What is this neuropsychological disorder and what symptoms does it present?
It is very common for people to express phrases like “you are bipolar” in common language.
Thus, the meaning that is popularly associated with this concept is that of an emotionally unstable person, who goes from crying to laughing in a matter of seconds. However, it is a totally wrong meaning, which refers rather to emotional lability.
A bipolar disorder is actually a serious mental disorder , characterized by manic episodes (bipolar disorder type I) or hypomanic episodes together with depressive episodes (bipolar disorder type II). In this article we will know its characteristics, symptoms, causes and treatments.
- It may interest you: “The 10 most common psychological disorders”
Bipolar disorder in the DSM
Bipolar disorder is part of the mood disorders of the 4th edition of the DSM-IV-TR (Diagnostic Manual of Mental Disorders).
In the fifth edition (DSM-5), however, an important change occurs, and bipolar disorders acquire their own independence, becoming an independent diagnostic category .
manic episodes
Bipolar disorder is a mental disorder that involves the onset of one or more manic episodes ; Manic episodes involve an abnormally elevated, expansive, or even irritable mood. The duration of a manic episode is a minimum of 1 week (or less if hospitalization has been required). On the other hand, psychotic symptoms may also appear.
The person with a manic episode will be verbose (talking a lot), racing in thought, and sometimes even agitated. She will have grandiose thoughts, and may even have self-referential and erotomanic delusions. She will appear energetic, euphoric, and with decreased control of her behavior.
Interference
Thus, the characteristic symptom of bipolar disorder is a manic episode (which can also be hypomanic, as we will explain later). But, in addition to the manic or hypomanic episode, the disorder causes serious interference in the person’s life , affecting their work, personal, social, etc. Sometimes it may even require hospitalization.
Types
Bipolar disorder can be of two types: bipolar disorder type I and bipolar disorder type II . Let’s see the difference between these two disorders:
1. Bipolar I disorder
To diagnose bipolar I disorder it is essential that a manic episode appears . In addition, a depressive episode may appear (or not) (that is, it is not essential, but it is usually accompanied). The depressive episode lasts at least two weeks, unlike the manic episode, which lasts at least one.
2. Bipolar II disorder
Bipolar II disorder, on the other hand, requires among its diagnostic criteria the presence of a hypomanic episode and a depressive episode , in different periods of time. The hypomanic episode is similar to the manic episode, but less severe; In addition, your symptoms last for at least 4 days in a row.
Another difference from the manic episode is that the hypomanic episode is not severe enough to require hospitalization; psychotic symptoms do not appear either (in the manic they may appear) and the global deterioration is less.
Symptoms
The euphoric and expansive mood that appears in an episode typical of bipolar disorder carries a series of characteristic symptoms, which also appear in the DSM diagnostic criteria for bipolar disorder, such as the following.
1. Feeling of grandiosity
The person with a bipolar disorder, during the episode, feels that he is unstoppable, that “he can handle everything” , and that he is unique in the world. Her self-esteem is abnormally expansive, and is exaggeratedly “high.”
2. Distractibility
An exaggerated distractibility appears , and the patient is unable to concentrate on anything; he can jump from one stimulus to another without apparent control. This distractibility can be observed by the clinician himself during the interview, or reported by the patient himself.
3. No need to sleep
During a manic episode, a person may feel rested just by getting 3 hours of sleep . In other words, the need for sleep is severely reduced, and the patient can stay awake for long hours, making plans, thinking of “bizarre” ideas, working, partying, etc.
4. Agitation
Unintentional psychomotor agitation may also appear , that is, the person with bipolar disorder cannot control it. Instead of agitation, there may also be an increase in purposeful activity; this means that the patient may start to make many plans (for example with friends), to work tirelessly, to have uncontrolled sexual relations, etc.
5. Flight of ideas
Flight of ideas , a thought disorder that can also appear in other mental disorders, such as schizophrenia, consists of accelerated thinking; in the person’s mind, the ideas “slip away” from each other and/or don’t make sense. The associations or ideas that the person thinks jump from one to another without apparent reason or before any external stimulus.
Thus, the person with bipolar disorder, during a manic episode, would have accelerated and rushed thoughts, and the interlocutor would not be able to understand anything or practically nothing.
6. Verbiage
In relation to the previous symptom of bipolar disorder, verbiage appears, which implies that the person speaks in a hurry , without stopping, quickly, without the possibility of interrupting him, etc.
7. Involvement in activities
On the other hand, the person is excessively involved in activities that cause pleasure ; this can lead to serious consequences, if we think that these activities may be of a sexual nature (for example sexual indiscretions, unprotected sexual intercourse,…).
It may also be that the person buys compulsively and uncontrollably, or invests exorbitant amounts of money in certain businesses, bets, etc.
Causes
There are different models that claim to explain the causes of bipolar disorder. They are the following.
1. Biological models
Biological models point to a genetic contribution to bipolar disorders ; In addition, they maintain that this contribution is greater than in depressive disorders. In fact, they place 85% of the variance explained by hereditary factors.
Several studies have shown how relatives of people with bipolar disorder have a general risk of suffering from any mood disorder, whether bipolar (bipolar disorder) or unipolar (depressive disorder).
On the other hand, these models also allude to a higher concentration of norepinephrine and dopamine in the brain of patients with bipolar disorder, and a lower concentration of serotonin.
2. Psychological models
Within the psychological models we find different orientations.
2.1. psychoanalytic models
Psychoanalytic models, for example, refer to defensive processes such as regression, which the patient would use to go back to a previous psychological functioning , guided by the pleasure principle (typical of earlier ages).
The goal would be to escape internal conflicts such as depression. On the other hand, these models also understand mania as an unconscious denial of a painful reality.
2.2. cognitive models
The cognitive models that try to explain the origin of bipolar disorder attribute it to dysfunctional mental schemes, with grandiose and excessive content . This theory is typical of Aaron Beck, a well-known cognitive author.
According to A. Beck, in the patient with bipolar disorder, there is distorted, irrationally positive information processing. Irrational ideas would explain the appearance of mania.
Treatment
The most appropriate treatment in bipolar disorder is the one that combines psychopharmaceuticals (lithium) together with psychoeducation , the latter focusing on the patient acquiring good adherence to pharmacological treatment.
1. Pharmacological treatment
At the pharmacological level, lithium (plenur) is mainly used, which is a mood stabilizer . It is the treatment of choice. In addition, it prevents future manic episodes. At the pharmacological level, anticonvulsants or antiepileptics such as valproate, carbamazepine or gabapentin are also used.
2. Psychological treatment
Regarding psychological treatment, family and marital therapy is committed . The central concept of this is the high level of expressed emotion, which consists of critical and hostile attitudes and overinvolvement on the part of the family, factors that increase the patient’s probability of relapse.
Other widely used psychological therapies are cognitive-behavioral therapies (derived from the A. Beck model), as well as Frank’s interpersonal and social rhythm therapy (IPSRT) and therapy for bipolar disorder and comorbid substance abuse , from Weiss. The latter is focused on patients who also consume some type of psychoactive substance (60% of cases of bipolar disorder).
Bibliographic references
- American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
- Belloch, A.; Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
- Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. 21st century (Chapters 1-8, 16-18).
- Perez, M.; Fernandez, JR; Fernandez, C. and Friend, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pyramid.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.