Have you heard this one before? I found this online when I searched the term “Bipolar” – “Bipolar people are easy. If you don’t like their current mood, just wait a few minutes and it will change.”

Here’s the problem – everything about this “joke” is wrong.

First off, it’s mean. Research on “Expressed Emotion” has actually demonstrated that with Bipolar Disorder, being mean towards someone versus being warm and nonjudgmental actually can alter the lifelong course of illness for that person. By a lot. To learn more, click here.

Secondly, there are no “Bipolar people.” People dealing with Bipolar Disorder are not a unique subset of individuals with a certain type of temperament, appearance, moodiness, level of creativity, impulsivity, spontaneity, or extroversion. It’s not a type of person or a type of personality. Bipolar Disorder is a condition where regular people experience seasons of Depression and seasons of Mania – two opposite ends of the spectrum of brain functioning. Two poles = bi-polar. When not suffering from these mood episodes, people are people and are capable of being as “normal” as normal can be. They don’t have a residual Bipolar-ness that permeates their baseline existence. Sadly, someone in my practice shared that their previous Psychiatrist had told him that every time he was experiencing any intense emotion, that it was “his Bipolar.” Not only was this wrong, it was really harmful because he didn’t feel that he could ever have any unpleasant emotions even when anger, sadness, or worry were the appropriate feelings for him to have, and it made him feel “sick” all the time because he would inevitably have these types of normal feelings.

So more accurately, Bipolar Disorder is defined by the presence mood episodes, at least one Mania/Hypomania and one Depression, over a lifetime. The experiences of Depressive episodes are the same as described in the previous post on Depression. Whereas the observable symptoms of Depression are a reflection of globally diminished brain functioning (cognitive, physical, emotional), symptoms of Mania are a reflection of an abnormally persistent amplification of these functions:

Cognitive – increased speed of thoughts, increased volume of thoughts and ideas, heightened sensory awareness and perception

Physical – decreased need for sleep, increased energy, increased drive and motivation

Emotional – elevated mood, greater intensity of positive emotion, escalated feelings of empowerment and competency

Just like with a Depressive episode, these symptoms occur simultaneously over a prolonged period of time, usually weeks to months – not minute to minute or from one day to the next. Some symptoms are a direct result of persistent amplified brain function, such as increased energy, drive, and the rapid speed of thoughts. Other symptoms reflect the consequences of these abnormally elevated functions, such as how increased thoughts and energy leads to fast and uninterruptible talking (pressured speech is the clinical term), or how increased drive coupled with a high volume of thoughts and ideas lead to periods of high but oftentimes disorganized productivity (increased goal directed activity). However, despite some of these changes sounding somewhat appealing on paper, in reality these symptoms are uncoordinated, dysregulated, and disorganized, and are more likely to create overestimation of abilities, poorly thought out ideas, high levels of impulsivity with poor judgment, and severely diminished insight. The level of harm caused by this troubling combination of changes varies, but very frequently during Manic episodes people suffer financial, relational, occupational, and sometimes legal consequences. And this is just relating to Manic episodes. Depressive episodes also occur, and in fact typically more so than Mania over the course of a lifetime. The consequences of Depression are different, but also disabling. Bipolar Disorder is also the condition most associated with suicide attempts, with studies showing 25 to 50% making at least one attempt in their lifetime.

If a person experiences just a few of the above symptoms over a period of time, these episodes are described as Hypomania, “hypo” being a Greek prefix meaning “under” – so Hypomania is under the level of a full Mania, but above the level of a person’s normal baseline. These episodes can be of shorter duration and of lesser intensity. If a person has only experienced Hypomanic episodes in their lifetime along with a propensity towards Depression, then this is categorized as Bipolar Type 2. If a person has experienced only Manic episodes or a combination of Hypomanic and Manic, then this would be described as Bipolar Type 1. Also, if Manic symptoms escalate further, they can also include symptoms of hallucinations and delusional thinking, and if these are ever present, then the diagnosis would also be categorized as Type 1. How common is Bipolar Disorder? Roughly 2.5% of the U.S. population, experienced equally between men and women. This includes both Type 1 and Type 2.

Thirdly, moodiness is not Bipolar. The commonly held belief in popular culture is that “Bipolar” is a state of constantly shifting moods, like someone who is happy one moment, then irritated the next. Not true. As described above, Bipolar Disorder is characterized by seasons of altered physical/cognitive/mood states, lasting weeks to months, not within minutes or hours. In other words, it’s not someone’s who’s “moody.” The clinical description for “moody” is termed “mood lability” and is a feature of many possible states, some of which have nothing to do with mental illness. For example, a person could have an observable mood lability if they are temporarily impaired, such as with sleep deprivation, low blood sugar, or intoxication. In these circumstances, the brain’s regulatory abilities to balance mood states and intensities is diminished and the result is an unstable mood. We’ve all been there before because these temporary impairments are common life experiences. This can also be observed as a normal reaction to changing and unstable circumstances, and in these cases the “moodiness” is just a barometer of the shifting environment. In other words, mood lability is the the effect, not the cause. This is the best explanation for all the times when someone believes that their partner/girlfriend/boyfriend/spouse is “Bipolar.” It’s probably a reflection of some inconsistencies in the relational interactions, instability in the context of life where the relationship exists, or it may be the accusing partner who is the inconsistent one. We’ve all been there before too, right? So moodiness = mood lability ≠ Bipolar Disorder.

Lastly, Bipolar is not easy, it’s hard. As I mentioned above, both Manic and Depressive episodes have their consequences. Even though Manic periods may make a person feel good, a Depression usually follows. This makes sense as a prolonged period of abnormally heightened brain activity (again weeks and months is the norm) is unsustainable, and inevitably the brain wears down, which is what Depression is – the results of a tired brain. This is also true for prolonged Hypomanic episodes as well, that a full Depression tends to follow. A full Depression because there is no such thing as Hypodepressive episode. Depression is unfortunately always fully depressing. Also, the poor judgment and impulsivity during Manic periods oftentimes leads to embarrassing, risky, dangerous, and costly behavior. People can spend all their money, have affairs, estrange their friends and family, get into fights, end up in jail, or all of the above. Many people spend time in a hospital for their own safety or the safety of others around them. Even if a person’s symptoms resolve – either spontaneously or with active treatment, they must spend time and energy piecing back together their lives, and depending on their help and resources or lack thereof, sometimes life stays permanently downgraded. Their lifelong course may still be one of disability even after resolution of symptoms for reasons that are not quite clear. Part of this is likely related to persistence of milder symptoms in between more serious mood episodes, sustained cognitive impairment, and the negativity of their relationships. And most seriously, as mentioned previously, suicidality is very common in people suffering from Bipolar Disorder. Not. Easy. At. All.

The positive news is that even though having Bipolar Disorder is hard, with effort and support it is: 1) a condition that is treatable during all phases – Mania, Depression, and during periods of mood stability, and 2) it is possible to minimize the frequency and intensity of mood episodes over a lifetime so that a person spends most of their life symptom free and is therefore able to live a healthy, productive, and meaningful life.

The best strategy to achieve this kind of positive life course is to integrate these three things:

1) a reliable medication maintenance regimen

2) a warm, supportive, and informed social network

3) a personal attitude that identifies more with one’s own individuality and humanness rather than the diagnosis

This entry started with someone’s misinformed attempt at being funny, but Bipolar Disorder is very serious and definitely not a joke. It’s not someone’s moodiness, but rather it’s a someone who needs acceptance, warmth, and empathy because positive relationships actually make the difference between a hard life of disability and suffering versus a good life full of opportunity, personal growth, and wellbeing. Be warm. Be compassionate. Be informed. See the person, not the diagnosis.

Written by Joseph Lee, M.D.

I'm a Psychiatrist in private practice in Redondo Beach, CA. I completed both medical school and residency training at UCLA. My practice is psychotherapy based with a health-oriented focus on personal growth and wellbeing. I also teach about mental healthiness and advocate for social emotional learning (SEL) in all contexts.

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