What is bipolar disorder?
01What are the symptoms of bipolar disorder?
02Are there different types of bipolar disorder?
03What causes bipolar disorder?
04How can counselling help with bipolar disorder?
05Getting Support
06Bipolar disorder is a mental health condition that causes extreme changes in mood. A person with bipolar disorder can find that their mood swings between major highs and lows, with these episodes often lasting weeks or months at a time.
The term ‘bipolar’ refers to the way in which the condition causes a person’s mood to change between two different states in particular - mania and depression. Mania results in emotional highs and overactivity, while depression causes low mood and lack of energy.
Bipolar disorder was once known as ‘manic depression’ due to the relationship between mania and depression associated with the condition. This term is now considered outdated, but some people may still use it when discussing bipolar disorder and its symptoms
While everyone experiences changes in their mood as part of daily life, bipolar disorder can make these changes particularly distressing. The extreme highs and lows caused by bipolar disorder can feel overwhelming and difficult to manage, which can have a significant impact on your general health and wellbeing.
Like with most mental health conditions, everyone can have a different experience with bipolar disorder. The severity of bipolar disorder can differ from person to person, and some people can experience the symptoms of mania and depression differently too.
There are an estimated three million people living with bipolar disorder within the UK. Research by charity Bipolar UK has revealed that bipolar disorder is one of the most common long-term health conditions in the UK, with almost as many people living with the condition as there are people living with cancer.
Despite bipolar disorder receiving wider attention in the media in recent years, some misconceptions still surround the condition. If you are diagnosed with bipolar disorder, it’s important to remember that you are not alone. Stigma surrounding bipolar disorder doesn’t have to be tolerated, and there are people out there who will support you.
The symptoms of bipolar disorder can be considerably varied. The following lists outline the symptoms of depression, mania, and the psychotic episodes that can occur as part of extreme changes in mood.
Depression
Depressive episodes cause extremely low moods. Some people with bipolar disorder can find these episodes to be particularly difficult, and may find that the contrast between the highs of mania and the lows of depression make depressive episodes feel worse.
The emotional and behavioural symptoms of depression include:
Emotional
• A lack of interest or enjoyment in normal activities
• Low self-esteem and low confidence
• Lack of appetite
• Difficulty concentrating
• Feeling upset or tearful
• Feeling tired and lethargic
• Feeling hopeless or worthless
• Feeling pessimistic or doubtful
• Feeling tense and irritable
• Feeling suicidal
Behavioural
• Not doing usually enjoyable activities
• Avoiding other people and social events
• Doing less physical activity
• Difficulty sleeping or sleeping too much
• Eating too much or too little
• Misusing alcohol or drugs
• Self-harming
• Attempting suicide
Mania
Manic episodes cause extreme emotional highs. These episodes can last for weeks or months at a time, and can disrupt your ability to carry out basic daily activities. In severe cases, treatment in hospital may be required to get symptoms of mania under control.
The emotional and behavioural symptoms of mania include:
Emotional
• Feeling very happy, euphoric, or overjoyed
• Feeling confident or extremely assertive
• Feeling uncontrollably excited
• Feeling irritable or agitated
• Feeling easily distracted and unable to concentrate
• Feeling full of new ideas and plans
• Feeling invincible and unable to be harmed
• Feeling like you can hear, see, and do things better than before
• Feeling like you can hear, see, and do things better than other people
Behavioural
• Talking a lot and talking very quickly
• Being more physically active than usual
• Being particularly friendly
• Being rude or aggressive
• Sleeping very little or not at all
• Losing social inhibitions
• Misusing alcohol or drugs
• Seriously risking your own safety
• Saying or doing things that are inappropriate or out of character
• Spending vast amounts of money, or spending more money than usual
Psychotic Episodes
Some people with bipolar disorder will experience symptoms of psychosis as part of their extreme changes in mood. This is when someone perceives reality differently from others around them, sometimes through hallucinations or delusions.
Psychotic episodes most commonly occur during manic episodes, but there are people who also experience psychosis as part of a depressive episode. Psychosis is particularly distressing and can result in hospitalisation at its most severe.
There are three types of psychosis that people with bipolar disorder may experience:
Delusions
A delusion is when someone holds a firm belief in something that is untrue. Even though other people may not share their belief and there is no hard evidence to prove the belief to be true, the delusion can feel very real for the person experiencing it. This can be particularly frightening and distressing.
A ‘delusion of grandeur’ may make someone believe they hold great power and authority, perhaps with the ability to control the weather or tomorrow’s winning lottery numbers. This can sometimes make someone vulnerable to financial issues.
‘Persecutory’ delusions can make someone believe that another person or organisation is conspiring to harm, control, or kill them. This can leave someone feeling very threatened or unsafe.
Hallucinations
Hallucinations occur when someone sees, hears, feels, smells, or tastes something that doesn’t exist outside of their mind. Examples of these include:
• Sight - seeing people’s faces, colours, animals, shapes, or religious imagery.
• Sound - hearing voices and other sounds, both pleasant or threatening.
• Touch - feeling touched when no one is there, feeling insects crawling on your skin.
• Smell - smelling odours that no one else can, both pleasant or unpleasant.
• Taste - tasting things that aren’t in your mouth, both pleasant or unpleasant.
Disorganised Thinking and Speech
Disorganised thinking and speech is a type of psychosis that causes racing thoughts and ‘flights of ideas,’ where we feel out of control of our thoughts and make links between ideas that can seem nonsensical to other people.
All of this can occur at the same time, affecting our ability to speak and articulate what we’re thinking. A person with disorganised thinking may find it difficult to hold their attention on one thing at a time, or change the topic of a conversation rapidly. Disorganised speech can make someone stumble over their words and speak very quickly, and may also cause them to group words together by the way they sound rather than by what they mean.
Mixed Episodes and Rapid Cycling
It’s possible to feel the symptoms of depression and mania at once or in quick succession. These are known as mixed episodes or rapid cycling, where the extreme highs and lows of bipolar disorder become entangled or there is little time between mood swings.
The symptoms of both depression and mania individually remain the same during these episodes. Someone experiencing a mixed episode might feel depressed yet overactive, while someone experiencing rapid cycling might swing between depression and overactivity very quickly with no relief.
Mixed episodes and rapid cycling can be significantly more challenging as it can be hard to pinpoint exactly how you’re feeling and what support you might need. This may make suicidal thoughts and self-harm worse, especially if others around you are struggling to identify the best way to help.
There are different types of bipolar disorder that are determined by the way you experience the symptoms of the condition and how severely they affect you. A doctor may diagnose you with a specific type of bipolar disorder depending on these criteria.
Bipolar I
This diagnosis may be given if you have experienced at least one manic episode that has lasted longer than one week. This mania may be accompanied by depressive episodes, but this is not the case for everyone.
Bipolar II
This diagnosis may be given if you have experienced at least one severe depressive episode and at least one severe manic episode.
Cyclothymia
This diagnosis may be given if you have experienced both manic and depressive episodes over the last two years or more, and your symptoms aren’t severe enough to meet the criteria for a diagnosis of Bipolar I or Bipolar II.
A diagnosis of cyclothymia can be difficult to receive as it can feel like your experience is not being taken seriously by healthcare professionals. However, cyclothymia can still cause distress to those it affects and should therefore be treated with the same understanding as other types of bipolar disorder.
Researchers have been unable to identify a definitive cause of bipolar disorder. Brain chemistry, genetics, stressful life events, and trauma in childhood have all been proposed as potential contributing factors to its development. These factors can affect everyone differently.
Brain chemistry
Some experts believe chemical imbalances in the brain can contribute to a person developing bipolar disorder. These chemicals are known as neurotransmitters and help to control the brain’s functions. Dopamine, serotonin, and noradrenaline are examples of neurotransmitters.
Evidence suggests that an imbalance of one or more of these chemicals can cause symptoms of bipolar disorder. For example, particularly high levels of noradrenaline in the brain have been found to contribute to episodes of mania.
As bipolar disorder can be treated with psychiatric medications that target the neurotransmitters in the brain, this also suggests that brain chemistry possibly plays a key role in the development of the condition.
Genetics
Bipolar disorder can run in families, which suggests there is a genetic link to the development of the condition. The family members of a person who experiences bipolar symptoms therefore have an increased chance of developing the condition themselves.
Despite this genetic link, there is no evidence to suggest that a single ‘bipolar gene’ exists. Researchers believe a variety of genetic factors could contribute, while environmental factors must also be considered as triggers for bipolar disorder.
Childhood trauma
Research has shown that trauma in childhood may increase the likelihood of a person developing bipolar disorder, as these experiences can affect the ability to regulate emotions.
Experiences such as neglect, physical or sexual abuse, a bereavement, or a significantly traumatic event can all contribute.
Stressful life events
A period of significant stress can act as a trigger for symptoms of bipolar disorder. This is usually a life-altering event such as a bereavement, financial difficulties, relationship breakdown, physical or sexual abuse, or a life-changing physical health diagnosis.
It’s unlikely that everyday stressful situations - eg. a hard week at work, sleep problems - can cause the development of bipolar disorder, but these can trigger episodes of mania or depression for someone already experiencing the condition.
Some antidepressants, as well as the recreational use of drugs and alcohol, have also been found to bring on symptoms of mania and depression associated with bipolar disorder. Read more about this and other causes of bipolar disorder in adults on our blog.
Counselling can be used in the long-term treatment of bipolar disorder to help manage symptoms. It provides a safe, confidential environment to explore your behaviours and emotions with the support of a qualified therapist.
Bipolar disorder is often treated through a variety of talking therapies. This form of therapy can help you to understand your bipolar disorder and the effects it has on your everyday life. A therapist will work with you to identify your symptoms and any warning signs that could suggest the beginning of a change in mood, while also helping you to develop strategies for when these episodes do occur. You can also draw up a crisis plan and set long term wellness goals with the support of your therapist if you wish.
Cognitive behavioural therapy (CBT) is a popular talking therapy used in the treatment of bipolar disorder. It can help you to better understand your thoughts, emotions, and behaviours and how they influence each other. CBT can also allow you to identify coping strategies when faced with situations that might trigger symptoms of your bipolar disorder.
Interpersonal therapy can also help to address bipolar disorder and the effect of relationships on the condition. It focuses specifically on how emotions and behaviours can be influenced by your relationships, and how these both affect your relationships in turn.
If you are experiencing an urgent mental health crisis, seeking assistance from an emergency mental health service may be more beneficial than counselling. Visit the Samaritans website for more information on what to do if you or someone you know is experiencing a mental health crisis. In urgent circumstances, contact the emergency services by dialing 999.