What Is Bipolar Disorder? Risk Factors, Symptoms and Treatment

Bipolar disorder is a mental illness that causes extreme fluctuations in a person's mood, energy and concentration, impairing the ability to function well in daily life. Up-and-down mood swings and erratic behavior associated with bipolar disorders can take a heavy toll on relationships and adversely impact work/school performance.

While these mood disorders can be challenging to diagnose, symptoms typically first appear in early adulthood. According to the National Alliance on Mental Illness, the average age of onset is 25. However, bipolar disorder can develop during adolescence and, less commonly, in childhood. Bipolar disorder afflicts men and women equally, with about 2.8% of the U.S. population diagnosed with the mental health condition and nearly 83% of cases classified as severe.

One of the reasons diagnosis can be difficult is that individuals with bipolar disorder often experience other co-occurring mental health issues such as obsessive-compulsive behaviors or post-traumatic stress. People with bipolar disorder also have a significantly increased likelihood of developing a substance use disorder.

In the past, bipolar disorder was commonly referred to as "manic-depression" because the condition is characterized by high moods, known as mania or hypomania, and low moods, known as depression. In terms of both duration and intensity, the highs and lows of bipolar disorder differ from what would be considered ordinary ups and downs in mood and behavior.

What Is Bipolar Disorder?

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), bipolar disorder is a category of brain disorders that includes three different sets of disorder symptoms: bipolar disorder 1, bipolar disorder 2 and cyclothymic disorder. All three of these mood disorders are marked by periodic, intense and extreme emotional states ranging from manic to depressive symptoms.

What Is the Difference Between Bipolar 1 Disorder, Bipolar 2 Disorder and Cyclothymia?

The biggest difference among the related mood disorders involves the severity of symptoms and length of mood episodes. Here are the general diagnostic criteria for each.

Bipolar I Disorder

A manic-depressive disorder that may or may not have psychotic episodes; acute mania and/or a major depressive episode may occur

Bipolar II Disorder

A manic-depressive disorder that alternates between depressive and manic episodes that are typically less severe than bipolar 1 and do not prevent daily functioning

Cyclothymic Disorder or Cyclothymia

Cyclothymia involves brief "cyclic" episodes of hypomania, an abnormally revved-up state of mind but less severe than mania, and depression. The mood changes and hypomanic symptoms with cyclothymia (cyclothymic highs and lows) are typically less intense than those characteristic of bipolar I disorder or bipolar II disorder.

A related diagnosis of "other or unspecified bipolar disorder" refers to hypomanic and depressive symptoms that don't meet the DSM-5 diagnostic criteria for bipolar disorder. 

What Are the Warning Signs and Symptoms of Bipolar Disorder?

Bipolar disorder symptoms vary in severity, length of time between episodes and duration of a manic, hypomanic or depressive mood. Some individuals experience very distinct manic and depressive episodes while others may not be able to clearly identify when one episode stops and the other begins. Some people may go for long periods of time, even years, without re-occurrence of episodes or extreme mood swings. Others may experience both extremes at the same time or in rapid sequence.

Bipolar disorder symptoms vary by person and not all need to be present for a diagnosis to be made. Typical bipolar symptoms are described here.

Manic Episodes

A manic episode spanning a period of at least one week where a person has an elevated mood most of the day and nearly every day. Symptoms of a manic episode include:

• Inflated self-esteem or grandiosity
• Less need for sleep
• Increased talkativeness
• Racing thoughts
• Easily distracted
• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Psychotic episodes with hallucinations or delusions

Engaging in activities that have the potential for negative consequences, e.g., unrestrained buying sprees, starting multiple projects but not finishing them, taking sexual risks or other risk-taking behaviors are other symptoms of a manic episode. A hypomanic episode which is similar to a manic episode but with less severe symptoms. Daily functioning is usually possible.

Depressive Episodes

A depressive episode where depressed mood results in a loss of interest or pleasure in life. Symptoms of a depressive episode include:

• Depressed mood most of the day, nearly every day
• Persistent feelings of sadness, worry or emptiness
• Feelings of hopelessness, pessimism or low self-esteem
• Loss of interest or pleasure in all, or almost all, activities
• Significant weight loss or marked decrease/increase in appetite
• Engaging in purposeless movements, such as pacing the room
• Fatigue or loss of energy
• Moving or talking more slowly
• Feelings of worthlessness or guilt
• Diminished ability to think, concentrate or make decisions
• Suicide attempts

Physical discomfort such as aches or pains, headache or digestive problems without a clear physical cause along with recurrent thoughts of death, recurrent suicidal ideation without a specific plan may also indicate the presence of a depressive episode.

What Are the Risk Factors for Bipolar Disorder?

While there is no single cause of bipolar disorder, mental health professionals have identified several potential contributing factors, including:

Genetics and Bipolar Disorder

The likelihood of developing bipolar disorder is much higher for those with a family history of the illness, particularly having a parent or a close relative with the condition

Stress and Bipolar Disorder

Experiencing stressful events and attempting to manage a stressful life can trigger a manic or depressive mood

Brain Structure, Neurochemistry, and Bipolar Disorder

Brain structure and neurochemistry may also play a role in the development of bipolar disorder.

How Is Bipolar Disorder Treated?

All forms of bipolar disorder are very treatable. The most-effective approach involves a treatment plan tailored to meet the individual patient's specific needs and circumstances. Antidepressants and other medications along with psychotherapy (talk therapy) are often used to manage symptoms. Screening for substance abuse issues should also be conducted.

Finding the most beneficial medication can be challenging because medication response varies from person to person. In working closely with patients, mental health professionals can recommend different medications and doses to determine the best options. Most people with bipolar disorder are prescribed more than one medication. Because bipolar disorder is a reoccurring mental illness, ongoing treatment and consistent, continuous use of medications is recommended.

Cognitive behavioral therapy is often recommended as a treatment option. A cognitive-behavioral psychotherapy approach helps patients replace negative thoughts, beliefs and behaviors with more useful and positive ones.

As with other chronic health issues and mental disorders, self-care is essential to getting well and staying well. Healthy habits such as sticking to a regular routine, getting enough sleep, exercising regularly and a maintaining a healthy diet are helpful in managing symptoms.