, but his lack of confidence makes his employers distrust him. He develops obsessive anxiety symptoms-going back into the house ten times to make sure the coffee pot is unplugged. He's constantly apologizing for himself.

The average age of onset for bipolar disorder is the early twenties. It affects men and women equally. Between 0.4 and 1.2 percent of men and women will develop the disorder. At any given time, between 0.1 and 0.6 percent of the population are suffering from an episode. There is a high genetic correlation; first-degree relatives of bipolar patients have a 12 percent lifetime incidence, while another 12 percent will experience major depression.

Untreated, a manic episode will last an average of six months, and a major depressive episode will last eight to ten months. The interval between episodes decreases as time goes on. There is a high mortality rate, due to suicide, accidental death due to risky behavior, and concurrent illness.

Many people with untreated bipolar disorder will die from alcoholism, lung cancer, accidents, or sexually transmitted disease; feeling so invulnerable during an episode, they simply do not take the precautions that most of us have come to accept as part of a sensible lifestyle.

Bipolar disorder seems to be a different breed from other kinds of depression, though the depressive episodes may look and feel the same as major depression. Bipolar disorder has such a high degree of genetic transmission, the manic episodes are so distinctive and limited to the disease, and the disease itself has such a unique response to a specific medication (lithium) that it makes sense to think of it as primarily a biogenetic disease that causes a chemical imbalance in the brain. This is not to say that the bipolar patient also doesn't have to change his lifestyle for his recovery.

On the next page we will discuss Adjustment Disorder.