Seeing an interaction on TV inspired me to teach you all a little about bipolar disorder.
Bipolar disorder often shows up in pop culture, but it’s widely misunderstood. Here are some facts about how bipolar disorder works.
Savvy Psychologist is hosted by Dr. Monica Johnson. A transcript is available at Simplecast.
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Recently I was asked by a patient to watch Love is Blind season 3 and yes, when it’s reasonable, I will follow up on a request by a patient or listener. There is a pivotal scene between one couple, Cole and Zanab, in which during a disagreement Cole asks, “Are you bipolar?”
You’ll hear my opinion on that in a minute, but since many of my listeners also email me asking about this often mentioned in pop culture, but rarely understood disorder, I wanted to take this opportunity to lay down some facts.
Welcome back to Savvy Psychologist, I'm your host, Dr. Monica Johnson. Every week on this show, I'll help you face life's challenges with evidence-based approaches, a sympathetic ear, and zero judgment.
Let’s make one thing clear: it’s not okay to use mental illness as an attack against another person. I’m doubtful that you would go up to your grandmother and say “Are you senile?” with a look of judgment if she was having a forgetful moment. To be fair, if you throw someone into a situation where they have to get engaged to and live with a person they met 2 weeks ago, they're going to have some wonky moments and heightened emotions. But seeing this interaction on TV inspired me to teach you all a little about bipolar disorder.
There are actually 2 forms of bipolar which we call bipolar I or II. Bipolar II is a milder form of the disorder. For the purposes of this episode, we are going to focus on bipolar I. According to the DSM-5-TR, bipolar disorder occurs in about 1.5% of the population and there is no difference in rates amongst identified males and females. The peak age of onset is between 20 and 30 years of age, but bipolar can occur throughout a lifespan.
A key feature of bipolar disorder is the presence of both manic and depressive episodes. This is why lay people talk about “mood swings.” Mania is one side of the pendulum and depression is the other. I am not going to spend any time talking about depression because I’m going to assume you know the basics on that (and if you don’t, search the Savvy Psych archives!), but mania is going to be murkier.
Now, let’s dig deeper into the idea of mood swings. You’d be surprised at the number of folks who have walked into my office during my career and claimed to have bipolar because they have “mood swings.” Here are some examples from a clinical perspective that are not mood swings. A mood swing is not, “I started the day happy and ended the day sad.” If that’s the case, me too. Who hasn’t had a day that turned out worse than you expected? A mood swing is not, “Well, I go through a lot of emotions during my day,” or “I’m so sensitive about XYZ.” Yes, some of us are intense and passionate and a bit more sensitive than the average bear. Stress can also heighten your emotional dysregulation. None of these scenarios are anything outside of the normal limits of human experience. For instance, if the average height of a cismale is 5’8, you’re not going to classify someone as having dwarfism because they are 5' 5. This negates the very real experience of those who actually deal with these issues.
Moreover, if you’ve ever witnessed or experienced a manic episode yourself, you’re well aware that comparing these smaller mood shifts to a full-blown manic episode can be like someone who did drugs at Burning Man once going up to someone who has struggled with heroin addiction for a decade and going “same.” Be careful with these comparisons because they may have the unintended consequence of reinforcing stigma and unhelpful ideas we have about mental health. Because if you had mood swings and all you had to do was go on a yoga retreat to fix it, why can’t I?
In order to qualify as a manic episode, you first must have a distinct period of abnormally and persistently elevated, expansive, or irritable mood, as well as abnormally and persistently
increased activity or energy, lasting at least 1 week and present most of the day, nearly every day. If you end up needing hospitalization, then any duration qualifies. In addition to this, you need 3 other mania criteria present, and that increases to 4 if you’re only experiencing irritability as the predominant mood change. These symptoms need to be significant and represent a change in behavior for the person. The build-up for many of my patients into a manic episode is over several days, sometimes a week or two, and they are able to notice it after coming to therapy to understand the signs and triggers for their mania. In many cases they are able to engage in actions to stop the manic episode from progressing.
Other possible symptoms of mania include inflated self-worth or grandiosity and a decreased need for sleep. Decreased need for sleep is different from insomnia. Oftentimes those with insomnia actually want to go to bed. In a manic episode, a decreased need implies that you are either well-rested after just a few hours or can go for several days without sleep and are still energized.
You can also have pressured speech or be far more talkative than usual. Pressured speech isn’t simply talking a lot. The speech can be more erratic, compulsive, and it can be impossible for you to allow another person to interject. Also, combined with other symptoms of mania like flight of ideas, otherwise known as racing thoughts and distractibility, others will feel like you are erratic and hard to follow. During a manic episode, you may also see an increase in goal-directed behavior. This can be seen socially, at school or work, or sexually. You may also experience psychomotor agitation.
The final potential criteria we need to discuss is excessive involvement in activities that have a high potential for painful consequences. This can be engaging in risky sexual activities like having unprotected sex with someone you met 5 minutes ago, investing in sketchy deals, or unlimited shopping sprees when you don’t have an unlimited bank account. All of these symptoms have to be to a degree that they are markedly impacting your life.
I’ve had patients who woke up in the hospital or literally in different states and didn’t know how they got there. I’ve worked with folks who maxed out all of their credit cards during a manic episode and then had to figure out how to return items and repair their credit score. I’ve known folks who have taken incompletes or failed out of college or lost jobs because of mania. This is not a joke or something to be used as a jab.
Until you get treatment, you can really feel like a victim of your mental health and completely out of control. The great news is that with therapy and medication, people can manage this disorder and go on to lead lives that are as fulfilling as anyone else.
What’s a way that the general public misuses mental health that gets under your skin? Let me know on Instagram @kindmindpsych. You can also reach out to me via my email at psychologist@quickanddirtytips.com, or leave a voicemail at (929) 256-2191.