Oluwafikayo Ojo

Intro to Psychology
Dr. Christine Hoskins
August 3, 2014.
Bipolar Disorders
There has been much speculation as to whether peoples behavior could be explained by
a diagnosis of bipolar. Approximately one to three percent of the worlds population has been
diagnosed with a bipolar disorder. (Merikangas, ?) Americans have a higher occurrence of over
four percent. (Merikangas, ?) Bipolar disorders do not discriminate between genders and is being
more frequently diagnosed in children. This paper will explain what bipolar disorders are and
how they affect the individuals ability to function. Bipolar Disorder, also known as manic -
depression, causes shifts in a persons mood, energy, perception, and ability to function in a
consistent day-to-day life. If untreated, it can cause a person to lose friends, jobs, money, and, in
the worst cases, their life. Fortunately, there are treatment options and ways a person with a
bipolar disorder can manage their life with minimum episodes to maintain a good quality of life.
There are four diagnostic bipolar disorders all differing in types, severity, and frequency of
episodes. The four types of bipolar disorders are Bipolar I Disorder, Bipolar II Disorder,
Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified. The disorders involve a
history of Manic Episodes, Mix Episodes, or Hypomanic Episodes usually accompanied by a
history of Major Depressive Episodes. (DSM-V, 2013) These episodes have certain criteria for
diagnostic purposes that are defined in the DSM-V.
The primary indicator of a Major Depressive Disorder is a period of two weeks in which the
individual experiences either a depressed mood or a lack of interest in activities. The depressed
mood may be described by the individual as sad, hopeless, discouraged, or as an increased
irritability. Children and adolescents particularly exhibit a more irritable mood. The individual
may notice a lack of interest in hobbies or other such activities that they once enjoyed. The
individuals friends, family, or co-workers may notice that they are less sociable, are making
excuses for not participating, or no longer enjoy outdoor activities. In addition to either of these
two criteria, the individual must experience at least four more accompanying symptoms from a
list of nine. The remaining symptoms for a Major Depressive Episode include changes in
appetite; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation,
fatigue or loss of energy nearly every day; feelings of worthlessness or guilt; difficulty thinking,
concentrating, or making decisions; recurrent thoughts of death or suicide. The changes in
appetite are typically represented by a loss of appetite resulting in weight loss. In an adult this is
marked by a five percent change of weight in a one month period. In children, it is observed as
not making expected weight gains. Psychomotor agitation is defined as excessive motor activity
associated with a feeling of inner tension. The activity is usually non-productive and repetitious
such as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still.
(DSM-IV, 2000) Psychomotor retardation is a visible generalized slowing of movements and
speech. (DSM-IV, 2000) These physical actions must be severe enough to be observable by
others to meet this criteria. The recurrent thoughts of death or suicide associated with Major
Depressive Disorder include the individuals belief that others would be better off if the
individual were dead, thoughts of committing suicide, or an actual plan of how to commit
suicide.
The term bipolar was introduced in the 1950s (Goodwin, Jamison, 2007), however
clinical observations of opposing mood occurrences in an individual have been noted and
documented since the first century. Bipolar I Disorder, Bipolar II Disorder, Cyclothymic
Disorder, and Bipolar Disorder Not Otherwise Specified all differ in the dominating mood
episode and severity. Individuals with a bipolar disorder typically experience a shift in the
polarity of the episodes, especially as the illness progresses. A shift in polarity is defined as a
clinical course in which a Major Depressive Episode evolves into a Manic Episode or Mixed
Episode or vice versa. (DSM-IV, 2000, p.382) Hypomanic Episodes are on the same pole as
Manic Episodes and Mixed Episodes.

Bipolar I Disorder is characterized by the occurrence of one or more Manic Episodes or Mixed
Episodes. Most often an individual will also have the occurrence of one or more Major
Depressive Episodes. Bipolar I Disorder is sub-classified according to the recurrence of episodes
or if the episode is the first that the individual has experienced. The recurrence is indicated by
either a shift in polarity or an interval of at least two months between episodes in which manic
symptoms is not present.
Recurrent Bipolar I Disorder can be specified according to the current, or most recent, episode
experienced. The specifier with Seasonal Pattern only applies to Major Depressive Episodes
that follow a pattern occurring during the same time period over at least a two year observation,
and without episodes occurring during the non-seasonal time period. Seasonal patterns are more
commonly noticed in Bipolar II Disorder individuals
Specifiers are used to indicate the current or most recent clinical status of Bipolar II Disorder.
The first specifier being either depressed or hypomanic. The remaining specifiers are similar to
Bipolar I Disorder including the pattern of Rapid Cycling. (DSM-IV, 2000, p.392-393)

Cyclothymic Disorder is characterized by a chronic, fluctuating mood disturbance involving
periods of hypomanic symptoms and periods with depressive symptoms. The individual must
have presented these symptoms for at least two years with no longer than a two month period
between mood disturbances. Children and adolescents need only to present these symptoms for
one year to meet the criteria. The individual must not have experienced a Manic Episode, Mixed
Episode, or a Major Depressive Episode during the initial two years. Cyclothymic Disorder
usually begins in adolescence or early adulthood.

The hypomanic symptoms for an individual with Cyclothymic Disorder are not of the severity or
duration to meet the criteria for a Hypomanic Episode. This is also true for the depressive
symptoms not meeting the criteria for a Major Depressive Episode. However, after the initial two
year period of Cyclothymic Disorder, if the individual experiences a Manic Episode the
diagnosis changes to Cyclothymic and Bipolar I Disorder. If the individual experiences a Major
Depressive Episode, the diagnosis, subsequently, changes to Cyclothymic Disorder and Bipolar
II Disorder. There is a fifteen to fifty percent chance that the individual will develop either
Bipolar I Disorder or Bipolar II Disorder. (DSM-IV, 2000, p.399)
The exact cause of bipolar disorders is still undetermined, however, genetics seem to play
a role in bipolar disorders. There is an elevated chance that an individual will be bipolar if they
have a parent with bipolar. Bipolar I Disorder has the highest chance of inheritance at four to
twenty-four percent in comparison to the general public, and Bipolar II Disorder at a one to five
percent chance of inheritance in comparison to the general public. (DSM-IV, 2000, p.386).
Scientists are working to locate the genes that may be associated with various symptoms of
bipolar disorders. Bipolar disorder cannot be prevented but it can be controlled and managed
through various methods. Mood stabilizers along with psychotherapy are the recommended
course of treatment for individuals living with a bipolar disorder. Lithium acts as a mood
stabilizer by controlling biochemical in the brain. There are other mood stabilizing drugs
prescribed if an individual does not respond to lithium. In many cases it may take a combination
of drugs to manage symptoms. Psychotherapy is the suggested clinical therapy for those with a
bipolar disorder. Psychotherapy can aid the individual in recognizing the triggers for the onset of
an episode and can help reduce the severity of an episode. (nimh.nih.gov, 2010) Cognitive
behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy are,
specifically, beneficial therapies. Children, especially, experience the onset of episodes as a
result of social anxieties. Interpersonal and social rhythm therapy teaches the individual tools on
how to improve their relationships to reduce those anxieties. (nimh.nih.gov, 2010).
Environmental factors contribute to the triggering of an episode. Periods of high stress or sleep
deprivation due to excessive travel or work demands can trigger episodes. These are factors that
individual can anticipate and manage. Most individuals become extremely aware of the factors
that act as their triggers and learn to control the onset with time management or simply being
aware of their limitations. Some individuals may find it necessary to restrict caffeine or
carbohydrates in their diet to avoid the highs and lows. (mental-health-today.com/bp)

The average age of bipolar disorder presenting is twenty years old. (DSM-IV, 2000,
p.386, 394) There are tests that can be given to present the individual with a self-reporting
checklist of general mood changes, changes in cognitive ability, or behavioral changes. These
tests do not meet the criteria for a diagnosis. A psychiatrist reviews the test and determines the
best course of action to determine a diagnosis. Without meeting with a clinician and determining
a course of treatment, the individuals bipolar disorder will progressively worsen. Bipolar
Disorders with a Rapid Cycling pattern have a poorer prognosis. (DSM-IV, 2000, p.386) An
individual experiencing so many episodes in a years time would have difficulty maintaining
employment, friendships, or school requirements. The same is true for individuals that do not
seek treatment or exhibit signs of substance abuse. (mental-health-today.com/bp). Bipolar can be
extremely disruptive in an individuals life. The symptoms can cause an individual to have failed
marriages, accrue great financial debt, and suffer occupational losses due to inconsistent
performance. However, after the initial diagnosis and beginning a treatment plan an individual
with bipolar disorder can live a normal life with minimal symptomatic disruptions.
Psychotherapy, self-managing triggers, and drug treatments are the key to living a normal life.









References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,

Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Goodwin, F., & Jamison, K.R. (2007). Manic-Depressive Illness: Bipolar Disorders and

Recurrrent Depression, 2nd Edition. New York: Oxford University Press

U.S. Department of Health and Human Services, (2010). National Institute of Mental Health:

Transforming the Understanding and Treatment of Mental Illness Through Research. Bipolar

Disorder. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder/

complete-index.shtml

Patty E. Fleener M.S.W. Mental Health Today. Bipolar Disorder. Retrieved from http://

www.mental-health-today.com/bp/art.htm