What is bipolar disorder?
Bipolar disorder can cause significant changes in a person's mood, energy and activity levels. These changes can affect day-to-day life, relationships and wellbeing.
People with bipolar disorder experience contrasting episodes of intense highs and lows (mania and depression). These cycles are unlike ordinary mood swings. They can last for days, weeks, or months, and can affect their health, relationships, day-to-day living and overall quality of life.
There are various means of treatment for bipolar disorder that can help to alleviate symptoms, making life easier and the condition more manageable.
In this video, counsellor Michelle Kelly explains what bipolar disorder is in more detail and how counselling can help.
Types of bipolar disorder
The term 'bipolar' means 'two poles', and this specifies the two extreme opposite moods, mania and depression, that characterise the disorder. These moods surface as episodes, which vary according to the symptoms that occur and patterns of mood changes. Sometimes, people can experience symptoms of depression alongside symptoms of mania or hypomania. This may be described as experiencing mixed features.
Mania
During a manic episode, a person may experience significant changes in their mood, energy and activity levels. They may feel unusually energetic or confident, have racing thoughts, need less sleep and talk more or faster than usual.
Overestimating how much they can do can lead some people to engage in reckless behaviour, such as making poor decisions, spending more money than they can afford, acting aggressively, and possibly even putting themselves at risk of serious harm. During a manic episode, people may talk very quickly, not eat or sleep and may become easily annoyed. In some cases, people will develop symptoms of psychosis.
Depression
The depressive phase of bipolar disorder tends to be worse than mild forms of depression – especially as episodes will last longer. During a depressive episode, everyday activities and responsibilities can feel much harder to manage. People may have little energy or motivation and may withdraw from activities or other people. Just as in a manic episode, depressive phases of bipolar disorder may involve symptoms of psychosis.
Mixed bipolar episode
Some people experience symptoms of depression alongside symptoms of mania or hypomania. This is sometimes described as a mixed episode or mixed features.
Hypomania
Hypomania can involve changes in mood, energy, and behaviour that are similar to those experienced during mania, although they may be less intense. How these changes affect day-to-day life can vary from person to person.
Who is affected by bipolar disorder?
Bipolar UK estimates around one in 50 people in the UK live with bipolar disorder, though around half of people with bipolar disorder (56%) don't have a diagnosis. It can affect people of all ages, from different backgrounds, regardless of gender and ethnicity. Symptoms are usually first noticed in teenagers and young adults. Research suggests almost 50% of people with bipolar disorder have symptoms before they are 21.
The pattern of mood swings and the type of bipolar disorder varies from person to person. This means that while some people have only had a couple of bipolar episodes in their lifetime, others may have frequent episodes and will rarely experience emotional stability.
Patterns of bipolar disorder
The pattern and frequency of mood episodes can vary from person to person. Some people may experience episodes more frequently than others, with periods of stable mood in between.
Rapid cycling is a term used when someone experiences four or more mood episodes within a year. These can include episodes of mania, hypomania or depression.
Cyclothymia is a condition involving periods of low mood and periods of elevated mood that are not severe or long-lasting enough to meet the criteria for episodes of depression or hypomania. These changes in mood can still affect day-to-day life.
Some people may notice a seasonal pattern to their mood episodes, with episodes tending to occur at particular times of year.
The way bipolar disorder is diagnosed and described depends on a person's symptoms and experiences. A mental health professional can explain what a particular diagnosis means and recommend appropriate treatment and support.
Symptoms of bipolar disorder
Symptoms vary depending on the type of episode someone is experiencing. A mental health professional will consider the type, severity, duration and impact of symptoms when assessing someone for bipolar disorder.
Symptoms of a manic episode
- feeling unusually 'high' and active
- easily distracted and struggling to concentrate
- racing thoughts and talking very quickly
- extreme irritability
- needing less sleep and having increased energy
- acting impulsively or taking risks without considering the consequences
- less inhibited in general.
Symptoms of a depressive episode
- sleeping too much or difficulty sleeping
- change in appetite – leading to weight gain or weight loss
- long-lasting sad or anxious mood
- decreased energy and extreme tiredness
- loss of interest in pleasure and activities usually enjoyed
- thoughts of death and/or suicide
- difficulty in starting or completing everyday tasks
- isolation from other people.
Seeking immediate help
If you need immediate help and are worried you can’t keep yourself safe, please:
- go to your nearest A&E department
- call 999 if you can’t get to a hospital
- ask someone to take you to A&E or call 999 for you.
If you need someone to talk to, you can call Samaritans on 116 123.
Psychotic symptoms
In some cases, people with bipolar disorder may experience symptoms of psychosis during a severe manic or depressive episode. This can include hallucinations, such as hearing or seeing things that are not there, or delusions, where someone strongly believes something that others do not.
During a manic episode, this might include beliefs about having special abilities or powers. During a depressive episode, psychotic symptoms may relate to feelings of guilt, failure or worthlessness.
Symptoms of a mixed bipolar episode
If someone is experiencing a mixed bipolar episode, their symptoms will reflect both mania or hypomania and depression. This combination of high energy and low mood will typically involve agitation, irritability, racing thoughts and anxiety. People with bipolar disorder experiencing these symptoms can be more vulnerable to thoughts of death and suicide.
Causes of bipolar disorder
The exact causes of bipolar disorder are not fully understood. A combination of genetic, biological and environmental factors is thought to play a role, while experiences such as stress and disrupted sleep can trigger mood episodes for some people.
- Genetics – Bipolar disorder runs in families, so a hereditary link is thought to be present. If a family member has the condition, individuals have a higher-than-average risk of developing it themselves.
- Stressful experiences – Life-altering events and stressful situations are common triggers of bipolar disorder symptoms. These may include the breakdown of a relationship, the death of a loved one, abuse or trauma.
How is bipolar disorder diagnosed?
In many cases, people with bipolar disorder may be unaware. Sometimes, changes in a person's mood or behaviour may first be noticed by friends, family or colleagues.
If your loved ones express concern, you should consider making an appointment with your GP. If left untreated, bipolar disorder can worsen and may lead to complications within your relationships, your career, and your health.
Bipolar disorder is often misdiagnosed, as many people will visit their doctor to seek help for what they consider to be depression. Depression is a common illness, and there is a great deal of awareness regarding symptoms, yet there is very little regarding mania or hypomania. As a result, people with bipolar disorder may not recognise that in the past they have experienced symptoms of mania or hypomania. Alternatively, at the time of visiting the doctor, they may not have had any episodes of such feelings.
A GP will ask about your symptoms and, if they think you may have bipolar disorder, will usually refer you to a mental health specialist for assessment. They may also ask you to complete a set of questions about your mood, such as how you feel leading up to and during an episode of mania or depression. Your family history might also be looked at to see if there is a genetic possibility you might have the condition.
The GP I saw was fantastic. He actively listened to my experiences and sent me for a psychiatric assessment where I was diagnosed with bipolar disorder.
- Read Katie's story.
Treatment for bipolar disorder
Due to the chronic nature of the condition, bipolar disorder normally requires long-term treatment to prevent relapses. Treatment is designed to help people feel in control of their illness – keeping symptoms at bay and preventing new episodes from occurring.
Treatment for bipolar disorder can include medication and talking therapies, alongside support with managing triggers and maintaining wellbeing. A mental health specialist can recommend treatment based on a person's individual needs.
Counselling for bipolar disorder
Working with an experienced therapist can help people explore how bipolar disorder affects them and recognise possible triggers or early warning signs of mood episodes.
Cognitive behavioural therapy (CBT) is one approach that may be used. It is designed to help individuals change negative thought patterns and learn new coping skills. Family therapy is another approach often used in bipolar treatment as it helps to improve communication between family members and the person living with the condition.
Lifestyle changes
Alongside treatment, looking after your general wellbeing may help you manage symptoms of bipolar disorder. This can include maintaining a regular routine, getting enough sleep, managing stress, staying physically active and eating a balanced diet. It can also be helpful to become familiar with your own triggers and early warning signs of a mood episode.
Finding support for bipolar disorder
If bipolar disorder is affecting your wellbeing or day-to-day life, counselling can offer a supportive space to explore your experiences and develop ways to cope. Find a counsellor or therapist with experience supporting people with bipolar disorder.
