Pen After the Storm

Bipolar disorder is a mood disorder that’s all about extremes. I was diagnosed with Bipolar Disorder Type 1 at a young age. Here’s everything I’ve learned about the disease and how you can advocate for yourself with this diagnosis.

Defining the Disease

There are two types of Bipolar Disorder listed in the DSM. (The DSM is the manual or guide book that psychology professionals in the United States use to diagnose mental health conditions.)

There is Bipolar Disorder Type 1, characterized by something called “mania.”

And there is Bipolar Disorder Type 2, characterized by depression.

More on the different types in the symptoms section.

What you need to know about both types of Bipolar is this: Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings. These include emotional highs and lows. Bipolar disorder affects approximately 1 in 200 people worldwide. Anyone- from any group or socioeconomic status- can have bipolar disorder. If one parent has bipolar disorder, the child has a 1 in 5 chance of also having it. Bipolar disorder is a LIFELONG condition. It can be treated, but will never fully “go away.” It can affect every area of lifestyle, cause great suffering, and must be managed by a mental health professional for good results. It can be considered a disability in the US when it is very severe.

Symptoms and How You Get Diagnosed

We’ll break down symptoms of Bipolar disorder and how you get diagnosed by type.

Both types of Bipolar disorder involve mood swings. The difference is, when you have Bipolar Disorder Type 1, the manic symptoms are more prominent. When you have Bipolar Disorder Type 2, the depression symptoms are more prominent. But both types of bipolar disorder involve highs and lows in mood. You might not even realize these changes are happening, when you’re in these states. But they could hurt you or someone you love. Mood episodes can last days, weeks, or months.

Here are the symptoms of Bipolar Disorder Type 1:

Bipolar disorder type 1 is characterized by prominent symptoms of mania. Mania is a persistent elevated mood that can cause people to lose touch with reality.

Symptoms of Bipolar Disorder Type 1 include:

MANIC EPISODES

• Quickly going from one idea to the next
• Fast-talking or loud speech, also called pressured speech
• Increased energy
• Compromised judgement for long-term decisions 
• Decreased need for food or sleep
• Very high self-esteem or exuberant confidence
• Excessive spending. You might blow through all your savings or impulse buy.
• Wanting to have sex a lot. Also called hypersexuality.
• Substance misuse, especially if you already have an addiction.
• Making big plans or life changes without thinking them through.

You may also have trouble telling what’s real. Meaning you may be experiencing hallucinations or delusions. This can cause symptoms of psychosis, including delusions or hallucinations such as:

• Thinking people are out to get you
• Hearing voices
• Seeing things that aren’t there 
• Thinking you can complete unrealistic goals
• Believing you have a divine purpose in life that no one else understands or recognizes

DEPRESSIVE EPISODES

Depression symptoms may include:

• Feeling very low and sad
• Having little energy
• Lower self-esteem
• Struggling to get out of bed
• Struggling to motivate yourself to do anything – even things you want to do
• Feeling restless and anxious
• Sleeping far too much or far too little
• Having trouble with memory or thinking clearly
• Wanting to be left alone / isolating yourself
• Suicidal thoughts and self-harm urges

Here are the diagnostic criteria of Bipolar Disorder Type 1:

• At least one manic episode: This must be a full episode that lasts at least 7 days -or requires hospitalization.
• At least one major depressive episode: This must last at least 2 weeks and be a significant change in the person’s behavior from how they usually are.
• The episodes must not be better explained by another diagnosis, such as schizoaffective disorder or schizophrenia.

Here are the symptoms for Bipolar Disorder Type 2:

Bipolar disorder type 2 is similar to Bipolar Disorder Type 1, with many of the same symptoms. But it is characterized by prominent symptoms of depression rather than mania. Depression is a persistent low mood that can make it very difficult to get anything done or to feel positively about yourself. Why is Bipolar Disorder Type 2 a diagnosis instead of chronic depression? Well, with Bipolar Disorder Type 2, sometimes the mood is elevated- usually hypomanic rather than full blown mania.

Symptoms of Bipolar Disorder Type 2 include:

HYPOMANIA

Hypomania is a less severe form of mania, lasting at least 4 days.

• Having a higher level of activity or energy.
• Feeling happy and more excited.
• Not sleeping or only getting a few hours of sleep but still feeling rested.
• Having higher self-esteem.
• Being more talkative than usual. Talking so much and so fast that others can’t interrupt. You may also feel irritable when interrupted even though you can’t stop talking.
• Having racing thoughts — having lots of thoughts on lots of topics at the same time (this is also called a “flight of ideas”).
• Being easily distracted by unimportant or unrelated things.
• Being obsessed with and completely absorbed in an activity you’re focused on.
• Displaying purposeless movements, such as pacing around your house or fidgeting when you have to sit still.
• Showing impulsive behavior that can lead to poor choices. This could include spending sprees, quitting jobs or no-showing impulsively, staying up late when you need to wake up early in the morning, risky investments, and saying things that should go unsaid, for example.

DEPRESSION

• Feeling excessively guilty
• Not enjoying things you usually enjoy. No interest or pleasure when you’re trying to do something fun.
• Feeling very tired
• Irritability
• Having no motivation for your goals, even when you try really hard
• Lying in bed all day
• Difficulty concentrating and remembering information
• Slow to make decisions
• Issues with appetite- over eating or not eating anything
• Physical symptoms, like having aches and pains that won’t go away
• Trouble switching off the brain and not overthinking
• Suicidal thoughts and self-harm urges

Here are the diagnostic criteria of Bipolar Disorder Type 1:

• At least one hypomanic episode: This is a distinct period of elevated mood and increased energy that lasts at least 4 days. 
• At least one major depressive episode: This episode must last at least 2 weeks. 
• The episodes must not be better explained by another diagnosis, such as Type 1 or schizoaffective disorder.

With either type of Bipolar Disorder, you may have periods when you’re just normal, in-between mood states. You may also experience “mixed states”, when you’re experiencing both mania and depression at the same time. Lastly, some people “rapid cycle”, which means their mood states last less time and change more quickly.

What if I don’t agree with my diagnosis of Bipolar Disorder?

Only a psychiatrist can diagnose mental health illnesses. But it is true that sometimes doctors get the diagnosis wrong. It’s important to advocate for yourself and speak up. More on that later. Know that you can work it out with a good doctor and do research together. But PLEASE do not stop taking any prescribed medication without your doctor’s permission. This is because the medications prescribed for mental health can be very, very dangerous to stop on your own. Even if you have no history of sucidal thoughts, for example, it can throw you into suicidal ideation. Stopping certain medications can also cause seizures. So go slow and advocate for yourself by speaking up, not by defensively quitting treatment altogether.

Common Treatments // Getting Better

Bipolar Disorder is generally treated with a combination of meds and therapy.

Meds

Generally, once a month you will meet with a psychiatrist or a nurse practioner to receive a prescription.

• Antipsychotics like Zyprexa may be prescribed for mania, especially for those individuals whose manic episodes include hallucinations, paranoia, or delusions.
• Mood stabilizers like Lithium may be prescribed for mania.
• Antidepressants like Zoloft may be prescribed.

Therapy

• Psychotherapy or counseling is very common. This is usually a 50 minute session, weekly or biweekly, where you talk about what you’re going through and find strategies to cope together. Each therapist has a slightly different approach and background, so make sure to use your first appointment to interview them and see if it’s a good fit what you need.
• Skills therapies and skills groups can be helpful. They are all about finding realistic actions you can take to calm down in the moment. A common skill based therapy is cognitive behavioral therapy, which teaches you to adjust your attitudes and behaviors. Some common skills groups include – dialectical behavior therapy, which teaches mindfulness, social skills, distress tolerance, and emotion regulation. Personally I am also in a self-care group once weekly.

Important Ways to Advocate for Yourself

Advocating for yourself requires doing some research and speaking up, being honest about your symptoms and what you’re experiencing.

• Know that when you’re manic or depressed, there may be times when you don’t really see it- but your loved ones notice it. This is common. It happens to me all the time.
• Try to keep track of mood swings in your journal.
• INTERVIEW YOUR THERAPIST. Don’t just choose one at random. Search for a therapist that understands you and teaches you what you need to know with plenty of experience.
• Speak up if a medication is causing unwanted side effects. There are things your doctor can do to protect you from side effects. for example, many meds have a side effect of sudden weight gain and increased appetite- but your doctor can prescribe you a second medication that keeps you from gaining much weight, if this occurs.
• When you’re manic or depressed, you may find you need to be hospitalized. On our blog and podcast we share tips on how to prepare for hospitalizaion and how to cope while you’re in-patient. Follow us for more information on stuff like that by typing your email below. It’s anonymous and we don’t send spam.

What Loved Ones Need to Know

It’s hard. You love them! You want to help. And you can’t bear it if things don’t change soon. Here’s what you need to know:

1. When someone is hallucinating, you cannot simply reason with them and talk them down. Their brain works differently than yours and hallucinations and delusions are very very convincing for the individual. It’s not because they’re stupid, lying, or refusing to see the truth. It’s an illness and only meds can reduce the intensity of psychosis.
2. It can be very painful and shameful to have Bipolar disorder in our culture. It’s hard to exist as a Bipolar person. Don’t talk to your loved one like they’re stupid or don’t understand their own mind. Fight for them to get help, not against them to punish them.
3. Know that Bipolar disorder is genetic and degenerative. (It damages the brain over time, especially without medication.)
4. Know that people with bipolar disorder have plenty of empathy. They do care about you. Studies show they are not any more likely to be violent or antisocial than an “ordinary” person.
5. Know that when people are manic or depressed, they are not being lazy or cruel. They are genuinely overwhelmed by the chemicals in their brain, which are different than yours. They may also have structural differences in their brain and a damaged prefrontal cortex. To learn more about how the brain chemistry of a bipolar person is different from yours, click here.

Another thing you should know: If someone is in danger of hurting themselves or something else, you can call 911 and tell the first responders that you think they need to go to the hospital for a “psych eval.” (psychiatric evaluation) The person with Bipolar disorder might be very angry at first, but the hospital will keep them safe until they are stable. Please don’t abuse this process- but don’t feel bad if it becomes necessary. In-patient stays may be necessary for many, many individuals with bipolar disorder. But as a loved one, please make the process as humane as possible, because they WILL be losing some of their rights and freedoms temporarily, and the hospital can be terrifying. Still, it’s much better than the harm that can be caused by someone homicidal or suicidal.

Planning for the Future

Bipolar disorder is a serious, life-long mental health condition. It causes suffering and isn’t curable. But you’re not fucked. With medication and therapy, you can absolutely have a wonderful life. Now that I’m on the right medications for me and investing in therapy, my life is pretty sweet.

Upcoming posts on our blog and podcast will include:

• Questions to ask a new therapist
• Stories of hope. How people overcame the worst of the bipolar episodes.
• What to pack for an in-patient hospital stay
• How to get health insurance
• How to apply for disability
• Supporting a child with bipolar disorder
• More detailed explanations of the types of therapy available to us

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Thanks for reading! If you have any questions or feedback about Bipolar disorder, feel free to comment on this post. We aren’t doctors, but we’re always here to provide some hope and love for people with the same struggles we’ve experienced.