What is bipolar disorder?

Tuesday 30th March marks the annual World Bipolar Day. Bipolar disorder (BPD) affects 1 in 100 people. Despite these high numbers, a great deal of misunderstanding and stigma surrounds the condition.

The vision of World Bipolar Day (WBD) is to bring awareness, create more understanding, and help eliminate the stigma surrounding the condition.

Bipolar disorder is a mental health condition that is marked by extreme mood swings. The main symptoms of bipolar disorder are episodes of extreme highs (mania) and lows (depression), which can last for several weeks.

Bipolar disorder can also be known as manic depression or bipolar disease.

Bipolar disorder according to experts from Nightingale Hospital

Dr Jonathan Beckett, Consultant psychiatrist

  • In my experience, patients are often relieved to receive a bipolar diagnosis. It can even be a diagnosis that some individuals self-diagnose and seek out
  • It is much more common than people generally realise. The concept of bipolar spectrum disorder is now widely accepted. This incorporates Bipolar I, Bipolar II Disorders, together with subclinical presentations that don’t meet the criteria for Bipolar I or II. Whilst subclinical presentations are not as severe, they are still important to recognise, as this will have implications for the course of the condition, prognosis, treatment options, as well as implications in relation to insurance and driving etc. Moreover, for those who are anxious to receive a bipolar diagnosis, we can sometimes reassure via the concept of bipolar spectrum disorder. This can enable a diagnosis of a milder version of the illness
  • It is also a condition that is often misdiagnosed, without there being a proper exploration of the poles of the mood by GPs and even some psychiatrists. This can result in patients being started off on the wrong treatment path of antidepressants. This, for example, can make the condition worse.
  • It is definitively a condition that has multiple psychiatric and medical co-morbidities, in particular, Borderline Personality Disorder (BPD) and Attention Deficit Disorder (ADD)
  • One of the challenges of making a diagnosis is to exclude the role of a substance use disorder, as this can be something that individual patients might overlook in the understanding of their mood instability
  • There is a strong relationship between childhood trauma, and in particular emotional abuse, and the later development of bipolar disorder. As such, treatment for bipolar disorder should always focus on psychological therapy as well as pharmacological interventions
  • Overall, it is a condition that requires specialist assessment and management. It is important to highlight that BPD is a condition that responds well to treatment, both pharmacological and psychological. Seeking specialist help can therefore be a very important step
  • There a strong link between bipolar disorder and creativity, with many notable historical figures and artists thought to have bipolar disorder

Dr Ify Okocha, Consultant psychiatrist

  • How is bipolar disorder diagnosed and why is it difficult to diagnose? Research shows that bipolar disorder can be difficult to diagnose especially in the early stages because of subtle variations in mood.  In some cases, there may be a delay of several years between the onset of the illness and the diagnosis especially in individuals presenting with depression. Also, physical illnesses and other types of mental illnesses can cause mood variations and so very careful assessment of behaviour, review of subjective reports of experiences, tests and investigations to exclude physical health problems are required.
  • What is the impact on individuals? Depending on when the illness starts, it affects individuals in different ways. It can, for example, affect school or work performance and relationships with peers, friends or family. It can lead to a loss of confidence in the individual and in some cases, result in the individual posing a risk to others or themselves. In those presenting with severe mania, there may be reckless and dangerous behaviour, excessive spending and trouble with the law.
  • Why is there a stigma surrounding bipolar disorders? Unfortunately, negative attitudes and beliefs about people with mental illnesses, including bipolar disorder, abounds in our society today. There is labelling, stereotyping and discrimination from families, friends and employers. Nearly nine out of 10 people with mental health problems say this has a negative effect on their lives. Individuals with bipolar are often portrayed as ‘crazy’ in books and movies, or as individuals that commit crimes. When looking at the way language is used, the word ‘maniac’ is loosely used to describe extremely wild or violent behaviour.

The situation is exacerbated by the media, with reports that often link mental illness with violence, or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives. Many people, therefore, believe that people with mental conditions, including bipolar disorder, are violent and dangerous, when in fact; they are more at risk of being attacked or harming themselves than harming other people. There is the implication that people with bipolar disorders, along with other forms of mental illness, are less likely to find, or stay in work, live in good housing or be in long-term steady and supportive relationships.

Furthermore, there can be a lack of understanding from family, friends and work colleagues and sometimes, bullying and harassment. As a result, people can become trapped in a perpetuating cycle of illness with increased reluctance to seek or accept help. There is also the added complexity of health insurances not providing adequate and comprehensive cover for treatment. Campaigns by groups and prominent individuals as well as the use of the law, such as the Equality Act 2010, would all help to address stigma.

  • Do you have any positive words for those struggling with BPD, or who may have just received a diagnosis? Research shows that over 70% of people diagnosed with bipolar disorder for the first time and admitted to hospital, can recover and function at a similar level as they did before they became unwell. It is possible to stay well and thrive with a bipolar diagnosis, but to do so requires a good working relationship between the patient and the clinician/s involved in their care. It’s also important to look after your wellbeing, which means regular sleep (there is some evidence that disturbance of the sleep-wake cycle can precipitate or make hypomanic or depressive episodes worse), healthy eating, regular exercise, limiting stress and staying away from drugs and alcohol. It is important to understand the early changes the individual experiences they begin to fall ill. It is important to have a support network such as family or friends and to be involved in discussions and decisions about medication as these are essential to staying well.

Bipolar disorder resources for individuals and carers

If you are concerned about your mental health, you should arrange a consultation with your GP to discuss your mood.

If you are struggling with your bipolar disorder and wish to seek specialist private care through Nightingale Hospital, please get in touch with us to see how we can help enable you to live your life to the fullest.

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