HealthyPlace’s
Introductory Guide
to Bipolar Disorder
By Natasha Tracy
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Index
Introduction 3
Chapter One Bipolar Disorder Basics 4
Chapter Two Bipolar Disorder Diagnosis 8
Chapter Three Treatment of Bipolar Disorder 11
Chapter Four Causes of Bipolar Disorder 15
Chapter Five Bipolar Disorder and Suicide 17
Chapter Six Learning to Live with Bipolar Disorder 19
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H E A LT H Y P L A C E . C O M
Introduction
Sometimes the words “bipolar disorder” are scary ones to people; sometimes they
are merely clinical ones; but what do you really know about the facts of living with
bipolar disorder?
To the people who have bipolar disorder, over 6.5 million in the United States alone,
bipolar disorder is much more than a boogey man or a diagnosis on a medical form:
it is a condition that drastically changes the way many people live their lives.
In saying that, though, while people with bipolar disorder may have to account for
their disorder in their everyday lives, it doesn’t change who they are: just people, like
you and me. In the case of bipolar disorder, they just happen to be people with brain
illnesses.
Of course, being diagnosed with a mental illness (an illness of the brain) can be
scary at first, and if you have just found yourself, or a loved one, diagnosed, fear is a
normal reaction. That’s why HealthyPlace has created this eBook, to help you learn
the basics of bipolar disorder and what it means to live with this mental illness. You
are not alone in looking for answers. We hope to provide some of them for you here.
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CHAP TE R O N E
Bipolar Disorder Basics
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H E A LT H Y P L A C E . C O M
Bipolar Disorder Basics
Bipolar disorder is a mental illness, or a disease of the brain. Just like your pancreas
or your liver can have an illness, so can your brain, and bipolar disorder is one such
illness.
Just because bipolar disorder is a disease of the brain, however, this doesn’t mean
that you are “crazy.” A mental illness is a medical condition that can be defined,
diagnosed and treated, just like any other illness. In the case of bipolar disorder, it
is considered to be an “affective” disorder, or “mood” disorder, that primarily affects
your mood (although there are other effects as well) and it is usually diagnosed and
treated by a psychiatrist.
What Is Bipolar Disorder?
Bipolar disorder is a disorder that is characterized by highly elevated moods –
known as hypomanias or manias – and unusually low moods known as depressions.
There is also a mood known as a mixed mood wherein symptoms of depression and
hypomania or mania are present. In between these moods, people may experience
periods of euthymia, which is state wherein symptoms of bipolar disorder do not
exist. Moving from one mood state to another is known as cycling.
The average person with bipolar disorder will be in a given mood state for weeks or
even months if treatment is not given. That said, some people with bipolar disorder
only experience a mood for a period of days (ultra-rapid cycling bipolar disorder) or
even less in some rare cases.
What Is Hypomania and Mania?
Bipolar disorder, and its components, are defined in the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5). This is the book that defines all
mental illnesses.
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H E A LT H Y P L A C E . C O M
Bipolar Disorder Basics
A person experiencing the highly elevated mood of mania will experience a noticeable
mood disturbance including elation, irritability or expansiveness (an abnormally
euphoric state typically accompanied with delusions of grandeur). Additionally, at
least three of the following symptoms must also be present:
• Grandiosity (an unrealistic sense of superiority)
• Diminished need for sleep
• Excessive talking or pressured speech
• Racing thoughts or flight of ideas
• Clear evidence of distractibility
• Increased level of goal-focused activity at home, at work, or sexually
• Excessive pleasurable activities, often with painful consequences
Also, the mood disturbance is sufficient to cause impairment at work or danger to the
self or others. The mood is not the result of substance abuse or a medical condition.
For diagnostic purposes, the mood must last for at least one week.
Hypomania actually has exactly the same symptoms as listed above but the
difference is in severity. Mania causes impairment and may be life-threatening
whereas hypomania does not cause impairment in social or occupational functioning
and does not pose a danger to the self or others. Diagnostically, hypomanias must
last three days or more.
Whether you experience hypomanias or manias affects your diagnosis (see the
following section).
What Is Depression?
Contrary to what some think, depression is not merely sadness. Depression is a
serious, medical condition and is part of what people with bipolar disorder experience.
The symptoms of bipolar depression are actually the same symptoms as those that
are experienced by a person who has major, unipolar (non-bipolar) depression.
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H E A LT H Y P L A C E . C O M
Bipolar Disorder Basics
According to the DSM-5, for two weeks, a person must experience five symptoms
with one symptom being either a depressed mood or a loss of pleasure or interest
(with the possibility of experiencing both). The other symptoms of depression include:
• Significant weight loss or gain or significant loss or increase in appetite
• Hypersomnia (oversleeping) or insomnia
• Psychomotor retardation or agitation (for agitation, a series of unintentional
and purposeless motions that stem from mental tension and anxiety of
an individual; for retardation, motor and cognitive impairments including
slowness)
• Loss of energy or fatigue
• Feelings of worthlessness or excessive guilt
• Decreased concentration ability or marked indecisiveness
• Preoccupation with death or suicide; person has a plan or has attempted
suicide
In order to be considered a depression, the mood must cause significant impairment
and distress and not be as a result of a substance or another medical condition.
More Information
For more on bipolar disorder basics, check out the following articles:
• What Is Bipolar Disorder?
• What Are the Symptoms of Bipolar Disorder?
• An Online Bipolar Test
• What Is Bipolar Mania?
• What Is Bipolar Depression?
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CHAP TE R TWO
Bipolar Disorder
Diagnosis
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H E A LT H Y P L A C E . C O M
Bipolar Disorder Diagnosis
Bipolar disorder diagnosis can be done by a healthcare professional such as a family
doctor or psychologist but is most commonly done by a psychiatrist. Typically, a
family doctor will suspect the diagnosis and then refer the person to a psychiatrist
for a formal diagnosis. This is because psychiatrists are specialists in treating mental
illnesses and bipolar disorder is considered a serious mental illness.
There are four types of bipolar disorder defined in the DSM-5 and they include:
• Bipolar disorder type one
• Bipolar disorder type two
• Cyclothymic disorder
• Other specified bipolar and other disorder (used to be known as bipolar not
otherwise specified)
Bipolar Disorder Type One
People with bipolar disorder type one experience mood states of depression and
mania, and this may be considered the more traditional form of bipolar disorder. Many
people with bipolar disorder type one also experience psychosis as part of their
mood states. Psychosis is the presence of delusions (falsely held beliefs, such as that
the police are following him or her) and/or hallucinations (any sensory perception that
doesn’t exist, such as hearing voices that are not there).
Bipolar Disorder Type Two
People with bipolar disorder type two experience mood states of depression and
hypomania. People with this type of bipolar disorder do not experience psychosis.
Bipolar disorder type two is not considered any less serious than bipolar disorder
type one.
Cyclothymic Disorder
Cyclothymic disorder is considered a less severe version of bipolar disorder. People
with this diagnosis experience elevated and low states but these states do not meet
the full criteria for mania, hypomania or depression.
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H E A LT H Y P L A C E . C O M
Bipolar Disorder Diagnosis
Other Specified Bipolar and Other Disorder
This diagnosis is included in the DSM-5 to encapsulate those who are considered to
have a version of bipolar disorder that doesn’t neatly fit into one of the other three
diagnoses.
How Is Bipolar Disorder Diagnosed?
Bipolar disorder is typically diagnosed via a personal interview. Professionals will ask
a series of questions designed to detect the symptoms of bipolar disorder or any
other disorder that may be present. Medical tests may also be run to ensure there
are no other illnesses present that may be responsible for the symptoms. No physical
test, such as a blood test, is available to diagnose bipolar disorder.
More Information
For more information, check out these articles:
• How to Diagnose Bipolar Disorder
• Types of Bipolar Disorder
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CHAP T E R TH R E E
Treatment of
Bipolar Disorder
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H E A LT H Y P L A C E . C O M
Treatment of Bipolar Disorder
While the diagnosis of bipolar disorder may seem scary, it’s important to know that
bipolar disorder can be successfully treated and people with bipolar disorder lead
full and fulfilling lives every day.
Treatment of bipolar disorder typically consists of a combination of medication and
psychotherapy.
Medication for Bipolar Disorder
The medication selected to treat your bipolar disorder will depend on your mood
state at the time (i.e. manic, hypomanic, depressed or mixed), the presence of
psychosis, as well as factors that are individual to you, such as those found in your
medical history.
Thirteen medications have been approved by the Food and Drug Administration
to be used in the treatment of bipolar disorder – different medications for different
mood states.
According to Medscape, if you are in a severe manic or mixed mood, typical
medications that are prescribed include:
• Antipsychotics – a class of medications that are used whether or not
psychosis is present. These medications include quetiapine (Seroquel) and
olanzapine (Zyprexa), among others.
• Valproate (Depakote) – an anticonvulsant that was originally used to treat
seizure disorders but now is also used as a mood stabilizer in bipolar disorder.
• Lithium – a mood stabilizing drug.
Most commonly, in severe cases, a mood stabilizing drug (i.e. lithium or valproate) will
be combined with an antipsychotic.
If the mood is not a severe mania or mixed mood, or is hypomanic, the following are
likely medications:
• Lithium
• Valproate or carbamazepine (Tegretol)
• An antipsychotic such as aripiprazole (Abilify) or olanzapine (Zyprexa)
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H E A LT H Y P L A C E . C O M
Treatment of Bipolar Disorder
According to the same article, if you are in a depressed phase of the illness, the top
choices for prescribed medications include:
• Quetiapine (Seroquel) – an antipsychotic that can stabilize mood.
• Lamotrigine (Lamictal) – an anticonvulsant that was originally used to treat
seizure disorders but now is also used as a mood stabilizer in bipolar disorder.
• Lithium
Except for in cases of severe mania or mixed moods, medications are typically tried
one at a time but if this approach doesn’t work, it’s common to combine medications
for greater effect.
Bipolar Medication Side Effects
Just as with any medication, medications for bipolar disorder do carry the risk of
side effects. However, your doctor has selected this medication for you because
he or she feels that the benefits outweigh the risks. Side effects can range from
dry mouth to weight gain, so it’s important to discuss the most likely side effects
with your doctor. Some people experience several side effects, while some people
experience none. Side effects are typically at their worst when a bipolar medication
is started but then reduce or go away as treatment is continued.
If you are concerned about the side effects from a medication, make sure to talk to
your doctor about it right away so that he or she can either adjust the dose, change
medications or address your concerns in other ways.
Psychotherapy for Bipolar Disorder
The evidence-supported type of psychotherapy in the treatment of bipolar disorder
is called cognitive behavioral therapy (CBT). This type of therapy teaches people
more about how they think, how their moods occur and how they can deal with their
thoughts and moods. This type of therapy can be given in a group setting or one-on-
one. Additionally, workbooks have been published that will walk a person through
this therapy if a professional in CBT is unavailable.
Other therapies such as psychodynamic therapy (“talk” therapy) may also be useful
for people with bipolar disorder.
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H E A LT H Y P L A C E . C O M
Treatment of Bipolar Disorder
Inpatient and Outpatient Treatment
Sometimes bipolar disorder needs to be treated in a hospital facility (inpatient) rather
than in the community (outpatient). Many people who have experienced their first
manic episode, for example, may initially be treated inpatient. Additionally, sometimes
a person may elect inpatient treatment if he or she feels that around-the-clock care
and treatment would be more effective given his or her circumstances.
There is also the option of a day treatment facility which is halfway between an
inpatient and an outpatient treatment. In this type of treatment, a person spends
most of the day in treatment but sleeps in his or her own bed at night. This type of
treatment is typically much more affordable than inpatient treatment.
Long-Term Treatment of Bipolar Disorder
Typically, people with bipolar disorder require long-term treatment and this often
involves lifelong medication treatment. Once a person is stabilized after the initial
mood episode, medications might be able to be reduced for long-term care.
The important thing to remember is that while treatment may be lifelong, life can still
be great but it can take some time to get there.
More Information
For more information on the treatment of bipolar disorder, check out these articles:
• Bipolar Disorder Treatment
• Bipolar Disorder Medications
• Side Effects of Bipolar Medication and How to Treat Them
• Bipolar Disorder Therapy
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CHAP T ER F O UR
Causes of
Bipolar Disorder
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H E A LT H Y P L A C E . C O M
Causes of Bipolar Disorder
The causes of bipolar disorder are complicated and bipolar disorder is considered
a bio-psycho-social illness in that biological, psychological and social/environmental
factors come into play in both causing and affecting the illnesses day-to-day. Some
factors people can’t control – such as genetics – while other factors that may worsen
the illness, such as an overly-stressful job, can be altered.
It is clear that a large component of bipolar disorder is genetic. In fact, first-degree
relatives of a person with bipolar disorder are seven times more likely to develop
bipolar disorder than the rest of the population. While no specific gene has been
located, it is thought that many genes have to be present to cause bipolar disorder
and many candidate genes have been found.
Traumas may also be risk factors for developing bipolar disorder. Even something
as common as a stressful birth can increase the risk of developing bipolar disorder.
What’s important to remember about the causes of bipolar disorder is that no one
person or one event can cause bipolar disorder. For example, parenting style does
not cause bipolar disorder; many variables have to be present for the illness to occur.
More Information
For more information on the causes of bipolar disorder, check out this article:
• Causes of Bipolar Disorder
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CH AP TE R F IV E
Bipolar Disorder
and Suicide
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H E A LT H Y P L A C E . C O M
Bipolar Disorder and Suicide
While no one likes to think about it, bipolar disorder is a major risk factor for suicide,
homicide and suicide attempts. In studies, it has been found that up to half of all
people with bipolar disorder attempt suicide and about 11% die of suicide.
While the vast majority of people with bipolar disorder are not violent, when a
person is in a very severe manic episode, it is known that things can escalate into
violence. Additionally, for those with bipolar disorder and a substance abuse issue
(not uncommon in bipolar disorder), violence is of particular concern.
According to The European Mania in Bipolar Longitudinal Evaluation of Medication
(EMBLEM) study, the following characteristics are found in people with bipolar
disorder who are suicidal:
• Female sex
• A history of alcohol abuse
• A history of substance abuse
• Young age at first treatment for a mood episode
• Longer disease duration
• Greater depressive symptom severity
• Current benzodiazepine (tranquilizer) use
• Higher overall symptom severity
• Not taking medication as prescribed
However, there are factors that can lessen the risk of suicidality. According to the
Centers for Disease Control and Prevention, these are:
• Effective clinical care for mental, physical, and substance abuse disorders
• Easy access to a variety of clinical interventions and support for help seeking
• Family and community support (connectedness)
• Support from ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution, and nonviolent ways of handling
disputes
• Cultural and religious beliefs that discourage suicide and support instincts
for self-preservation
While the idea of suicide can be very scary, remember that working with your doctor
to find the best treatment for you is the most important thing you can do to reduce
the risk.
If you are at immediate risk of hurting yourself or someone else, call 9-1-1 immediately or walk into a
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hospital. If you are looking for help with suicidal feelings, please see our helplines and resources page.
CH AP TE R SIX
Learning to Live with
Bipolar Disorder
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H E A LT H Y P L A C E . C O M
Learning to Live with Bipolar Disorder
While there are many challenges to living with bipolar disorder, and bipolar disorder
can affect all areas of your life, it’s important to know that you can learn to successfully
live with bipolar disorder.
Part of learning to live with bipolar disorder is acceptance of the illness. While this
can be hard, once you’ve been diagnosed by one or more professionals, it’s time to
admit to yourself that you have an illness and that illness is bipolar disorder. You can’t
expect this acceptance will come overnight, and, in fact, you may find yourself going
through a cycle of grief including feelings of denial, anger, bargaining and sadness
before you finally reach acceptance, but that’s okay. What matters is that you start to
move along that process.
The second part of acceptance is learning to accept the need for bipolar disorder
treatment. Remember, you didn’t seek out treatment for no reason. People normally
only seek treatment when they and/or their lives are out of control; and in order to
avoid that in the future, treatment is needed.
You also want to learn about lifelong management of the illness. You have to accept
that bipolar disorder is not typically an illness that you can treat and forget. You will
likely be dealing with it, in some way, for the rest of your life. It’s important that you
learn the facts about bipolar disorder and that the people around you do, too.
Finally, focus on finding new coping skills to deal with events and stressors in your
life. Typically, before a diagnosis, things like stressful events might make a person
with bipolar disorder more symptomatic and it’s important to not allow that in the
future. As mentioned earlier, cognitive behavioral therapy can be a major source for
learning coping techniques to help handle the, often extreme, feelings and thoughts
that come with bipolar disorder.
And remember to take it slowly. You’ve made a great start by reading this guide, but
don’t feel overwhelmed by everything there is left to learn. Keep moving forward
one day at a time and face bipolar disorder the best way that you can on that day.
More Information
For more information on learning to live with bipolar disorder, check out these articles:
• Self-Help for Bipolar Disorder
• Living with Bipolar and Living with Someone Who Is Bipolar
• Effects of Bipolar Disorder
• Supporting Someone with Bipolar
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For Your Mental Health
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