Bipolar disorder is characterized by fluctuations in mood between mania and depression. There are many misconceptions about bipolar disorder, which can influence stigma, willingness to seek treatment and appropriate illness management.
1. Myth: Bipolar disorder is a rare condition
Fact: Bipolar disorder is a common mental health condition, affecting millions of people.
It’s estimated that up to 2.1% of the population will experience bipolar disorder in their lifetime. Rates of bipolar disorder are relatively equal between men and women. However, the prevalence of bipolar disorder may vary based on individual characteristics. For example, bipolar disorder may be greater among:
- Native American communities
- People with lower education levels or socioeconomic status
- People who were previously married
- Young and middle-aged people
Bipolar disorder includes significant fluctuations in mood, from periods of mania to periods of depression. Although bipolar disorder is not as common as some other mental health conditions, it is one of the most burdensome psychiatric illnesses. Bipolar disorder is chronic and long-lasting, and the presence of both manic and depressive features can significantly impair a person’s ability to live normally.
People with bipolar disorder often receive multiple types of care, may be in treatment for an extended time and may not be able to work or participate in their regular activities. Even though bipolar disorder is not the most common mental health condition, it has a significant impact on individuals and communities.
2. Myth: There’s only one kind of bipolar disorder
Fact: There are several types of bipolar disorder.
There are multiple types of bipolar disorder, and each has its own unique features. The subtypes of bipolar disorder include:
- Bipolar Disorder I: Includes at least one manic episode. Although people often experience depressive episodes in Bipolar I, it’s not required for diagnosis.
- Bipolar Disorder II: Diagnosis requires a major depressive episode and a hypomanic episode, or an episode with similar symptoms to mania, but slightly milder
- Cyclothymia: For a diagnosis to be made, cycling between hypomanic and depressive moods must occur for a least two years with symptoms present for at least half the time
- Rapid Cycling: Rapid cycling involves at least four episodes of mood changes within a 12-month period and cannot be caused by substance use or another medical condition
There are a few other bipolar-like disorders that may not meet full criteria for a diagnosis of bipolar disorder but can still have a significant impact on a person’s life. These include:
- Not Otherwise Specified: This is when an individual experiences symptoms of bipolar disorder but does not meet the full criteria for a specific subtype diagnosis
- Mixed Episodes: This occurs when someone experiences manic and depressive bipolar symptoms at the same time.
Even without meeting specific diagnostic criteria for bipolar I or bipolar II, cycling between manic and depressive symptoms can be extremely distressing and disruptive to normal functioning. Bipolar disorders may require slightly different treatment based on the subtype of disorder, but all classifications and symptoms often require and would benefit from psychiatric treatment.
3. Myth: Mood swings always indicate bipolar disorder
Fact: Mood swings are not the same as bipolar disorder.
Fluctuations between times of happiness and times of sadness are a normal and expected part of life. Most people experience mood swings on a daily or weekly basis. Even though inconsistency in mood might be unpleasant, mood swings are not the same as bipolar disorder.
Differentiating between mood swings and bipolar disorder is often dependent on the extent and severity of mood swings. Bipolar disorder is characterized by frequent, persistent and extremely distressing fluctuations in mood. For cases of bipolar disorder that meet diagnostic criteria, cycles of mania and depression are often associated with harmful behaviors. During mania, people may engage in risk-taking behaviors or go days without sleeping. During a depressive episode, a person may not leave their house or be at risk of self-harm.
Mood swings are a normal part of life, particularly in response to stressful or challenging situations. However, if mood swings are frequent, long-lasting and cause significant distress, they may be evidence of an underlying psychiatric condition.
4. Myth: People with bipolar disorder switch frequently between manic and depressed moods
Fact: Transitions from manic to depressed episodes can be long or short, depending on the person.
Many people assume that people with bipolar disorder fluctuate between mania and depression quickly and often. The idea that people who have bipolar might change moods daily or even multiple times in a day is not supported. In fact, a diagnosis of bipolar requires clear and defined periods of mania and depression that last a certain amount of time. These requirements are:
- A hypomanic episode that lasts for at least four days
- A manic episode that lasts for at least one week
- A depressive episode that lasts for at least two weeks
These are the minimum guidelines required for a hypomanic, manic or depressive episode to meet diagnostic criteria. In many cases, these episodes or cycles last much longer. When cycling between manic and depressive symptoms happens quickly, this is known as rapid cycling bipolar. The criteria for rapid cycling includes at least four distinct mood episodes over the course of a year. Although this type of cycling is referred to as rapid, cycling from manic to depressed certainly doesn’t occur in the course of a day.
5. Myth: Mania is a happy, fun feeling
Fact: Mania can be seriously debilitating and may lead to impaired functioning or even hospitalization.
People often assume that the symptoms of mania are euphoric and overwhelmingly positive. While a manic episode can have people feeling on a high, there can be many negative aspects to it as well. Some of the other symptoms of mania can include:
- Extreme irritability
- Psychotic symptoms, including delusions
- Impulsive or erratic behavior
Although people with bipolar disorder may feel some relief if they have come out of a depressive episode, the feelings of a manic episode are not overwhelmingly positive. A manic episode can feel like a person does not have control and people or situations are working against them. This can make it hard to function socially and professionally.
6. Myth: Children cannot get bipolar disorder
Fact: Children can be diagnosed with bipolar disorder.
Bipolar disorder can certainly be diagnosed in children, with kids as young as preschool age receiving a diagnosis of bipolar disorder. However, diagnosing children with bipolar disorder has been somewhat controversial, with researchers noting a significant increase in children being diagnosed with the condition.
Some professionals suggest that bipolar disorder in children is extremely rare, and that symptoms may indicate a separate condition. Sometimes, children can display dramatic episodes of irritability or sadness, or can seem to cycle between moods quickly. It’s not clear whether symptoms of bipolar disorder are the same in children as they are in adults, and this can make a clear diagnosis difficult.
Despite some of the uncertainty surrounding bipolar disorder in children, it’s generally accepted that symptoms that might be similar to this condition are distressing and require professional support. Seeking professional help is important in identifying appropriate diagnosis and treatment.
7. Myth: There’s a simple test for bipolar disorder
Fact: There is currently no simple test for bipolar disorder.
Unlike many physical conditions, there is no clear biological marker or test for bipolar disorder. This can make testing for and diagnosing bipolar disorder challenging, as a diagnosis includes several criteria that require a detailed understanding of a person’s history and symptoms.
Since there is no distinct biomarker for bipolar disorder, diagnosis is based on clinical assessment. This assessment can include collecting a mental health history, assessing severity and duration of symptoms and monitoring the progression or cycling of episodes. While brief screening tests for bipolar disorder are available, a formal diagnosis requires additional professional assessment.
Diagnostic interviews may also involve close friends and family. Because the process is complex and not everyone with bipolar disorder seeks treatment right away, there can be a delay between the onset of symptoms and a formal diagnosis. Although the process of diagnosis is more intensive than a simple bipolar test, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines very specific criteria required for an official diagnosis. This formal and standardized diagnostic process ensures that the assessment follows high-standards and diagnosis is accurate.
8. Myth: Medication is the only treatment for bipolar disorder
Fact: There are multiple treatments for bipolar disorder.
When establishing a treatment strategy for bipolar disorder, it’s important to establish whether the patient is experiencing a depressive, manic or hypomanic episode. It’s also necessary to consider factors like:
- Medical history
- Other physical or mental comorbidities
- Previous responses to treatment
- Willingness to be treated
Since episodes of bipolar disorder can be distressing and extreme, the first concern of treatment is often to make sure that patients are safe and medically stable. In the short term, this usually includes the prescription of mood stabilizers or antipsychotic medications. In some treatment-resistant cases, electroconvulsive therapy may be recommended.
Over the long term, treatment for bipolar disorder likely involves other strategies. The relationship between a patient and their psychiatrist is important. Treatment may require changes or adjustments through different episodes, and it is important that a patient trusts the person giving them care. Long-term treatment strategies can include:
- Prevention or anticipation of episode cycling
- Lifestyle interventions, including improved diet and exercise
- Education about the disorder
- Cognitive behavioral therapy
The best treatment will differ for each person depending on their individual needs and symptoms.
9. Myth: People with bipolar disorder are violent
Fact: People with bipolar disorder are not inherently violent.
Symptoms of bipolar disorder, and in particular mania, include irritability and impulsivity. Although these symptoms may make people feel agitated or aggressive, having bipolar disorder does not automatically make a person violent.
Research has shown that bipolar disorder is linked with an increased risk of violent crime. However, it is believed that violent behavior in people with bipolar disorder might have more to do with their environmental exposure both currently and in their childhood, as opposed to being a direct cause of bipolar disorder. It’s also not overly clear whether the phase, mood swings, or speed of cycling between episodes might impact violent behavior.
It’s also important to note that violence in bipolar disorder has been significantly linked to comorbid substance use disorders. This highlights that violence among people with bipolar disorder may be a result of another psychiatric condition or aspect of their life or upbringing.
10. Myth: People with bipolar disorder cannot work
Fact: Bipolar disorder might make work challenging, but not impossible.
Because bipolar disorder is associated with mood swings and dramatic changes in behavior, it can be difficult for people with the illness to maintain productivity and optimal function in their jobs. There are several different aspects of bipolar that can impact work. These can include:
- Loss of productivity due to symptoms or medication side effects
- Missed hours or days due to symptoms or time spent attending medical appointments
- Being fired or let go from a job due to symptoms or lack of understanding about the illness
Despite these challenges, it is not impossible to work with bipolar disorder. A successful professional life is possible with relative stabilization of bipolar disorder, symptom and behavior management and communication with employers. Working with bipolar disorder can be assisted through workplace strategies that encourage understanding and make adjustments for people with psychiatric illness.
11. Myth: There’s nothing you can do to help a loved one with bipolar
Facts: Support of a loved one can benefit people with bipolar disorder.
One of the best ways to help a loved one with bipolar disorder is to educate oneself about the disorder. Knowing what to expect and being aware of available treatment options can be a great source of support for someone with the condition. In addition, being open, accepting and working to reduce stigma for a loved one with bipolar disorder can improve their daily functioning.
Loved ones can also help someone with bipolar disorder by identifying changes in symptoms and behaviors that might indicate a cycling from a manic to a depressive episode or vica versa. This can encourage a patient to seek professional assistance and adjust their treatment accordingly.
12. Myth: Drug abuse causes bipolar disorder
Fact: Substance abuse is not a cause of bipolar disorder.
Bipolar disorders have been shown to be associated with substance use disorders. This means that these two mental disorders often co-occur alongside each other. However, this does not mean that substance abuse causes bipolar disorder.
Diagnosis of bipolar disorder requires the sustained and long-term presentation of manic or depressive symptoms. Although drugs and alcohol may produce some of the symptoms of bipolar disorder, these are likely to be transient, and will not meet criteria for a formal diagnosis of bipolar.
The causes of bipolar disorder are understood to be a combination of genetic and environmental factors, as well as deficits in signaling systems in the brain. These factors are complex and interact in varying degrees, and it is unlikely the chronic substance use will cause bipolar disorder on it’s own. Although not the cause, comorbid substance use can worsen symptoms and the prognosis of bipolar disorder.
13. Myth: Once symptoms subside, treatment can be stopped
Fact: Treatment should not be stopped, even when bipolar symptoms subside.
If symptoms of bipolar disorder subside, it can mean either that a person is cycling between phases or that their medication is working. When medication is effective in stabilizing the symptoms of bipolar disorder, it can feel like the medication is no longer necessary. However, continuing with medication is essential to keeping bipolar disorder as stable as possible, and minimizing the amount of distress and disruption caused by the disorder.
Treatment adherence is related to better functional outcomes in bipolar disorder, meaning that people who follow their treatment plan might be able to better participate in work, social and community activities. Even though there may be some unpleasant side effects of medication, treatment can be life-changing and life-saving for many people. The consequences of stopping medication can include relapse of mood episodes and risk of health complications or side effects.
If you or someone you care about is experiencing symptoms of bipolar disorder that are related to a substance use disorder, contact The Recovery Village today to discuss available treatment options.
Blanco, C., et al. “Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions – III.” J Psychiatr Res, 2017. Accessed May 24th, 2019.
Grande, I., et al. “Bipolar disorder.” Lancet, 2016. Accessed May 24th, 2019.
Angst, J. “Bipolar disorders in DSM-5: strengths, problems and perspectives.” International Journal of Bipolar Disorders, 2013. Accessed May 24th, 2019.
Fountoulakis, K. N., et al. “A systematic review of the evidence on the treatment of rapid cycling bipolar disorder.” Bipolar Disord, 2013. Accessed May 24, 2019.
Parens, E. & J. Johnston. “Controversies concerning the diagnosis and treatment of bipolar disorder in children.” Child and Adolescent Psychiatry and Mental Health, 2010. Accessed May 24, 2019.
Fazel, S. et al. “Bipolar Disorder and Violent Crime: New Evidence From Population-Based Longitudinal Studies and Systematic Review.” Arch Gen Psychiatry, 2010. Accessed May 24, 2019.
McMorris, B.J. et al. “Workplace productivity, employment issues, and resource utilization in patients with bipolar I disorder.” Journal of Medical Economics, 2010. Accessed May 24, 2019.
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