What is bipolar disorder? Everything you need to know

What is bipolar disorder?

Bipolar disorder is a mental health condition where people experience extreme mood swings, to the point where their moods interfere with their daily life. If you have bipolar disorder, your mood is likely to go through extreme highs (known as mania or hypomania) and lows (known as depression). However, what you experience during each mood, and how quickly or slowly you move between high and low moods, is different for everyone.

People with bipolar disorder can experience moods that don’t necessarily make sense in the context of what’s going on around them. The moods can be very disruptive and make it difficult to function in day-to-day life.

When does bipolar develop?

It’s most common to begin experiencing symptoms of bipolar disorder in the late teens and early twenties, and bipolar symptoms for teens and children can sometimes be different from those experienced by adults.

What are the signs and symptoms of bipolar disorder?

Someone with bipolar disorder will experience mood changes ranging between depressive and manic episodes. Symptoms and signs of bipolar disorder will be different for each person.

Depressive episodes

Not everyone with bipolar disorder experiences major depressive episodes, but the majority do. The symptoms of depressive episodes will usually align with those of major depressive disorder.

These are some common symptoms of depressive episodes of bipolar:

• a persistent low mood, which will often involve feelings of sadness or emptiness

• fatigue or low energy

• loss of interest in activities, hobbies or things that usually make you happy

• feelings of worthlessness or guilt

• changes in appetite, or significant changes in weight

• changes in sleeping patterns (usually periods of either too much or too little sleep)

• difficulties with concentration, focus and motivation

• difficulties with decision making

• thoughts of suicide or death.

Mania and hypomania

People with bipolar disorder may experience feelings of mania or hypomania.

Mania

An episode of mania is identified as a period of time with feelings of increased energy, impulsiveness and euphoria. To be considered mania, these feelings need to last more than a week (and be present for most of the day, every day).

With periods of mania, it’s common to experience:

• high self-esteem or feelings of invincibility

• increased energy

• a reduced need for sleep

• an increase in goal-directed behaviour (e.g. staying up all night to get something done)

• anxiety or anxious thoughts racing thoughts

• irritability

• anger or frustration

• heightened creativity, starting new projects or signing up for new hobbies

• paranoia or psychosis

• sudden ‘spiritual’ behaviour or mystical beliefs – for example, believing that things have special significance or connection to them personally, or that there are connections between unrelated events or things, or strong feelings of being ‘at one’ with nature or with the world around them.

Mania can also involve impulsive or risk-taking behaviour, such as:

• excessive spending

• quitting work on a whim

• substance abuse or increased use of alcohol or drugs

• impulsive or dangerous sexual activity

• speeding while driving or recklessly disobeying laws

• going on spontaneous trips/vacations

• excessive use of social media

• increase or decrease in contact with family/friends, such as excessive texting or calling, or suddenly reducing or ending all contact.

Hypomania

Hypomania can involve any of the above symptoms, but the symptoms are usually less severe than for mania and last for a shorter period of time.

Hypomania will most often include increased energy, risk taking, distractibility, and changes to self-esteem. Other symptoms can be experienced during a period of hypomania, too, but they are usually not so severe that they completely disrupt everyday activities such as work or school.

What are the different types of bipolar disorder?

There are different types of bipolar disorder, which are characterised by the appearance of mania, hypomania and depressive episodes. The length and severity of these different episodes determine which type of bipolar someone is diagnosed with.

The most common types of bipolar disorder are:

• bipolar I

• bipolar II

• cyclothymic disorder.

Bipolar I

People with bipolar I experience extreme symptoms of mania that affect their day-to-day functioning and can last for a week or more. People with this type of bipolar disorder can also experience psychotic episodes, and are more likely to be hospitalised.

Bipolar II

People with bipolar II experience symptoms that affect their mood and ability to function, but they experience hypomania, rather than mania. The hypomania-related symptoms (e.g. changes in mood, energy, concentration, and more) are likely to be noticeable to them and the people around them, but they won’t necessarily affect their day-to-day functioning.

People with bipolar II usually experience shorter episodes of hypomania and longer depressive episodes. A diagnosis of bipolar II requires at least one episode of hypomania that lasts at least four days, and at least one depressive episode that lasts two weeks or more.

Cyclothymic disorder

Cyclothymic disorder is characterised by milder, but longer-lasting symptoms of hypomania and depression. These symptoms last for long stretches of time, rather than appearing as defined and noticeable episodes. People with cyclothymic disorder tend to have very few periods of time when they experience no symptoms at all.

The hypomania and depression symptoms are generally considered milder than with bipolar I or II, but they can still impact on the person’s daily life and cause them significant distress.

A diagnosis of cyclothymic disorder requires some hypomania and depression symptoms, but not enough of them to meet the diagnostic criteria for bipolar I or II. The symptoms must have been experienced on and off for at least two years, and intervals without any symptoms at all would have been less than two months.

If someone with cyclothymic disorder does experience an episode of mania, or begins to develop additional or more severe symptoms of hypomania or major depression, their diagnosis may change to bipolar I or II.

Other types of bipolar disorder

There are other types of bipolar disorder that are less well known. Many of these diagnoses are related to another condition being acknowledged, or to the use of substances or medications.

Common causes where another type of bipolar is recognised includes:

• substance/medication-induced bipolar

• bipolar and related disorder due to another medical condition

• other specified bipolar and related disorder

• unspecified bipolar and related disorder.

If you feel your symptoms align with these types of bipolar disorder, the best thing to do is speak to a mental health professional.

Specifiers for bipolar disorder

In addition to the different types of bipolar disorder, there are also ‘specifiers’. These aren’t separate diagnoses, but descriptors added to a diagnosis that help to explain the person’s symptoms.

These specifiers can be:

• with anxious distress

• with rapid cycling

• with melancholic features

• with atypical features

• with mood-congruent psychotic features (i.e. the content of delusions or hallucinations aligns with the person’s mood)

• with mood-incongruent psychotic features (i.e. the content of delusions or hallucinations doesn’t match their mood)

• with catatonia

• with peripartum onset

• with seasonal pattern.

You can learn more about these types and specifiers of bipolar disorder at Bipolar Australia.

Common mental health conditions related to bipolar

Some people with bipolar disorder may have co-occurring mental health conditions and symptoms. Symptoms of these conditions can appear simultaneously with the mania/hypomania and depression symptoms of bipolar I and II, and can also affect the fluctuation or severity of the symptoms of bipolar disorder.

Some of the common conditions that can occur alongside bipolar disorder include anxiety disorders, substance abuse disorders, eating disorders and ADHD.

What causes bipolar disorder?

There is currently no simple, definitive answer for what causes bipolar disorder. It is understood that a variety of factors can contribute to someone developing bipolar, including their genetics, chemical imbalances in the brain, their environment, and social experiences such as trauma, stress or substance abuse.

Genetics

While there isn’t something as simple as one ‘bipolar gene’, if you have a family member with bipolar disorder, you are more likely to develop it yourself.

Genes aren’t the sole cause of bipolar disorder, but doctors generally agree that genetic factors play a very large part in how the disorder develops. This factosheet from Black Dog Institute notes that bipolar disorder is actually largely inherited, and genetic factors account for approximately 80% of the cause of the condition.

Chemical imbalances

Brain chemistry could also be a factor in the development of bipolar disorder. While scientists are still working out exactly what it means, brain imaging has shown that certain areas of the brains belonging to people with bipolar disorder, or people who have a family member diagnosed with bipolar, look or react differently from those without it.

Research suggests that the drastic mood shifts that characterise bipolar disorder could be caused by issues with the production of abnormal levels of neurotransmitters such as serotonin, dopamine, acetylcholine, adrenaline and gamma-aminobutyric acid (GABA). Abnormal levels of serotonin in particular are believed to have a feedback effect on other chemicals in the brain, which causes dramatic mood swings.

Environmental factors

If someone is predisposed to bipolar disorder due to family genetics or chemical or hormone imbalances, this increases their chances of having bipolar disorder triggered by environmental factors. In other words, things around them could ‘set off’ bipolar-related episodes of depression or mania/hypomania.

These environmental factors are most commonly stressful life events. They could be anything from relationship breakdowns, stress from school or work, poverty, physical or sexual assault, being arrested, or having experienced trauma or sexual abuse during childhood.

Bipolar disorder treatments and support options

The two main treatment approaches for bipolar disorder are medication and psychological therapies. Psychological therapy is often undertaken in addition to medication.

It can sometimes be difficult to find the right combination of treatments, as everyone is different, and finding the right balance for you personally may take time and patience. The mental health professional that you are referred to will work with you to find the mix of treatments that’s most effective for you.

Psychological therapy

Psychological therapies can help with managing day-to-day life. This might include identifying warning signs of mood changes, improving depression, and developing routines and healthy sleep patterns. Most people are referred to a psychologist for psychological therapy.

There are different types of psychological therapy, including cognitive behavioural therapy (CBT), psychoeducation, and interpersonal and social rhythm therapy. Different types of talking therapies work for different people, and sometimes it can take a while to find which one is right for you.

Medication

Different medications such as mood stabilisers, antipsychotics and antidepressants can all be used to manage bipolar disorder. Most people are referred to a psychiatrist for medication, as they specialise in identifying and prescribing the most effective medications for various mental health conditions.

It is really important to take medication as prescribed. It can be tempting to stop taking it if you start to feel better, but this is a sign that the medication is working and should be continued. If you’re having difficulties with taking this medication or having issues with side effects, it’s important to talk to your prescribing doctor.

Learn more about treatments for bipolar disorder here, or by checking out the Black Dog Institute or Bipolar Australia.

What should I do if I think I have bipolar?

If you think you may have bipolar disorder, or another mental health condition alongside bipolar disorder, the best thing to do is visit your GP. They will be able to evaluate your symptoms and set up a referral and a mental health-care plan for you, which will entitle you to see a psychologist or psychiatrist under the Medicare scheme. Learn more about what’s involved in getting a mental health-care plan.

Once you see a psychiatrist, they will work with you to go through the diagnostic process for bipolar disorder. This is likely to take several sessions, as your moods and symptoms may need to be monitored over a period of weeks or months in order to accurately determine which type of bipolar, or other mental health condition, you may have.

Find support services for bipolar disorder

If you would like to find other types of support for bipolar disorder, there are a variety of services you can call, chat to and visit. Learn more about finding support services for bipolar disorder.

There are also plenty of online resources available that can be helpful for learning about bipolar disorder. You can:

• Visit Bipolar Australia to access more resources about living with bipolar disorder.

• Head to the Black Dog Institute to take the online self test for bipolar disorder, or visit the Black Dog Online Clinic for an online assessment of your mental health.

• Learn about self-management strategies to help manage the day-to-day symptoms of bipolar disorder.

• Check out the Centre of Clinical Interventions' guide and workbook for bipolar disorder.

• Try out the eMoods Bipolar Mood Tracker app to help track moods and other symptoms.

• Read some personal stories, like this story from Zoe about how she managed her bipolar disorder during COVID-19.

• Get some tips on how to support a loved one who lives with bipolar disorder.