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The Many Faces of Bipolar Disorder

The Many Faces of Bipolar Disorder

You know what it means to feel overwhelmed with inspiration. You know what it means to feel terribly sad. And you probably know how it feels to have either of these emotions consume you suddenly and completely—be it during a time of great happiness and creativity or during a time of deep loss.

But what if those emotions consumed you all of the time, without warning and without reason, to the extent that you had trouble focusing, concentrating, making decisions, working, and living a "normal" life? Life would get pretty exhausting.

Imagining that scenario gives you a small window into what it can be like to have bipolar disorder.

One illness, many faces
Bipolar disorder is a mood disorder that can come in many forms. And it can spiral into a completely disabling disease if left untreated. Whereas clinical depression takes mood in just one direction (down), bipolar disorder takes mood on a roller coaster ride of extreme highs and terrible lows, sometimes in cycles, sometimes all at once. The mood peaks are called mania, a state that causes extreme irritability along with a big burst of energy, elation, little need for sleep, and other "high" feelings. The lows correspond with depression, low energy, extreme pessimism, and other negative emotions.

The different types of bipolar disorder are defined by the extent of the highs and lows as well as how long those moods last and how much (or how little) they impair function.

  • Bipolar disorder I: The most serious form of bipolar illness, also known as manic depression, is characterized by extreme mania or mixed episodes as well as at least one single event of major depression. In severe cases, it can cause a complete loss of touch with reality (psychosis) and may include hallucinations and delusions. Hospitalization may be needed.
  • Bipolar disorder II: The lows of bipolar disorder II can dip just as low as they do with bipolar disorder I, but the highs are not as high. These more subtle highs are called hypomania. But, unlike bipolar disorder I, psychosis is not a feature of bipolar disorder II.
  • Cyclothymia and other bipolar disorders: The mildest form of bipolar disorder is cyclothymia. It consists of more shallow lows than bipolar I or bipolar II. Instead, it's a persistent alternation of hypomania and low-grade depression (dysthymia). Other types of bipolar disorder that don't fit neatly into any established categories -- for example, a person with recurring episodes of hypomania but no major depression or dysthymia -- are called bipolar disorder not otherwise specified (NOS).

Bipolar disorders affect men and women in equal numbers, but women tend to experience more depressive and mixed-mood episodes than men do. The median age of onset for both men and women is 25.

Difficult diagnosis
Altogether, nearly 3% of adults suffer from some form of bipolar disorder, a percentage much greater than researchers once thought. Unfortunately, many of those people are undiagnosed or misdiagnosed. In fact, people with bipolar disorder spend an average of 8 to 10 years seeing multiple healthcare professionals before getting the proper diagnosis and treatment. Learn more about why bipolar disorder is often mistaken for depression.

Treatment matters
If you think you or someone you love may have a mood disorder, see a doctor.

Misdiagnosed, inappropriately treated, or untreated bipolar illness can have serious consequences. Symptoms tend to become more frequent and more severe, and they can make work, home life, and relationships difficult. In extreme cases, they can even lead to hospitalization or suicide.

But people who have bipolar disorder can lead active, productive lives once they're properly diagnosed and treated.

Medically reviewed in June 2018.

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