Types And Variations Of Bipolar Disorder

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Bipolar disorder, or manic depressive, is a mood disorder fluctuating between states of extreme highs and major lows from the societal norm. Mood swings associated with the disorder can be severe and incapacitating as compared to most other individuals. Many with the disorder attend school, work, and live a productive life, but courage, dedication, and the help of medications and psychotherapy help to make it possible. Sadly, some patients stop taking their prescribed medication(s), or choose not to at all, when they feel better because they think it’s no longer needed. Mood swings can cause attention spans to dwindle, the person leaving projects unfinished and plans undone. The disorder differs from person to person, with some expressing mania for a few days, then depression hits for months. Others go months or years without experiencing a mood shift at all. A mixed state is even possible, where both manic and depressive episodes are present at the same time. Studies conducted have shown those with the disorder may even have enhanced creativity and empathetic skills (NationalInstituteofMentalHealth.com).

Different variations of bipolar disorder exist, including disorder type I & type II, hypomania, and rapid cycling. Psychosis can occur in both manic and depressive episodes. Mania and hypomania are known as the ‘high’ moods where mania is the more severe form of the two. Manifestations during a manic episode are definitive from how the person normally acts and create obtrusive, and sometimes destructive, behavior. According to the DSM-5, the time frame for a manic episode lasts (DSM-5). Symptoms include increased mental/ physical energy, a decreased need for sleep, grandiose thinking brought on by an inflation of self-esteem or self-importance, rapid or exaggerated speech, and racing thoughts where internal ideas rollercoaster through the mind without control. Some may be incapable of making logical decisions in this state and engage in unhealthy activity, such as excessive purchasing/ gambling, or using illegal substances. These symptoms can be bothersome, causing conflicts at work or in personal life, and in severe cases, can lead to the person being hospitalized. This is the realm of Bipolar Disorder type 1, where the patient experiences more euphoric states than depressive ones. The DSM-5 states hypomania includes the same features as a manic episode but are usually not as severe or have a long duration. Hypomanic features lasting four consecutive days could indicate possible bipolar disorder, but a few symptoms expressed are not reliable enough for a clear diagnosis. More information would need to be gathered along with further elevation. (DSM-5).

Major Depression is at the opposite end of the bipolar spectrum, characterized by five or more symptom markers that have been bothersome for two weeks straight. When a person’s mood seems filled with desperation and gloom for most of the day or every day, this could be the first red flag of depression (DSM-5, pg). These feelings must not be induced by another medical ailment or from the physiological means of substances. Common physical symptoms associated with major depression are wavering eating habits and consumption, weight loss not achieved through dieting or weight gain, restlessness, and fatigue. It’s been reported that pain at times will not respond to treatment. Psychological issues present loss of interest in things that once gave pleasure, interrupted sleep patterns, feelings of inadequacy, concentration and memory problems, along with reduced attention spans (DSM-5, pg). At times, a person may not be able to face societal demands and withdrawal from the world, adding to the constant feeling of guilt (if present), and create disturbances in important life areas. The darker side of depression procures suicidal tendencies and thoughts of death (medicalnewstoday.com). In severe cases, a depressive person may act on their thoughts, potentially ending their life. Bipolar disorder type 2 dwells here, often dipping into the lower tiers of the disorder and occasionally reaching the manic highs. In accordance with the DSM-5, the prevalence for 12 months, also known as someone who had the condition during a certain period, for bipolar disorder type 2 on a world-wide scale affects 0.3% of the population, and the United States 12-month prevalence stands at 0.8%. The DSM-5 credits the DSM-4 with ‘bipolar I, bipolar II, and bipolar disorder not otherwise specified yield a combined prevalence rate of 1.8% in U.S. and non-U.S. community samples’ (DSM-5, pg). The prevalence rate in children is harder to establish, but those twelve and older have a higher score at 2.7%. Men and women are equally affected, diagnosable between ages 15 to 25, but can be triggered at any age (medicalnewstoday.com).

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Journal of Medical Genetics elaborates further, determining the lifetime prevalence of bipolar disorder is around 0.5-1.5% and onsets around age 21 (Journal of Medical Genetics). Morbidity rates are high, with approximately 15% of people committing suicide. Bipolar does not seem to have a singular cause but rather could be a combination of mixed factors interacting with each other. Some studies theorize genetics can play a role in determining the likelihood of developing the disorder, especially when a family member already has the condition. This does not mean, however, that those with a family history of bipolar will develop it, but the predisposition is there (NIHM). It’s a possibility that environmental influences could trigger the genetic code and activate a severe mood swing in someone, even if noticeable symptoms were not there.

Found in a National Institute of Mental Health article, Lauren B. Alloy and Lyn Y. Abramson tested the Behavioral Approach System (BAS) theory, which aims to explain ‘the role of sensitivity to rewards and goals [and how it] plays in bipolar disorder’ (The Role of the Behavioral Approach System (BAS) in Bipolar Spectrum Disorders). Behaviorists believe bipolar disorder is caused by a reward and failure system, with frequent fluctuations in BAS scores could be indicators of manic and depressive symptoms alike. For example, when goals are successfully earned, or rewards are involved, their BAS becomes hypersensitive and activates, which is thought to trigger a hypomanic or manic episode. The person could experience symptoms such as ‘goal-directed behavior, decreased need for sleep, and euphoria’ (The Role of the Behavioral Approach System (BAS) in Bipolar Spectrum Disorders). Definitive losses and failure of accomplishment creates depressive behavior that include lack of energy, sadness, and hopelessness, along with the behavioral approach shutting down.

Cognitive Behavorial Therapy, or CBT, Treatment can mean many different forms of therapy. The most common are prescribed medications and psychological therapy. The Journal of Medical Genetics claims mood stabilizers such as lithium and various anticonvulsants reduce phases of mania and depression (Journal). If left untreated, symptoms can be problematic and trying, but effective treatment can promote wellness in months as opposed to years. Although treatment is useful for mood swings and depression, the person is still prone to these issues while in a stable condition. Maintaining a close relationship with their doctor can help ease and make symptoms manageable.

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