Bipolar disorders, or manic-depressive illness, is a group of disorders characterized by the presence of pronounced high-energy phases known as manic episodes. Typically, unusual shifts in mood and energy manifest in increased activity levels and impair ability to function. The impairment created by bipolar disorder can be severe and can result in damaged relationships, poor job or school performance, and even suicide.
There are several different types of bipolar disorder. Bipolar I disorder refers to a condition in which an individual experiences a full-blown manic episode for at least one week and may or may not also experience depression. The manic symptoms may be so severe that hospitalization is required. Bipolar II refers to the presence of a current or past hypomanic episode, which is a slightly less severe form of mania lasting at least four consecutive days, as well as the presence of a current or past episode of major depression. Cyclothymic disorder, or cyclothymia, refers to recurring hypomanic and depressive mood shifts over at least a two-year period in adults.
According to the National Institute of Mental Health, an estimated 4.4 percent of adults in the United States experience a bipolar disorder at some point in their lifetime. The condition occurs with equal frequency among males and females. The median age of onset is 25 years. Nevertheless, a bipolar disorder may begin in childhood or may have its onset late in life. Bipolar disorders are typically chronic conditions and require lifelong management. More than 90 percent of people who have a single manic episode go on to have recurrent episodes of mania or depression.
People experiencing a manic episode are often described as excessively cheerful or "feeling on top of the world." Often, however, the dominant mood during a manic episode is irritability. Additionally, persons experiencing mania may display suddenly inflated self-esteem, decreased need for sleep, talkativeness and distractibility, and often engage in activities that have high potential for painful consequences (gambling, heavy spending, sexual indiscretions). Hypomania is similar to mania in that the disturbance in mood and the change in functioning are observable by others, but the episode is not severe enough to cause major impairment in social or occupational functioning or to require hospitalization.
During a manic episode, an person may start multiple new projects and feel that they are capable of accomplishing anything, regardless of their level of experience or talent. One of the most common features of mania is a decreased need for sleep; a person might go days without sleep, yet not feel tired. Often, a manic person's thoughts race faster than they can be expressed; the result may be abrupt shifts in topic and pressured and incoherent speech. Sometimes during a manic episode people display hostility and angry tirades, particularly if an attempt is made to interrupt them.
Children who are at risk for bipolar disorder (because a parent has the disorder) display a developmental sequence beginning with symptoms that are not specific to bipolar disorder, notably sleep problems and anxiety. The condition progresses from minor mood disorder to major depressive disorder in adolescence, with full-blown bipolar disorder developing in the transition to adulthood, typically with an episode of mania or hypomania or a first episode of psychosis following an episode of depression.
It is characteristic of the condition that those who are experiencing mania do not perceive that they are ill or in need of treatment and resist engaging with treatment. Diagnosis and treatment are incredibly important; the lifetime risk of suicide among individuals with bipolar disorder is at least 15 times that of the general population. Bipolar disorder is often not recognized, or may be confused with other conditions, and people may suffer for years before they receive appropriate treatment.