By: Lauren Porter
World Bipolar Day is held annually on March 30, the birthday of Vincent Van Gogh who was posthumously diagnosed with bipolar disorder. His works of art, time in psychiatric hospitals, letters to and from friends, and even his last words, “The sadness will last forever" point to his suffering from this condition. This day is a time to raise awareness, reduce stigma, share stories of hope and healing, provide education, and advocate for treatment and research funding. This second half of this blog serves to provide a broad overview and introduction to the illness following a personal story in part one.
How does the illness present? In the media, people are often portrayed as going from very happy to very sad often in the course of an hour or a day. This is not how the illness looks in real life. There are actually five types of bipolar disorder. All types are cyclical mood disorders meaning there are two distinct sets of mood episodes that individuals experience in some type of pattern often prolonged periods in between at a baseline state where someone may present with few to no symptoms.
Bipolar I is marked by periods of highs (mania), which can include symptoms like euphoria, grandiosity, impulsivity, energy, and psychosis, to deep lows (depression), which may include pervasive sadness, emptiness, self-harm behavior, suicidality, and issues sleeping. The most significant difference between Bipolar I and II is that people with Type II do not have mania but rather hypomania, which is a milder form and may present itself more in anxiety and irritability over euphoria. They also tend to have longer-lasting, frequent, and severe depressive episodes. Cyclothymic disorder is the third type and presents with less extreme mood fluctuations ranging from mild depression to hypomania but still in a cyclical manner. The DSM-5 also recognizes Bipolar Other Specified and Bipolar Unspecified when someone does not meet the criteria for the other three but still experiences some type of cyclical mood fluctuations that are clinically significant. People may have specifiers to their illness, for example, rapid cycle (4+ episodes in a year), mixed states (experience symptoms of both episodes together), or seasonal modifiers (episodes triggered by seasonal changes). It is often co-occurring with other disorders, such as PTSD, substance use disorders, and anxiety disorders.
What causes bipolar disorder? Research has not found one single cause for the illness. Current research indicates it is typically caused by a mix of genetic predisposition, chemical imbalances, biological factors, environmental triggers, and life events.
How is it treated? Standard treatment is medications like mood stabilizers and antipsychotics. Typically therapy like CBT is also done alongside medication. People in the beginning stages of recovery may benefit from intensive day treatment programs while their illness stabilizes. In cases of severe episodes or the presence of psychosis, temporary hospitalization may be necessary. Behavioral interventions like mood tracking, sleep hygiene, and limiting substance use are often beneficial.
Why is understanding this important? The NIH estimates approximately 4.4% of the US population has bipolar disorder. For people with the illness, it can affect every part of life from relationships to work to school to daily functioning to overall well-being. It increases the risk of things like substance use disorder, self-harm, and suicide. In fact, approximately 20% of people with bipolar disorder die by suicide, and at least half will have one or more attempts. They often experience stigma, ostracization, and discrimination from other people and society. It’s important to raise awareness about the condition, know how to support people, reduce stigma, and increase resources so people can seek treatment, while also valuing the strengths that people have. While people with bipolar disorder face significant obstacles and suffering, many people credit it as a core part of making them who they are. For example, they may recognize it as increasing their empathy for others, amplifying creativity, and shaping their understanding of the world. Many people take their experiences and use them to support other people.
How to support someone with bipolar? Everyone’s experience with the illness is different and what they need may be different based on their experience or your role in their life. Educating yourself on the illness, addressing your existing assumptions, and directly asking how you can be supportive are critical first steps. What they need should be prioritized over any ideas shared here. Being close to someone with bipolar can take an emotional toll, and as such, there are support groups for affected others and also family counselors who can support everyone involved. For some people, it can be helpful if they share early warning signs of episodes with you, and if you notice them, you can point them out. Helping with plans for episodes or safety concerns can also be useful. Accompanying people with some of their lifestyle changes, like
implementing exercise, routine, and sleep hygiene can be another way to support them. Above all, patience and understanding are key.
What to do if you think you have bipolar disorder or another mental illness? The first step is typically to talk to your primary care physician and discuss your concerns. From here, a referral to a psychiatrist for a more thorough assessment and treatment plan may be indicated. Seeking out a clinical therapist is also a good place to start or do at the same time. If you are facing severe mood episodes, having thoughts of self-harm or suicide, or experiencing psychosis, you can contact crisis resources right away at 988.