How does bipolar disorder manifest itself?
Bipolar disorder is divided into subcategories, which are characterised by fluctuations in well-being and vitality.
Bipolar I always involves at least one manic episode and most people also experience periods of depression. Hypomania may also occur but neither that nor depression is necessary for this diagnosis. You can read about how depression expresses itself HERE and that description also applies to depression in bipolar disorder. Mania is incredibly different between individuals because the symptoms are not always the same and people show different symptoms. Symptoms can also be the same but manifest in different ways. For example, mania is often characterised by increased goal-oriented behaviour (when people are working towards goals) and this can range from writing a book to trying to find a cure for cancer. The main characteristics of mania, used for the diagnosis of bipolar disorder, are:
- To be in a really good mood and feel good, often called an elevated mood. -Increased energy and power.
- Excessive optimism, inflated self-esteem or belief in one's own greatness (even a superiority complex). For example, it is common for people who experience this symptom to think that they have a special relationship with someone famous or that they have some extremely important role.
- Less need for sleep, in a mania, people often sleep very little and yet feel rested and energised after very little sleep (2-3 hours even).
- A lot of talk and more need to keep talking, people even become unable to talk to because they do not allow others to speak and jump from one thing to another so it can be difficult to follow. Sometimes people speak louder than usual, inconsistently or say extremely inappropriate things.
- Really fast thinking that can be difficult for the individual themselves to keep up with. Thoughts and ideas pile up. This is often the reason why speech can become inconsistent and very fast flowing.
- Easily interrupted, have trouble staying focused and easily draw attention to things in an environment that don't matter.
- Goal oriented behaviour, when people work diligently towards some specific goal or objectives. The goals can be in school, work or personal life.
- Irritation, uneasiness or restlessness. The irritation can be emotional or physical. People are often very fidgety and show great activity that serves no purpose (for example, moving your feet up and down continuously).
- Increased risk behaviour, e.g. driving too fast, gambling or having an affair.
- Unrealistic ideas on your own competence and abilities, when this symptom is very severe, may even manifest itself with symptoms of a psychotic order such as delusions, e.g. where people consider themselves to have supernatural abilities or experience hallucinations, such as hearing voices.
Bipolar II always involves at least one hypomania and one depressive episode. If a person is diagnosed with Bipolar II and then gets a mania that is not hypomania then the diagnosis changes to Bipolar I. Some people think that Bipolar II is like a mild version of Bipolar I, since hypomania does not cause as much disturbance and is less severe than mania. However, one cannot look at it that way, as the depressive episodes in Bipolar II can be very serious and cause great disturbance. Unlike Bipolar I, a depressive episode is necessary for the diagnosis of Bipolar II and, therefore, depression is more of a characteristic in Bipolar II and often longer and more frequent episodes than in Bipolar I. In Bipolar II, it is common that people experience symptoms of depression at the same time as hypomania and it can be expressed with depression with increased energy and irritability which is a very difficult and even dangerous state. Numbers I and II, therefore, do not represent different stages of seriousness, but only two different disorders that are similar in some respects.
You can read about how depression expresses itself HERE and that description also applies to depression in bipolar disorder. The symptoms of hypomania are the same as in mania, but they do not appear in an exaggerated way as most often last for a shorter period of time. The symptoms are not serious enough to significantly interfere with people's daily life, they are never accompanied by a psychotic disorder and admission to a psychiatric ward is not required. However, there is a significant change in activity and well-being, and people are not necessarily entirely themselves.