Lori Colbo's personal experiences, research, and writing on mental illness have given hope and understanding to those affected by it.
• The information in this article is not meant to assist you in diagnosing yourself, or a loved one. Please see your physician if you have symptoms you believe might be bipolar disorder.
The basic facts of bipolar disorder
Information about Bipolar Disorder given on a great many medical websites and literature is often pretty basic, although things are changing and more detailed information is being written. There are many variables that people may not be aware of - even people who have this diagnosis. This article offers information about bipolar disorder that goes outside the general information and rigid criteria of diagnosis from the Diagnostic and Statistical Manual (5th edition).1
Bipolar is a brain disorder characterized by intense mood swings. It is formerly known as manic depressive illnes. As you might guess, the word bipolar indicates two opposite poles - the high moods (mania) on one pole, and the low mood (depression) on the other pole. Approximately 5.5 million adults (2.6%) have this mood disorder in the United States. 2
Bipolar is a spectrum disorder. People have different severities and symptoms within their classification. It is cyclical in nature, although not necessarily in a regular pattern. This disorder is no respecter of persons - it can occur in anyone, at any age, and at any stage of life. It tends to run in families. Some research studies have suggested that people with certain genes are more likely to develop the disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the condition compared with children who do not have a family history of it .3 Doctors and scientists are still trying to determine the exact cause of this disorder. It is believed that in addition to the biochemical brain side, environmental factors can also be at play. Following are the basic symptoms of bipolar disorder. You can note that a few of the symptoms are evident in both mania and depression.
- Feelings of euphoria, invincibility, and grandiosity.
- Continuous high energy.
- An abnormal, increased level of irritability.
- A flight of ideas.
- Rapid speech (also known as pressured speech), and jumping from one topic to another.
- Decreased amount of sleep.
- Pleasure-seeking and increased risk taking behavior (spending sprees, risky sex etc.).
- Racing thoughts or jumping from one idea to another.
- Easily distracted.
- Feeling agitated or jumpy.
- Extended period of sadness, hopelessness, helplessness, and low self-esteem.
- Decreased energy and fatigue.
- Lack of interest in things that once brought pleasure.
- Inability to make decisions.
- Inability to concentrate.
- Being agitated.
- Slow movement, speech and thought.
- Thoughts of suicide and/or attempts at suicide.
Types of bipolar
Some doctors and scientists believe there are only three types of Bipolar - Types l and ll, and Cyclothymia. Following are the traditional forms of thought on bipolar types. 4
Bipolar l is the most severe form. The mania is more intense out of all the other types. Type l is said to lead to hospitalization more often; however, due to personal experience and talking with my clinicians and other people who have it , I believe this is not completely accurate. People with type ll have to deal with more serious depression at times.
Many people are under the impression that mania is only a positive experience (euphoria, high energy). The fact is, mania can be a very negative experience. Irritability, agitation, psychosis can all be symptoms of mania. In an agitated, irritable state, one may become angry and enraged, frenzied and irrational, and may act out in some way. The high mania can be characterized sometimes by risky behaviors. Hypersexuality is one symptom that might lead to careless, impulsive sexual encounters. Or during mania one might go on spending sprees or make poor business decisions.
Bipolar ll has milder mania called hypomania - hypo meaning a lower (or under) mania. Literature often tells us that hypomania is less likely to cause marked impairment, that one is less likely to have difficulty functioning in their work, social situations, and day to day living. It's a case by case situation. Without the right treatment, people with type ll can progress to full blown mania. Type ll tends to be more on the depressive side, the depression is much more severe, and there is a higher rate of suicide with this type.
Cyclothymia is the mildest form. Milder hypomania and depressions than types l and ll. This diagnosis is seldom used because the symptoms are so mild many doctors don't want to characterize it as a bipolar illness.
These are the most commonly known types of bipolar in the DSM IV and DSM V and other medical texts and publications. The research in recent years has brought a lot more to the table - type lll, soft bipolar, and NOS (not otherwise specified) and the spectrum theory, to name a few. 5
Rapid Cycling Moods
Rapid cycling is a phenomenom many are not aware of; however, it is discussed frequently in medical and mental health educational literature now. Rapid cycling is a pattern of frequent, severe mood swings. It is most often seen in type ll and in women, but it can happen anywhere on the spectrum. Statistics show that rapid cycling occurs in ten to twenty percent of people with this disorder. 6
Author and journalist Gloria Hochman describes rapid cycling this way,
"...rapid cyclers, with mood changes colliding with each other, from month to month, day to day, or sometimes even within the same day. These men and women zigzag between highs and lows so rapidly they often feel as though they are about to die. They bounce from euphoria to despair and back again within hours. They are in exquisite pain, out of control, like a race car gone berserk, and sometimes say that they are afraid of being alone with their episodes because they don't know what they will be doing next." 7
I find Ms. Hochman's explanation spot on in my personal experience. For me it feels like an out of control locomotive rather than a race car. It is scary living with moods so powerful, wild, and unpredictable. Suicidal thoughts can arise and become very intense. I think the person who coined the phrase 'Stop the world I want to get off' might have been experiencing rapid cycling.
In the last century, we didn't hear about rapid cycling. Now doctors, mental health professionals, and researchers have taken due note of this phenomenon in people who struggle with bipolar of any type; perhaps because overall, scientists and doctors are more observant as they research it. They believe that the use of antidepressants and stimulants (for people with ADD and ADHD) could be one of the major reasons. Certainly though, other factors could be at play - lack of sleep, more stress, trauma, etc. 8
I know for me lack of sleep and severe stress can catapult me into a rapid cycling episde.
Patty Duke on her diagnosis
The dangerous experience of a mixed mood state
A mixed mood, also known as a mixed state, can take someone by storm. It can be one of the most frightening experiences for someone with bipolar disorder ever. Often it is combined with rapid cycling. One clinician told me a mixed state was mania and depression simultaneously. That sounds impossible but Gloria Hochman describes it as "...a smorgasboard of symptoms that are at odds with each other."
My experiences with mixed state were not euphoria and depression simultaneously, but severe depression, severe irritability and agitation, and racing (frenzied) thoughts. I liken it to being caught up into tornado. Dr. James R. Phelps, author of Why Am I Still Depressed: Recognizing and Managing the Ups and Downs of Bipolar ll and Soft Bipolar Disorder, doesn't beat around the bush when he states, "This combination is one of the most dangerous mood states known."
The combination of self-loathing, agitation, terror, and despair is indescribable. The risk for suicide is at it's highest in this state. This too is very accurate from my life.
This combination is one of the most dangerous mood states known."
— Dr. James R. Phelps
The symptom of psychosis
Psychosis is loosing touch with reality. During psychosis one can have visual or auditory hallucinations, or have irrational, false beliefs or ideas that can't be corrected by someone confronting them with conclusive reality, including paranoia (known clinically as delusions). During psychosis someone may believe they're being followed or plotted against, they may hear voices, or see something that isn't there.
Many professionals will say that psychosis can be one of many symptoms of bipolar l. The fact is, it is possible with any form of the disorder, as well as schizophrenia, and severe depression, (including postpartum depression). Brain diseases or conditions, medications, illegal substances like cocaine, meth, and crack, can also cause psychosis. Many of these causes can actually be a result of sleep deprivation. When one is up for days with only a few hours of sleep here and there, or none at all, psychosis can set in. There are medications to help with psychosis. If caused by sleep deprivation, finding ways to get enough and quality sleep will help a great deal. It can be a challenge.
I figured I must have this for a reason and I'm supposed to tell people about it."
— Patty Duke
The importance of quality and quantity of sleep
Quality sleep is of the utmost importance for most mental disorders. With bipolar it is probably one of the most important necessities for stability. I can say emphatically it is true for me. For years it was thought that the decreased need for sleep, or decreased sleep, is a symptom of mania. Not necessarily. Experts grappled with the question 'Is sleeplessness a symptom of mania, leading to depression, or is lack of sleep during depression causing mania?' They have discovered it can be both - either/or. It could be that someone is in a normal state but not sleeping well due to stress or some other non-related issue, and after a prolonged period, end up in a manic or depressed state. Inability to sleep and too much sleep can both be a symptom of depression.
People with bipolar can have a quality, meaningful life
People with bipolar and similar brain disorders can live meaningful lives. This is not something new. Many people with serious medical conditions manage them successfully by taking medication, other regular treatments, and practicing good self-care daily. Take diabetes, for example. It's a very serious disease. For most people, if they practice good self-care by monitoring their blood sugar, eating the right foods and avoiding the harmful foods, exercising, and taking their medication as prescribed, they still can live happy, fulfilled lives. Symptoms may arise still, some may have more challenges, more severity than others and have to work harder.
This is not to say people with bipolar will never have symptoms if they are enjoying a quality life. It means their treatment and self-care is working significantly enough to allow them more stability. When symptoms arise they see their providers to make adjustments and continue good self-care. Flare ups and setbacks come up, I've had them, but we can learn and develop resiliency, the ability to bounce back and recover more quickly. Setbacks can be overcome, or smoothed out. It may take time and require a lot of hard work between the person and their providers.
My experience finding a quality life
I think the best way to drive home to people with bipolar being able to acquire and enjoy a quality, meaningful life is to share what I've discovered and put into practice in the last two years. My purpose is not to imply I have arrived. But I have found more stability and meaningfulness in my life than I have ever experienced since my diagnosis almost two decades ago. It's actually very simple, but not always easy. In fact it's been hard work.
One of the first and biggest steps I've taken is to make attitude adjustments. I've discarded my pessimism and stopped interacting with pessimistic professionals and non-professionals. I have sought clinicians who are encouraging cheer leaders and are willing to listen and respect me when I voice a concern. I, in turn, have done the same toward them. I had to learn this the hard way. I also avoid people with judgemental attitudes, or don't talk about this part of my life.
I've also become willing to participate in my recovery. It's not my clinician's responsibility to make me well. They guide and direct, give me tools, but I'm the one that has to heed and use them. I discovered the hard way again by being unwilling, lazy, or passive. I got tired of suffering the consequences.
I've taken a holistic approach in my journey. Spiritually, physically, mentally (attitude, thinking), and emotionally (laughter, realizing feelings won't kill me and I'm not going to be a slave to them).
I have a daily maintenance plan I try to be faithful to. I listen to my body and mind to appreciate feeling well and recognizing when things are slipping south. I pay attention to stressors and triggers and have a plan for those times.
I also reach out to help others, to practice more kindness and compassion, to try to bless instead of drain my friends and acquaintances. Many times I've been given the privileged opportunity to share my experiences and knowledge with people who cross my path with people struggling with mental health issues.
I still have more to learn. We all do.
1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2Treatment Advocacy Center. Bipolar Fact Sheet (2011), from http://www.treatmentadvocacycenter.org/resources/briefing-papers-and-fact-sheets/159/463
3 National Institute of Mental Health (n.d.). Bipolar Disorder in Adults (NIMH publication No. 12-3679) Revised 2012. Retrieved July 25, 2014 from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml
4 Phelps, J. (2006). Why Am I Still Depressed?: recognizing and managing the ups and downs of bipolar ll and soft bipolar disorder. New York, NY: McGraw Hill Publishers.
6 Web M.D. Medical Reference. Reviewed by Joseph Goldberg MD (2014, May 11). Rapid Cycling in Bipolar Disorder http://www.webmd.com/bipolar-disorder/guide/rapid-cycling-bipolar-disorder
7 Duke, P. and Hochman, G.(1992). A Brilliant Madness: Living with manic depressive illness. New York, NY: Bantam Books.
8 Phelps, J. (2006). Why Am I Still Depressed?: Recognizing and managing the ups and downs of bipolar ll and soft bipolar disorder. New York, NY: McGraw Hill Publishers. p. 170-171
© 2014 Lori Colbo
Candypantsx on September 29, 2018:
Loved reading this it’s a far more personal account than most information read on the internet.
My mum was diagnosed with bipolar when I was a child and we have had some extremely hard times. She is stable at this point, but still there can be a lot of struggles and her attitude can be very poor and very draining and she can be hurtful. It’s often very hard to remember she is suffering and I find myself silently cussing her for not trying harder to control things. Reading things like this calms me down, there hasn’t been any support for the people who live or look after her and we where never educated about her illness, something I think every family living with someone bipolar should be.
Thank you for writing and you are an inspiration.
Lori Colbo (author) from United States on February 27, 2018:
Hi Kathy, nice to see you again. Thank you for your support on this topic. I hope to see you again.
Kathy Burton from Florida on February 27, 2018:
A thoughtful article again. It can't be overstated how involved you must be in your own treatment and how difficult it can be to get back on your feet sometimes. I'm glad you talked about the three types of bipolar on the continuum. Most people only know about Bipolar I.
Daphne D. Lewis from Saint Albans, West Virginia on January 17, 2015:
You're welcome! I was blessed to have her in my life, too!!
Lori Colbo (author) from United States on January 17, 2015:
Thanks for stopping by daphne. Your sister is blessed to have a compassionate sister like you.
Daphne D. Lewis from Saint Albans, West Virginia on January 17, 2015:
A great article on bipolar disorder. My younger sister was bipolar and could rapid cycle in a manner that was exhausting just to witness. This is such a struggle for so many.
Lori Colbo (author) from United States on December 05, 2014:
You are welcome Joel. That is the purpose of these kinds of hubs - to help people. God bless you on your journey.
Joel Diffendarfer from Jonesville on December 05, 2014:
Thanks, caught this article at the right time...helped make a differnce in my life today.
Lori Colbo (author) from United States on October 02, 2014:
Greetings Adventure, I am glad you learned something. So many people are afraid and baffled by it. I believe in educating and advocation for things that have stigma attached or for anything people don't know about, thus afraid or judgmental.
I don't know how close you are to your neighbor, but if you are close enough, try to find out as much as you can and if she's doing poorly, just be there to talk.
Giovanna from UK on October 02, 2014:
Thank you so much for writing this hub. My neighbor has Bipolar and this has helped me - it's difficult understand what is happening to her - it's a very complex thing. Thanks again.
Lori Colbo (author) from United States on August 06, 2014:
Jeannie, your friends are living proof that people with Bipolar can live quality lives. Thanks for stopping by.
Jeannie Marie from Baltimore, MD on August 06, 2014:
This is a really interesting read. I have several friends with bipolar disorder and each one is totally different from the other. The good news is, all are doing well now, have jobs, and one even has two children. Thank goodness for modern medicine!
Lori Colbo (author) from United States on August 05, 2014:
Thanks for sharing Nell. It can be a very big challenge trying to be supportive and knowing boundaries. You are a wonderful sister. It is for people like you I write to help educate. Often times if we know what we're dealing with, at least to some degree, we can find ways to move forward. I pray your brother finds some quality help.
Nell Rose from England on August 05, 2014:
Hi, this is really familiar to me as my brother is bipolar, the mood swings and how he can't go out on certain days does take a toll on both of us, I am trying to get him out and about but its so difficult, great job, nell
Lori Colbo (author) from United States on July 31, 2014:
Amen to that midget.
Purpose Embraced, Thanks you for your words of affirmation. If I clinician can find anything I write on mental illness than I am very happy. Advocacy and education are very important to me. Ad I am more stable than I have ever been I think peer work can be much easier. Thanks again.
Michelle Liew from Singapore on July 31, 2014:
Mood management, even for anyone without the disorder, is already tough!
Yvette Stupart PhD from Jamaica on July 30, 2014:
Thanks so much lambservant for writing an easy to understand hub on bipolar disorder. As clinical counselor I understand the difficulties people who have this disorder face, but your account helps me to see it on a different level.
I really believe that despite the difficulties, you will be an effective peer counselor.
Lori Colbo (author) from United States on July 29, 2014:
Denise, prayers going up for your daughters and your family. Schizo affective disorder is a more serious condition, as from what I've heard and read it involves two disorders. I hope you are doing well and getting the support you need as a mom. There is always a way to at least improve your quality of life. Daily self-care, learning to recognize your symptoms early one or what triggers them, and how to manage them is crucial. I hope your daughters are experiencing joy and happiness through their challenges. You are a special mom.
Denise W Anderson from Bismarck, North Dakota on July 29, 2014:
I have two children with Bipolar Disorder. One high functioning, as that is the only issue that she has. She is able to hold down a job, attend college, and have a meaningful social life. She is able to manage with one medication and good self-care. My other daughter is lower functioning intellectually, and has other issues as well. Her most recent diagnosis is Schizzo-affective disorder and she has had several delusional/psychotic episodes that landed her in the hospital. It has been interesting to see the difference between the two of them, and how each has to learn to function in their own way. It makes life very interesting!
Lori Colbo (author) from United States on July 29, 2014:
billybuck, I certainly plan to keep informing people. Thanks for your comments.
Nanderson500, thanks for stopping by.
Ms. Dora, as always, it's a pleasure to hear from you. Thanks for your comments.
Eric, thanks for stopping by. You are mostly right about constant modifications and moderations. Really it depends on the severity and other things. For someone with a mild case it may just be that they exercise, eat well, daily, and learn management skills for stress so that it doesn't propel them into an episode. But as you saw, it is hard work to live a quality life. This is true with many medical conditions. But it's worth all the effort.
William Kovacic from Pleasant Gap, PA on July 29, 2014:
Well, I think you covered just about everything - at least it seemed to. You did a very thorough and well documented job, and brought attention to this difficult problem. I know of some who suffer from bipolar, and at times he's almost like two different people. Thanks for helping me to understand the situation better.
Dianna Mendez on July 28, 2014:
The story behind Duke's quest helped to understand the depth this illness can take in ones life. I found new information on this disorder. Thanks for the education. Well written!
Eric Dierker from Spring Valley, CA. U.S.A. on July 28, 2014:
Very well done article. One thing about the disease is you will never just be able to put it on autopilot again. It takes constant modifications and moderations to keep up with the changes. Vigilance is required.
Suzanne Day from Melbourne, Victoria, Australia on July 28, 2014:
I used to think I was bipolar. I was told by others and professionals I was. I also took medication for it. Today, I am not on any of that horrible medication and have decided to call it "moodiness due to life experience and trauma" and just live with it. To be honest, the more I decided to get on with life, the easier it got with the mood swings, especially when I sought out some role models on how to live life well. I am sure a lot of other people suffer the same thing as me.
The medication can be awful. Yes, you do have less anxiety and more stable moods. But you can get ready to send your doctor an enormous bill for all the car accidents you have due to "relaxing" your moods with pills. Not to mention the relaxed promiscuity and new and relaxed ways of putting your life and health in danger every week. It isn't worth it.
These drugs are designed to fry your brain and bipolar people are the perfect guinea pigs. Apparently you get addicted after 2 years. Something like 80% of people who take them die from suicide before their 10 years is up. I have personally known a number of people who have died from them. If you are on them, find another way, I beg you!
Dora Weithers from The Caribbean on July 28, 2014:
Great information that is new to me. Thank you for these insights and especially for Patty Duke's account. It's good to know that there are effective treatments.
nanderson500 from Seattle, WA on July 27, 2014:
Lots of great information here, and definitely a hopeful message about people with bipolar disorder still being able to live satisfying lives.
Bill Holland from Olympia, WA on July 27, 2014:
Important information for sure my friend. Keep raising awareness and continue to help others by doing so.
Rachael O'Halloran from United States on July 27, 2014:
I agree that medication is key, as well as regulating it for each person. But I also believe attitude, education and a good support system are needed. You did a fine job with this hub with up to date information and good examples. Voted up and shared.
Faith Reaper from southern USA on July 27, 2014:
Thank you for this comprehensive hub on Bipolar disorder. I learned a lot here and I believe it is possible for someone who has such to live a happy and meaningful life, by taking take of oneself as you have indicated here.
God bless you