Bipolar
Bipolar disorder is not quite the same as depression or anxiety. There are two types of bipolar disorder: bipolar 1 and bipolar 2. There is also a condition called “borderline personality disorder” which frequently gets confused with bipolar disorder, but is diagnosed and treated very differently. People with bipolar type 1 often are depressed, though many can be symptom free between bouts of mania. Manic episodes are the defining feature of bipolar type 1. A manic episode is a period in which a person displays an over-the-top level of activity or energy with significantly erratic behavior. This elevation must be a change from your usual self and be noticeable by others. Symptoms include feelings of invincibility, complete lack of sleep, racing thoughts and ideas, rapid talking and having false beliefs or perceptions. In some cases, people fly across the country and spend all their money, behaving completely unlike their usual selves, sometimes including delusions that they are another person like Jesus or Superman. To be diagnosed with bipolar type 1 you must have at least one manic episode that impacts your ability to function normally and lasts at least seven days or is severe enough to require hospitalization. Bipolar type 2 is different in that people with this disorder will almost always have a baseline of depression, but this depression is interrupted by bouts of “hypomania.” Hypomania is like mania but shorter and less severe. Patients will experience elevated or irritable mood, increased self-esteem, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, overactivity, and excessive risky behavior, but it is rarely as excessive as true manic episodes and does not have delusions or false beliefs.
A bout of hypomania is expected to last for at least 3 days, but often does not significantly decrease function. The third diagnosis, called borderline personality disorder, sometimes gets misconstrued as a type of bipolar disorder. Borderline personality disorder is characterized by emotional instability in a minute to minute or hour to hour time frame. People with borderline personality disorder often experience unstable relationships with others, identity disturbance, chronic feelings of emptiness, and excessive anger. All three of these diagnoses are at least possibly caused by genetics, but childhood trauma, abandonment, and current situation also play a role. People with bipolar disorders almost always need both counseling and medication to help regulate mood stability, though people with borderline personality disorder often need just counseling, self-awareness, and coping tools to help control their symptoms. Your Primary care provider is oftentimes able to help start treatment for any of these conditions, so if you have questions about them then a message to your PCP is a great place to start.
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Information provided by
Stewart Decker, MD, MPH, FAAFP, FWMS
Jeanette Rutherford, MA, LPC
Jennifer Newton, RD, LD, CDCES, MPH
