Bipolar disorder is a mood disorder, and the Diagnostic and Statistical Manual of Mental Disorders currently lists five types: bipolar I, bipolar II, cyclothymic disorder, other specified bipolar and related disorders, and unspecified bipolar and related disorders.
In the United States, about 4.4 percent of adults experience bipolar disorder at some point.
People with bipolar disorder tend to have moods marked by highs and lows, or periods of mania and depression.
The duration and intensity of these episodes enable health professionals to determine which subtype of bipolar disorder a person has.
Types of bipolar disorder
A medical professional can diagnose the type of bipolar a person may have.
The categories include:
- Bipolar I disorder: This involves manic episodes lasting 7 days or more, or severe mania that requires hospitalization. The person may also experience a major depressive episode that lasts 2 weeks or more. A person does not have to experience this type of episode to receive a bipolar I diagnosis.
- Bipolar II disorder: This features both mania and depression, but the mania is less severe than in bipolar I, and doctors call it hypomania. A person with bipolar II may experience a major depressive episode preceding or following a manic episode.
- Cyclothymic disorder: Also known as cyclothymia, this type includes symptoms of hypomania and depression that last for 2 years or more in adults or 1 year in children. These symptoms do not fit the criteria for wholly manic or depressive episodes.
- Other types: People with these disorders experience symptoms that do not fall into the above categories. The symptoms may stem from drug or alcohol use or medical conditions, for example.
Bipolar I and II are the most common subtypes, with bipolar I being more severe in terms of manic symptoms.
Symptoms of bipolar disorder include episodes of mania or hypomania and can include depression.
People may also have periods during which they feel fairly stable. Symptoms vary and may change over time.
Manic episodes involve extreme highs, during which a person may experience:
- anger or irritability
- difficulty sleeping and less need for sleep
- high energy levels and periods of overactivity
- high self-esteem
- an inability to make decisions
- intense enthusiasm and excitement
- loss of concentration
- racing thoughts
- pleasure-seeking behaviors, such as increases in sexual activity or alcohol or drug use
- reckless behavior, such as risky sexual activity
Manic periods can affect a person’s daily life, job, and relationships.
Symptoms of hypomania are similar to those of mania, but they are less severe. Nonetheless, others often notice these symptoms, which can interfere with the person’s life and relationships.
Many people with bipolar experience depression more often than mania.
According to a 2012 study in the journal American Family Physician, while bipolar disorder involves manic or hypomanic symptoms, most people with the condition experience depression the majority of the time.
Depressive symptoms of bipolar disorder are the same as the symptoms of clinical depression and include:
- fatigue and low energy
- feeling sad or hopeless
- insomnia or sleeping too much
- a loss of appetite or overeating
- a loss of concentration
- a loss of interest in things once enjoyed, or anhedonia
- low self-esteem
- physical aches and pains with no obvious cause
- suicidal thoughts or behaviors
For health professionals to classify these symptoms as depression, they must last for at least 2 weeks.
Bipolar I and II may cause additional symptoms, such as anxiety or psychosis. During psychotic episodes, people lose touch with reality and may experience hallucinations or delusions.
People with bipolar I or II may experience what doctors call “rapid cycling.” This means that they have had at least 4 episodes in the previous year, with occasional periods of remission for at least 2 months or a shift to the opposite mood, such as from mania to depression.
Symptoms in children and adolescents
It can be difficult to identify symptoms in younger people because the signs can resemble regular developmental highs and lows.
Patterns of symptoms in children and teenagers can also differ from those in adults.
Most people with bipolar disorder receive a diagnosis in early adulthood, after symptoms have persisted for several years.
A doctor or psychiatric nurse practitioner will diagnose bipolar disorder based on a person’s medical history and symptoms. They may:
- explore the person’s thoughts, feelings, and behaviors
- with the person’s permission, speak to family members or close friends about their symptoms, particularly during periods of mania
- ask the person to keep a journal of their moods, sleep patterns, and other symptoms
- compare the symptoms to the criteria listed in the current Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5
To rule out other causes of depressive and manic symptoms, a doctor may also perform a physical examination, blood tests, or brain scans.
A healthcare provider will suggest a treatment plan based on the person’s symptoms and situation.
Bipolar disorder is a lifelong condition, so treatment aims to manage symptoms.
Treatment options include:
A doctor may recommend mood stabilizers to treat bipolar disorder.
Prescribers often recommend medications for people with bipolar disorder, with many individuals taking multiple drugs.
The mood stabilizer lithium is a common treatment, with some research suggesting that it can significantly help prevent long-term relapse.
Other medicines for bipolar disorder include:
Psychotherapy can be an important treatment component for people with bipolar disorder. It can enable them to recognize changes in thoughts and mood and respond accordingly.
Therapy can also help people establish healthful routines and learn new coping skills. It may take place on a one-to-one basis, with family, or as part of a group.
Most people with bipolar disorder and other mood disorders find lifestyle changes beneficial. Typical changes include:
- avoiding alcohol and drugs
- eating a healthful diet
- engaging in regular exercise
- establishing a sleep pattern
- keeping a mood diary to recognize behavior patterns and triggers
- minimizing stress
- seeking help and support from family, friends, and others
- staying educated about bipolar disorder
- using mindfulness and meditation techniques
Potential causes and risk factors
Experts do not know exactly what causes bipolar disorder, although they believe that several factors play a role. These include:
- Genetics. People with bipolar disorder seem to have variations in genes that may have increased their risk of developing the condition. However, it is unclear exactly how these variations lead to the onset of the disorder.
- Family history. If a sibling or parent has bipolar disorder, a person is more likely to develop it themselves.
- Environmental factors. Experiencing periods of high stress, such as bereavement, can trigger bipolar symptoms. A traumatic head injury or abusing alcohol or drugs may also increase the risk.
Most likely, a combination of heredity and environmental factors plays a role in bipolar development.
There are several types of bipolar disorder, with significant symptom overlap between them.
While bipolar disorder is a lifelong condition, treatments such as medications, therapy, and lifestyle modifications can effectively help people manage their symptoms.
To support their mental health, it is vital for people with bipolar disorder to seek help from others and stay in regular contact with their doctors.