By Mikell R. McCray, PsyD, Licensed Clinical Psychologist, John R. Day & Associates, Christian Psychological Associates
| Mikell R. McCray, PsyD |
Historically referred to as “manic-depression,” bipolar disorders constitute a group of mood disorders characterized by distinct mood episodes of mania, hypomania, and depression. Despite the attention it has received in recent years, bipolar disorder is frequently misunderstood.
To start, it’s important to emphasize the word “distinct” as it refers to the mood episodes of bipolar disorder. A distinct mood episode suggests that the person, or those who know the person, perceive an obvious change in their mood and/or behavior. Questions to ask yourself when identifying if a mood episode is a distinct change from the norm:
- Is the person experiencing rapid mood swings within the same day? Have the mood swings been a chronic problem that happens daily or almost daily? If the answers to these questions are yes, a diagnosis of bipolar disorder may not be accurate.
- Does the individual go through a period (days, weeks, or months) of stable or “normal” mood, followed by an obvious change in mood or behavior? Does the contrasting mood or behavior last several days to a week? If the answers to these questions are yes, a diagnosis of bipolar disorder may be accurate.
One of the distinct mood episodes one might observe or experience in bipolar disorder is a manic episode (also referred to as mania). The following behaviors and moods might be observed in someone experiencing a manic episode:
- Abnormally euphoric, dramatic, or irritable mood
- Abnormally and persistently increased goal-directed activity (starting many projects, making lists, engaging in multiple activities, making excessive plans)
- Extreme energy
- Inflated self-esteem or attitude of grandiosity
- Psychosis, e.g. delusions about having special powers or special connections with a famous person, etc.
- Decreased need for sleep while still feeling refreshed
- More talkative than usual or pressure to keep talking
- Rapid speech with frequent subject changes, or subjective report of racing thoughts
- Distractibility
- Extreme restlessness
- Excessive involvement in risky activities such as unprotected sex, gambling, spending money, or drugs
A manic episode would be diagnosed if several of the above symptoms are present most of the day, nearly every day for at least one week, or less duration if the person requires hospitalization. A manic episode causes significant difficulties in the person’s social and occupational functioning (e.g. strained relationships, financial loss, legal difficulty, job loss, injury, etc.).
A person may also be experiencing what is called a hypomanic episode. Very similar to a full manic episode, a hypomanic episode will have a shorter duration (a minimum of four consecutive days as opposed to one full week), and is less severe (no severe impairment of functioning, no psychosis, and no hospitalization).
Some people who are diagnosed with bipolar disorder go through periods of depression (sadness, low energy, hopelessness, loss of interest, inability to experience pleasure). It is often presumed that bipolar disorder characteristically presents with extreme highs and lows in mood. However, not everyone with bipolar disorder experiences depressive episodes.
Before a diagnosis is made, it should be certain that psychological symptoms are not due to the direct physiological effects of a substance (various stimulants and other substances can result in an elevated or euphoric mood). Additionally, it should be certain that symptoms are not related to another underlying psychological disorder (similar symptoms can present in depression, disruptive mood dysregulation disorder, borderline personality disorder, conduct disorders, psychotic disorders, impulse control disorders, etc.).
Bipolar disorder and conditions that present similarly are sometimes misdiagnosed, and as such, ineffectively treated. If a person suspects they might be suffering from bipolar disorder (or any psychological disorder), some helpful steps include:
- Be your own advocate and do some research about your symptoms.
- Document your own symptoms, and ask loved ones to document their observations of your symptoms as well. Keep a daily log of moods, behaviors, energy level, etc. The more thorough your documentation and its duration, the easier it will be for your physician or therapist to diagnose or rule out bipolar disorder.
- Psychological tests and questionnaires administered by a licensed clinical psychologist can help clarify the symptoms and diagnosis.
- Gather a family history of psychiatric symptoms and diagnoses.
- Consider psychotherapy, medication, or both.
For more information, contact John R. Day & Associates, Christian Psychological Associates, located at 3716 West Brighton Avenue, Peoria or at their locations in Normal, Canton, Pekin, Princeton, or Eureka. Call us at 309-692-7755 or visit us online at christianpsychological.org.
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