What Is Bipolar Disorder? Meaning, Types and Episodes

Bipolar disorder is a global mental health condition that is characterised by recurring episodes of elevated mood (hypomania or mania) and depression. Bipolar episodes affect someone’s mood, energy and thought patterns. Worldwide, it affects 1 in 200 people, which means approximately 37 million people live with bipolar disorder. It is regarded as a chronic health condition that persists throughout a person’s lifetime. However, a bipolar mood disorder can successfully be managed with professional treatment, lifestyle changes and support.

There are a range of care options that help people with bipolar stay well.

World Health Organisation

Bipolar Meaning and Definition

The bipolar meaning refers to the presence of two opposite mood states. These are periods of unusually elevated mood (mania or hypomania) and periods of depression. Bipolar episodes are more intense and longer-lasting than a person’s usual everyday mood fluctuations. The result is that having a bipolar mood disorder causes significant shifts in mood, energy and activity levels, which can impact everyday functionality.

Bipolar disorder is defined by episodes of mania or hypomania and episodes of depression that represent a marked change from a person’s usual mood and behaviour.

American Psychiatric Association

Unlike normal moodiness or stress reactions, bipolar mood changes occur in clear episodes that can last days, weeks or longer. These episodes can affect every area of someone’s life, from their ability to work and maintain relationships to being able to manage daily responsibilities. Accordingly, the World Health Organisation (WHO) notes that bipolar mood disorder is a leading cause of disability worldwide. 

What is a Bipolar Episode?

Bipolar episodes are characterised by someone having a significant shift in mood and behaviour compared to the person’s normal state. Episodes of bipolar disorder involve noticeable changes in energy, thinking patterns and daily functioning. They are also defined by their duration and impact on someone’s ability to function successfully. 

There are three main types of bipolar episodes:

1. Manic Episodes
2. Hypomanic Episode
3. Depressive Episode

1. Manic Episodes

Manic episodes are extreme “up” moods; they last for at least a week. During this time, someone is usually highly energised with increased activity levels. During a manic episode, some people also experience dissociation and the inability to rationally evaluate a situation. For example, someone might feel like they are a character in a video game and thereby disconnected or dissociated from the reality of their actions. The result is that manic episodes can sometimes be more life-endangering than depressive episodes.  

5 Potential Signs of a Manic Episode

1. Increased energy and activity levels. 
2. Uncharacteristically agitated, aggressive or irritable; feeling jumpy or “live-wired”. 
3. Needing less sleep while feeling more energetic. 
4. Unusually impulsive or increased risky behaviour. 
5. Exaggerated self-confidence and wellbeing result in feelings of euphoria or superiority. 

The intensity of mania can feel exhilatating at first, but it often carries series consquences when judgment becomes impaired.

Dr K Redfield Jamison, An Unquiet Mind

2. Hypomanic episode

Hypomanic episodes are less intense manic periods. Accordingly, symptoms of a hypomania are milder and tend to last around four days in a row instead of a week. Generally, hypomanic symptoms do not interfere significantly with daily functioning. Instead, during a hypomanic episode, someone might become more productive than usual. For example, in some cases, people experience increased creativity or improved work output. However, at times, hypomania can also negatively impact someone’s life through an increase in erratic behaviour. 

Key Characteristics of Hypomania

• Elevated mood or increased energy. 
• Increased productivity or creativity.
• Reduced need for sleep.
• Symptoms last around four days. 
• Usually less disruptive than full mania. 

3. Depressive Episode

A major depressive episode is diagnosed when someone experiences continuous symptoms for a duration of at least two weeks. When someone is clinically depressed, they usually feel very down, indifferent or hopeless. The impact of these depressive periods is a decrease in motivation, energy levels and the ability to find enjoyment in everyday life.

5 Common Signs of Depressive Episodes

• Intense feelings of sadness, despair, guilt or worthlessness. 
• Low energy or fatigue. 
• Changes in appetite and cravings, which may cause weight fluctuations. 
• Loss of interest in previously enjoyable activities such as socialising, hobbies or exercise. 
• Aches or pains that seem to have no obvious physical cause. 

Types of Bipolar Disorder

Bipolar disorder used to be called manic-depressive illness or manic depression. There are three recognised bipolar disorders, each involving changes in mood, energy and activity levels. The differences between the types of bipolar disorders mainly relate to the severity of manic symptoms and the pattern of depressive episodes. 

The 3 Types of Bipolar Disorders

1. Bipolar I

• A person experiences at least one major manic episode. 
• Many people also experience depressive or hypomanic episodes. 
• Periods of neutral mood often occur between episodes. 

2. Bipolar II

• Requires at least one major depressive episode. 
• One or more hypomanic episodes. 
• Hypomanic episodes can feel productive or enjoyable, which can delay an accurate diagnosis as the person is often unaware of them.

3. Cyclothymic Disorder

• Characterised by frequent mood swings between hypomanic and depressive symptoms. 
• Symptoms are less severe than bipolar I or bipolar II. 
• Mood instability continues for two years without stopping for more than 2 months at a time. 

Despite presenting with clinically significant abnormal mood elevations, a person still might not meet the diagnostic criteria for one of the three types of bipolar disorders. In these cases, they might be diagnosed with other or unspecified bipolar disorder. 

Signs and Symptoms of Bipolar Disorder

What warning signs and symptoms manifest during a bipolar period can vary from person-to-person as well as from episode-to-episode. However, there are still universal bipolar disorder signs and symptoms which can assist in diagnosis and successful bipolar management.

Bipolar Symptoms

Bipolar disorder symptoms typically affect mood, thinking patterns, behaviour and energy levels. They vary depending on whether someone is experiencing mania, hypomania or depression.  

Common Bipolar Signs

• Dramatic mood changes. 
• Unusual energy fluctuations. 
• Changes in appetite or sleep. 
• Impulsive and/or risky behaviour. 
• Difficulty concentrating. 

Common Bipolar Disorder Symptoms

• Periods of intense productivity followed by exhaustion. 
• Hypersexuality during manic or hypomanic episodes. 
• Difficulty managing daily responsibilities. 
• Loss of interest during depressive periods. 
• Hostility and/or increased irritability. 
• Self-harm and/or suicidal thoughts. 

“Moods are by nature compelling, contagious, and profoundly interpersonal, and alter the perceptions and behaviours not only of those who have them but also of those who are related or closely associated.”

Dr K Redford Jamison, Psychiatry Professort, John Hopkins University School of Medicine

What Causes Bipolar Disorder?

The exact causes of bipolar disorders are unknown. Experts believe that it’s linked to a complex combination relating to physical, environmental and social factors. They also note that stressful life-events can trigger bipolar disorder in people who are vulnerable to having a mood disorder. 

A key underlying factor involves chemical imbalances in the brain. Brain chemicals called neurotransmitters, such as serotonin, dopamine and noradrenaline, influence how the brain regulates mood and behaviour.  

Possible contributing factors:

• Genetic factors – bipolar disorder often runs in families. 
• Brain chemistry differences involving neurotransmitters. 
• Stressful life events or major life changes. 
• Physical illnesses or health conditions. 
• Substance use, including drugs or alcohol. 
• Certain medications that affect brain chemistry. 

How is Bipolar Disorder Diagnosed?

Psychiatric illnesses like bipolar disorders are primarily diagnosed through a professional mental health assessment, usually conducted by a psychiatrist. During an assessment, the professional will review a person’s medical history, behavioural patterns and current symptoms.  

A primary goal when diagnosing bipolar disorders is to understand how mood changes occur and what may trigger them. In addition to assessments, medical tests may sometimes be conducted. This is to rule out certain medical conditions, such as thyroid disorders or Cushing’s disease, which can cause symptoms that resemble bipolar disorder. 

The Bipolar assessment process may include:

• Discussion of current symptoms and mood changes. 
• Dialogue around how mood changes affect everyday life and life experiences. 
• Review of personal, physical and mental health history. 
• Questions about family mental history. 
• Exploration of recent life events or stressors. 
• Possible medical tests to rule out other conditions. 

Bipolar disorder can be difficult to diagnose because it is cyclical. Manic episodes may be mild or infrequent, which can result in bipolar disorder sometimes being mistaken for depression. Additionally, another challenge with correctly diagnosing bipolar disorder is that bipolar symptoms fluctuate between different mood states. The result is that they can sometimes be misinterpreted or misdiagnosed, particularly when depressive episodes appear first. The average time to correctly diagnose someone who has bipolar disorder is 10 years. 

Can Bipolar Disorder be Managed?

While there is no known way to prevent bipolar disorder from manifesting, there are very successful bipolar treatment strategies. These can assist in reducing the likelihood and severity of manic, hypomanic and depressive episodes. Healthy lifestyle habits, such as consistently sleeping enough, avoiding stimulants and practising mindfulness, have all been shown to help manage bipolar disorders.

Important points about long-term bipolar management:

• Bipolar symptoms can come and go in cycles. 
• Treatment helps reduce the severity and frequency of episodes. 
• Many people live stable and productive lives with the right support. 
• Ongoing care improves relapse prevention. 

Is Bipolar Disorder Lifelong?

Bipolar disorder is generally considered a lifelong mental health condition. However, this does not mean that someone receiving proper treatment and long-term support cannot live a productive, balanced and fulfilling life. The goal of ongoing treatment for a bipolar condition is to prevent relapses, build resilience and improve overall quality of life.

Treatment and Support

For most people with bipolar disorder, treatment involves a combination of medication, psychotherapy and lifestyle support. Because bipolar disorder affects people differently, bipolar treatment plans are often tailored to the individual. 

Common approaches to bipolar support:

• Psychiatric treatment and medication management. 
• Talk therapy, such as Cognitive Behavioural Therapy (CBT). 
• Lifestyle strategies to manage anxiety, stress and sleep patterns. 
• Long-term support from mental health professionals. 
• Learning to identify bipolar triggers, mood and emotional fluctuations early. 

If you have a family history of bipolar disorders, then it’s important to be aware of early warning signs. Having people who you trust aware that you have bipolar disorder can be very helpful, as they are often more quickly aware of the warning signs of a relapse. As support is an important part of managing bipolar disorder, many people, especially those without family and friends to assist, join a bipolar support group. It’s also imperative to always seek medical intervention as soon as possible if the onset of a bipolar relapse is suspected. 

How to Help Someone with Bipolar Disorder

The human mind is a fascinating study, and assisting someone with a mental health issue, such as bipolar disorder, can be a fulfilling vocation. If you’re interested in understanding mood disorders and supporting people in practice, explore SACAP’s Applied Psychology study options. SACAP offers a range of degrees which can pave the way to a psychology or psychiatry specialisation. SACAP Global offers short courses which can assist both professionals and those interested in better supporting people with a diagnosis of bipolar disorder or other life challenges. Contact a SACAP Admissions Officer today to discuss your options.