What is Bipolar Disorder?

March 13, 2023

Kristi Wragg, MD, MSW, Director of Outpatient Services

Bipolar disorder is more than mood swings: understanding accurate diagnostic terminology

Bipolar Disorder Stigma 

Mental health diagnostic terminology is often used in everyday conversation, and commonly, the general public unknowingly misuses them. Unfortunately, misuse can further perpetuate the stigma of mental illness. I bet you can easily recall an instance when you heard someone say, “It’s like you’re bipolar”, when referring to someone’s mood swings or temper. Incorrect use of diagnostic terms can minimize the significance of someone’s experience with mental illness, increase shame and prevent people from seeking treatment . Therefore, it is important to understand the true meaning of bipolar disorder and how it manifests itself.

How Common is Bipolar Disorder?

According to the National Institute of Mental Health, in 2022 about 7 million adults in the US alone were diagnosed with bipolar disorder. There are many others living with bipolar disorder without a formal diagnosis, and also, a large number of people with bipolar disorder who have been misdiagnosed. While the label itself is far less important than its impact on someone, understanding the true meaning of bipolar disorder is significant in how we effectively manage the symptoms, optimize well-being, and reduce stigma.

Types of Bipolar Disorder

There has been a dispute in the psychiatric community for years regarding the types of bipolar disorder, and this is likely a reflection of how bipolar disorder uniquely manifests itself. This article will focus primarily on the most common type, bipolar I disorder.

What is Bipolar 1 Disorder?

By definition, bipolar I disorder is characterized by manic episodes, which are sometimes alternate or present in conjunction with depressive episodes. Providing an accurate diagnostic assessment requires a skillful clinician to differentiate true mania from “mood swings” or a “hot temper”.

Symptoms of Mania in Bipolar 

While we all experience mood fluctuations, bipolar disorder involves much more extreme highs and lows. Bipolar disorder typically involves a collection of symptoms that are seemingly out of context and significantly impact energy, activity, and sleep. Disturbances in mood that we define as mania can include, but are not limited to:

• Feeling abnormally upbeat, jumpy, wired, or edgy;

• Over-activity, increased energy, or agitation;

• Exaggerated sense of well-being, self-confidence, or euphoria;

• Decreased need for sleep;

• Racing thoughts, distractibility, and/or unusual talkativeness;

• Poor decision making, spending sprees, sexual risks, recklessness, or impulsivity;

• Detachment from reality, hallucinations, delusions, or paranoia with psychotic features;

• Impairment in ability to function at work/ school, in social settings, or caring for oneself.

To accurately diagnose, other conditions commonly confused with bipolar disorder must be ruled out. These can include substance use disorders, personality disorders, delirium, hormonal changes and thyroid conditions.

Effects of Manic Episodes on the Brain 

Mania usually lasts at least a week or more, but can be less with rapid cycling. The symptoms may seem exciting or appealing to a person, but are more likely to be extremely unpleasant, debilitating, and may even require hospitalization. The brain sustains a tremendous amount of stress from these episodes, and the recovery can be lengthy.

Depression in Bipolar Disorder 

The other extreme of bipolar disorder is depression, which often follows a manic episode and can be deeply difficult. The shift from mania to depression is considered a high-risk period for suicide, and the duration of depression is generally more prolonged than the manic episode. However, depression and mania can co-exist, which is referred to as a mixed episode.

While a depressive episode typically follows a manic episode, it is important to note that the first type of episode to ever present itself in someone’s lifetime is usually a depressive episode, even years before they exhibit any symptoms of mania. Someone may initially be diagnosed with a depressive disorder, only to experience symptoms of mania down the road, prompting an update to their diagnosis from depression to bipolar disorder. This does not mean that the clinician “misdiagnosed” the condition, but rather that the condition has continued to unfold over time, which highlights the importance of ongoing care and routine check-ins.

Euthymia

While bipolar I disorder is complex and can present in different ways, it can certainly be well managed. The third type of mood that can exist in bipolar disorder is “euthymia”. This is when people with bipolar disorder are not experiencing any symptoms of depression or mania. It can be safely achieved with proper education and the combination of medication, therapy, social support, stress management, and healthy lifestyle modifications to address nutrition, physical activity, and sleep. While it is common for people who have achieved euthymia to start to question whether they still need medication, continuing an effective treatment regimen is critical in maintaining recovery, and can lead to stability for years, if not indefinitely.

Dr. Kristi Wragg is a board-certified adult psychiatrist, originally from Michigan. After working as a clinical social worker in the psychiatric emergency department at Rutger’s University, Dr. Wragg decided to pursue medicine at Central Michigan University. During her residency training, she served as the Chief Resident for the Sandra & Leon Levine Psychiatry Residency Program within Atrium Health in Charlotte. Dr. Wragg was named the inaugural Outstanding Resident of the Year by her colleagues and program faculty, as well as Resident Teacher of the Year by the UNC-Chapel Hill medical students.

Dr. Wragg has a passion for working with adults with mood disorders, psychosis, and survivors of domestic violence and trauma. She has specialized training and proficiency in Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and Esketamine. As a lifelong learner, Dr. Wragg is committed to staying abreast of cutting-edge medications and treatment. She understands the power of psychotherapy to effectively restructure and optimize brain function and is currently a fellow in the Pearsall Fellowship Program within the Carolina Psychoanalytic Institute.