In the first article of a four-part series, we will discuss the different types of bipolar disorder.
What Is Bipolar Disorder?
In general, bipolar disorder is a brain disorder that causes unusual shifts in mood, energy and activity levels. Bipolar disorder is multidimensional in nature and is highly influenced by environmental stressors, and because of this, experts are now considering bipolar I, bipolar II, and cyclothymia as the "bipolar spectrum." Here are definitions of the different types:
• Bipolar I is identified by episodes alternating between manic periods (of abnormal euphoria, optimism, and energy) and, usually, depressive periods (of sadness, helplessness, guilt and sometimes suicidal feelings). In between these two extremes, people can experience normal moods. People with bipolar I can experience hallucinations and delusions while people with bipolar II do not.
• Bipolar II is marked by major depressive episodes alternating with episodes of hypomania, a milder form of mania. People with bipolar II depression often have extremely low energy, slowed mental and physical processes, negative thinking, and profound fatigue. There are many different feelings and behaviors associated with bipolar II.
• Cyclothymia is a chronic mood disturbance lasting for at least two years (one year in adolescents) involving numerous hypomanic episodes and numerous periods of depressed mood that aren't severe enough to meet the criteria for a major depression or a manic episode.
Much research has been done on bipolar I, but less attention has been focused on bipolar II. People with bipolar II don't have the psychotic features or extreme elevated moods of bipolar I, and hypomania usually doesn't cause significant distress or greatly impair one's daily life. However, some research indicates that bipolar II can be severe because of the chronic and deep depressions that these people struggle with. Nevertheless, with advances in education, more people are getting diagnosed, new medications and treatment strategies are being developed, and further research continues.
It is especially important to diagnose and treat teenagers with bipolar disorder because the condition can interfere with healthy growth and development: mood shifts can cause a decline in school performance and a loss of friends, and excessive sleep can waste valuable life opportunities. Bipolar also causes unnecessary pain and suffering, which can lead to substance abuse and sometimes suicide in untreated young people.
If your teen talks about suicide, it is crucial to take it seriously. Call your doctor, or if the doctor isn't available, contact 911 or your nearest hotline. If you are a parent, try your best to get your teen to a psychiatrist. Make every effort to get your teen into individual therapy and/or a support group for teens with mental health challenges.
Bipolar and Drug Abuse
A percentage of people with undetected bipolar II conditions may abuse alcohol and/or drugs. Teenagers with bipolar disorder abuse substances to escape the chronic lows or agitated states of bipolar II. One self-destructive drug used for the depressive side is methamphetamine because it can energize depressed people and get them up and out, getting things done. However, they subsequently crash, become more depressed, and end up in a dangerous cycle. Many who use methamphetamine gradually need more of the drug, and it kills off important brain cells. The possibility of drug abuse is another argument for early identification of bipolar conditions.
Research indicates that college students abuse prescription drugs, and I expect that the rate is particularly high among students with depression and undetected bipolar conditions. The demand for counseling in colleges has greatly increased, but many colleges don't have the necessary services to meet students' needs. Bipolar appears most frequently after kids have left home and are in their early twenties.
If you have a patient or teenager who you believe is using drugs, make every effort to get him or her to a drug specialist who has knowledge of mood disorders. Involvement in a Narcotics Anonymous or an Alcoholics Anonymous program has also been successful and often provides a good support group for people trying to quit addictive behavior.
Drugs are a dead-end street, and most people with bipolar conditions need to get on the right prescription medication although a fairly small percentage of people with bipolar disorder are able to manage without medication and lead successful lives. If your patient or teen doesn't want to take medication, make sure they eat well, sleep well and stay involved in activities they enjoy. Of course, help them use the positive coping skills discussed in the fourth article in this series "Bipolar II Disorder and Teenagers: Part Four -- Positive Coping Skills."
The Bright Side of Bipolar
Important research has been done regarding the special gifts of people with bipolar conditions. Research by Dr. Kay Jamison indicates that many of our talented poets, actors, politicians, and painters had bipolar conditions. Abraham Lincoln, Winston Churchill, Catherine Zeta Jones and Robin Williams are a few of those with bipolar who have had remarkable success. There are many people, in a range of professions, who are making significant contributions when they are effectively treated for bipolar. In my practice, I have found that many teenagers with bipolar are highly talented and want to make significant contributions with their talents. It's important to realize that the high energy, creativity and goal-oriented behavior patterns of bipolar II can enable people to make major contributions to society and/or be highly successful.
One area that needs research is the creative management of hypomanic symptoms for success in life. For example, racing thoughts can be used for brainstorming, journaling and creative writing. For a person who commits to the practice, meditation or a martial art can calm thoughts down and help to open new vistas. Writing about symptoms can enable a teen to work through issues, solve problems and move toward positive goals. The chronic irritability, depression and hypersexuality of bipolar II can motivate people to begin a daily fitness program and stay fit for life. People with bipolar II can also learn to channel their irritability into assertiveness and get a lot accomplished.
Working through a depression requires teens to develop resiliency (the ability to master the biological and psychological challenges of life) and take responsibility for their moods and behaviors. Additionally, cultivating discipline and a support network helps teenagers with bipolar manage their symptoms and develop success skills. It's especially important for teens to develop solid habits, which can help them move forward when they're depressed or experiencing hypomania. Teens can become compassionate and sensitive to the pain of others when they deal with the depressive side of bipolar, and this can motivate them to become involved in important social causes.
Overcoming a depression is a struggle that allows young people to develop a variety of strengths and capacities such as willpower, ego strength, flexibility, patience, persistence and, most importantly, responsibility. Bipolar conditions provide an ongoing challenge for teens and young adults to find their outer limits in life and become multidimensional people. I like to call this "the bipolar challenge."
In the next article, we'll look at the progression of symptoms of bipolar II in "Bipolar II Disorder and Teenagers: Part Two -- Wendy's Story."
Patrice Wolters, Ph.D., is a licensed psychologist with over 22 years of experience. She specializes in relationship therapy, child and adolescent therapy and in the early identification and treatment of mood disorders in teenagers and young adults. She has helped many couples revitalize their marriages, improve family functioning and create healthy environments for children and teens. Dr. Wolters is particularly interested in helping parents cultivate resiliency, responsibility and healthy relationships in their children and teens. Her trademark "Go from a Maze to Amazing" represents her model of therapy, which is based in the emerging area of positive psychology. For more information about her approach to change and to read various articles she has written, go to http://www.patricewolters.com.