Bipolar Affective Disorder (BPAD) is when a person experiences periods of extreme mood changes that range from mania (emotional highs) to depression (emotional lows). These mood shifts can affect a person’s behaviour and thinking day to day. BPAD can be a long-term condition and it can develop during adolescence or early adulthood. Some people with BPAD also experience psychosis.
BPAD can be very challenging to live with. While people often experience mood shifts in response to identifiable triggers, with bipolar the shifts can instead be cyclical, triggered by risk factors such as lack of sleep, not eating enough, and stress. This can leave a person feeling extremely disoriented and out of control, as though their mood is out of their hands. People around them can also feel frustrated or frightened by these unpredictable shifts.
Mood Swings vs Bipolar
What makes Bipolar different from labile mood (mood swings), is that although the mood can shift rapidly, the low mood or the higher mood is sustained for days. When someone’s mood makes multiple shifts within the same day, it is considered labile mood or emotion dysregulation. People can experience both bipolar and labile mood.
Bipolar I vs II
Bipolar I is the classic type of Bipolar depicted in popular culture and is characterised by periods of mania, often alongside periods of depression. Bipolar II is when a person experiences periods of depression and a milder form of mania known as hypomania.
Another note on Bipolar representation in popular culture - While the representation of Bipolar in popular culture is of mixed accuracy, it is worth noting that even accurate representations can leave people with BPAD feeling misrepresented, because everyone’s experience of BPAD is different.
Mania vs Hypomania
While mania lasts for at least one week and is more severe, hypomania usually lasts for at least 4 days and is mild to moderate. People experiencing hypomania can usually carry on with daily life much as usual, whereas in mania, work and social relationships are significantly affected.
What can BPAD look like?
Often people experience episodes of elation/mania followed by depression/low mood. These episodes vary in how long they last and how often they happen for each person, and many people feel balanced and well between episodes. Manic episodes can feel like being invincible, followed by a crash into despair and hopelessness in the depressive phase.
Manic/Hypomanic episodes can involve:
· Intense energy, hyperactivity
· Elevated mood - euphoric, irritable, or agitated
· Taking on too much physically, mentally and emotionally.
· Overcommitting to activities and finding it hard to follow through
· Increase in creativity
· Setting unrealistic plans
· Overspending
· Making decisions you might not usually make
· Sleeping less - reduced desire to sleep because of wanting to finish tasks and be creative
· Grandiosity, inflated self-esteem and less self-awareness than usual
· Easily overstimulated
· Easily distracted, with memory and concentration affected
· Pressured speech, talking loudly, interrupting others
· Racing thoughts, flight of ideas and derailing conversations
· Unpredictable emotional states
· Being more open and trusting than usual, which can leave you open to being taken advantage of
· More risk taking, sometimes in ways that put yourself or others in danger
· Increase in sex drive
· Delusions or hallucinations
Depressive Episodes:
· Decrease in self-esteem
· Dwelling on perceived failures and shortcomings
· Feelings of guilt and shame
· Sleeping more, sometimes as a way to escape
· Loss of interest and pleasure in day to day activities such as work, recreational activities, family and friends.
· Crying more frequently
· Feeling numb and disconnected
· Decrease in sex drive
· Withdrawing from people and commitments
· Suicidal thoughts
· Change in appetite
· Lack of energy
Mixed Episodes
A mixed episode is when a person experiences the racing thoughts, flight of ideas (mind jumps from topic to topic), and pressured speech of mania, but rather than feeling elevated, they feel depressed and despairing. Mixed episodes can be extremely frightening, especially if you don’t know what is happening.
There is some controversy around the term mixed episode, with some health professionals arguing that the phenomenon is better understood as a form of agitated depression. Regardless, it is an extremely uncomfortable and frightening experience.
What Causes Bipolar Affective Disorder?
Research indicates a few contributing factors to BPAD, however, like other mental health conditions there is no definite cause. Genetics, brain chemistry, and environmental factors such as significant life events or trauma are all thought to play a part.
Can BPAD coexist with other mental health conditions?
BPAD can coexist with other conditions such as personality disorders, anxiety disorders, substance use disorders, eating disorders, and ADHD, PTSD and cPTSD.
What support is available for BPAD?
Support for BPAD usually involves a combination of approaches, and different approaches are used for manic, depressive and rapid cycling episodes. These include:
· Medication - this will vary depending on manic, depressive, or rapid cycling episodes.
· Talk therapy, such as Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT), Acceptance Commitment Therapy (ACT), Psychotherapy etc. - the approach will depend on each person’s needs.
· Electroconvulsive Therapy (ECT)
While there is no cure for BPAD, with the right therapy and medication many people with BPAD feel more in control of their mood and live rich and fulfilling lives.
