Imagine that you are sitting in a sailboat. Looking out at the water, you envision where you want to go. You set the rudder, lift the anchor, put up the sails and away you go. If the wind is strong, you can move quickly to your destination. Perhaps the wind picks up and up and you’re suddenly feeling less like a sailor and more like a pilot. The wind is carrying you faster and faster and this has become an incredibly fun thrill ride! You look down at the water and enjoy watching the waves go by as you speedily fly atop the waves, nothing holding you back. However, the wind eventually dies down. After some time, it crawls to a stop and you are stuck.With no wind in your sails, you float in the ocean all alone. You feel isolated. You look at your boat and realize that that high speed thrill ride you were on a short while ago left your hull damaged, chunks of wood flown off, and you neglected basic maintenance for some time. Perhaps you try blowing into the sails, but nothing can get your boat going again.
Eventually, the winds pick up and once again you’re flying. But soon they die and again you’re stuck. This process goes on and on for some time. It wears on you, and you never get where you wanted to go in the first place. Ultimately, you are at the whims of the wind.
This can be what it is like to live with bipolar disorder.
Of the many diagnoses of mental health issues out there, bipolar disorder can be one of the trickiest to identify, treat, and live with. When looking for the signs of bipolar disorder, some can be less than obvious, and even be deceptive to the person living with bipolar disorder, as well as to their close friends and family members.
For the person experiencing the disorder, it can quite literally feel like a roller coaster. Your emotions run so high and it can feel quite exhilerating for long periods of time. However, usually this is followed by a deep crash and ensuing depression.
For those who have loved ones experiencing bipolar disorder, it can feel like the person you thought you knew is slipping away or changing. Sometimes it even feels like a positive change. As the highs of bipolar disorder begin to come, people often become very productive, but problems arise when this productivity proceeds into risky behaviors. Recognizing the signs of bipolar disorder in yourself or your loved one and entering treatment early is critical for achieving success and healthy living.
Understanding Bipolar Disorder
Now, to properly understand bipolar disorder can be complicated. One complication is that calling someone “bipolar” is fairly common, but is often used entirely incorrectly. Someone who frequently changes their mind is not bipolar. Someone who seems to react differently depending on their mood isn’t necessarily bipolar. The weather can’t be “bipolar.” People who are happy one day and then sad the next probably are not bipolar, either (if extremely high and low, potentially, but usually episodes are at least weeks long).
All of these misnomers stem from a basic understanding that someone with bipolar disorder fluctuates between highs and lows, but serve to create a murky public understanding of what bipolar disorder actually entails. Further, even in clinical uses, the term bipolar can have slightly different meanings.
In general, there are 3 distinct diagnoses of bipolar: Bipolar I, Bipolar II, and cyclothymia. Bipolar I is the classic, high-highs and low-lows. Bipolar II is an experience of hypo-mania (hypo meaning less, so an elevated mood but not full blown mania), and the deep depression. Cyclothymia is a long term (talking over the course of multiple years) of cycling between periods of elevated and depressed mood, but never full mania or full depressive episodes.
However, even more complicating is the fact that the individual experiences of bipolar disorder I, II, or cyclothymia can be drastically different. Someone who presents as predominantly depressed but had only one manic episode of mania at any point in their life fits the definition of bipolar, even without any recent episodes of mania. But with the same diagnosis could be someone who is more baseline manic and has had a depressive episode at some point in their life, too. Clinicians have a way to differentiate these experiences, but most individuals with this diagnosis tend to talk about their experiences as simply “bipolar.” This can cause problems down the road as people talk about their experiences. Are they really talking about the same thing?
I break all of this down so that you can understand that bipolar is a complicated disorder that can look similar or different to others with the same “label,” but the expression of bipolar disorder is quite varied. As such, it is critical to see a professional for a more accurate diagnosis and to discuss what treatment options might exist for you or your loved one.
Signs of Bipolar Disorder
Below I have broken down some of the signs and symptoms of bipolar disorder so that you might relate to some or all of these symptoms in yourself or a loved one. Again, please consult a professional before diagnosing yourself.
Depressive episodes in bipolar look just like those in major depressive disorder. However, they can still look quite varied depending on the individual experiencing them. Classically, depression has been synonymous with a sad mood. This is part of depression for many, to be sure, but technically doesn’t have to be present for depression to be an accurate fit.
Either sadness/depressed mood or a severe lack of interest in pleasure must be present in order to make a diagnosis of depression. That means for many, they might not necessarily feel sad or tearful but still be depressed. The lack of interest in pleasure often manifests in a lack of motivation, too. I’ve had many clients describe being in a funk or a sort of fog. Further, I have heard them describe it as “a case of the screw-it’s” (often the language is more colorful than that). Simply, there is a sort of blasé approach to life that depression tends to bring.
Beyond these hallmark symptoms, there are also a host of experiences tied in with depression. You may see all or a few of them. These include significant changes in weight, eating habits, sleep patterns, feeling tired all of the time, feelings of inexplicable or inappropriate guilt, a hard time concentrating, and a focus on thinking about death.
What differentiates bipolar disorder from major depressive disorder is the presence of a “manic episode” at any point in life. The DSM-5 (the sort of go-to manual for clinicians making diagnoses) summarizes a manic episode as “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary).”Basically, the mania is the highs of bipolar and this is where people can get themselves into a lot of trouble. People experiencing manic episodes tend to be fairly impulsive, often going out on big spending sprees or making large purchases they may or may not have the budget for. Sitting with someone with bipolar can feel rather tiring, like you’re struggling to just keep up with the pace of the individual’s thoughts. If you’re noticing a lot of fast talking, along with intense drives to complete projects or do fun things, it could be part of mania. Additionally, people with mania often find themselves with a decreased need for sleep. All this “manic energy” coming out will often get the individual into situations where they are setting themselves up for hardship once they come down off of the high.
If you are experienicng a lot of these symptoms, it often feels really good in the moment. Like really, really good. People tend to enjoy this experience and often want it to come back. However, these symptoms have a tendency to take over, and, like the boat I talked about in the beginnig, you end up rough for the wear in the process. Further, if you’ve only ever experienced these sorts of things without any of the depression, you still may be experiencing bipolar disorder as well.
While depression and mania are the main components of bipolar disorder, as I alluded to earlier, there are subtypes of bipolar disorder to look out for. While Bipolar I experiences the full blown highs, Bipolar II experiences only a “hypomania.” The moods might not be quite as elevated, and the minimum length of an episode to qualify is less, at four days rather than a week.
The main difference in how it manifests is that people experiencing hypomania tend to be able to stick to their routines in work/school/home, just with a more directed energy. Note, in Bipolar II, it is implied that you have experienced a major depressive episode, but that is not necessarily the case in Bipolar I (you may have only had the highs).
Cyclothymia, then, is a mix of hypomania with some mild depression. Maybe you’re experiencing some elevated mood, but not really getting yourself into trouble, followed by depression but you’re still able to get to school or work. You’re still “functioning” but over the course of cycling between this for a few years, you’ve got some emotional whiplash of life.
A final thing to look out for: bipolar disorder can be accompanied with “psychotic features,” and these can vary depending on the person. Often, it looks like hearing or seeing things that other people do not. These are often voices, and frequently they say negative or hurtful things. This can be one of the most distressing elements of bipolar disorder for those who have this symptom as well.
Treatments for Bipolar Disorder
So what are your options, then, if you feel like you might have some of the signs of bipolar disorder? Again, first and foremost, get in to see a therapist who is qualified to sit with you and diagnose. As with most mental health issues, the gold standard is for a mix of therapy and medication to target the problematic experiences.
By meeting with a psychiatrist or other qualified prescriber, you can get yourself on to a mood stabilizer. Be sure to be open about having had mania before if you’re only experiencing depression now, though. Many of the medications that help people with major depressive disorder can actually cause mania to come back and/or become much worse. Antidepressants often trigger this mania, whereas mood stabilizers serve to do exactly as advertised: stable your mood. To return to the boat metaphor, these can help provide steady and reliable wind to your sails so that you can get where you want to go.
Therapy, then, is the complement to medication. This might be akin to putting a little motor on your boat and taking even more control over your situation. Talking through bipolar disorder with a therapist can help to develop skills and tools to use when you notice your mood beginning to fluctuate in either direction.
Even better, family therapy can serve to wrap yourself in support from your loved ones. Bipolar, especially the mania side, is often first seen from others around you before you notice it in yourself. Family therapy, then, can empower your whole family to work with you to recognize the signs of bipolar disorder and help you cope with the experience.
If this feels like you or a loved one, please reach out. I would love to work with you on how to get the steady wind back in your sails and help you to meet your goals. Living with bipolar can be a scary experience, however, it is manageable. Through a mix of therapy and some medication, we can get you back on your feet and being the best version of yourself.
“Sailing,” courtesy of unsplash.com, pexels.com, CC0 License; “Jump,” courtesy of stokpic.com, pexels.com, CC0 License; “Darkness,” courtesy of pixabay.com, pexels.com, CC0 License