What You Need to Know About Bipolar Disorder

Patient Expert
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Bipolar. That one word is attaches a set of adjectives to approximately 4.4 percent of the American population that live with the disorder as if we were all the same and can be treated identically. The truth is that bipolar disorder is a complex condition that affects each person differently. Here are a few things you should know about the illness to shatter your misconceptions of bipolar and what it means for the people who live with the condition.

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Bipolar is a cycling illness, not an episodic illness

Bipolar disorder is more complex than depression and other mood disorders that are episodic illnesses. It is characterized by a lot of fluctuation. In fact, if we strip bipolar to one universal trait, it is that our moods cycle up and down, and not necessarily in sync. Back in the 1850s, the French psychiatrist Jean-Pierre Falret came up with the term “la folie circulaire” (circular insanity) to describe the constant state of flux our brains are in.

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Our cycles are not the same

Some of us are abruptly whiplashed from one extreme to the other. Others almost imperceptibly slide up to down to in between at the pace of continental drift. Some of us skyrocket into mania. Others barely rise above depression. But cycle we do.

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Our cycles coincide with other stuff going on

In the early twentieth century, the pioneering diagnostician Emil Kraepelin noted that our cycles, along with our moods, were linked to intellect and volition, which loosely translates to thought and energy. One minute, our brains are on rocket fuel, the next stuck in molasses - and often rocket fuel combined with molasses. “Excited depression” and “manic stupor” were two of the terms he used to describe these very common “mixed” states.

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Our cycles interact with our personalities

Kraepelin also touched on how our cycles are related to our personalities. Cycling is all about transiting into temporary states. Personalities, by contrast, are based on heritable traits that remain fairly constant over a lifetime. What, for instance, is mania supposed to look like in someone born with a depressive temperament? Probably a lot different than in someone who is usually upbeat.

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We have stress to think about

A combination of genes and environment (including past trauma) creates a negative bias in some brains – a default, negative reaction to stress or whatever life throws our way. Those with fragile wiring have exaggerated perceptions of feeling threatened and overwhelmed, combined with a lack of ability to control the situation. One guess - which type of brain is more likely to experience runaway depression or mania?

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We need to take the situation into account

Shouting insults at someone is okay if you’re a football coach raging against the guy in the striped shirt. Doing the same thing to a flight attendant at 40,000 feet in the air will get you arrested. The behavior may be the same, but it is viewed very differently. Bipolar symptoms, like the rest of life, happen in a context which can confuse matters. What some people fail to understand is that a bipolar person who is enraged by a situation may be acting no differently than someone without the condition. Context is everything.

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Very few of us have just one diagnosis

Imagine an anxious depression or an anxious mania and you can see why mood is colored so differently, from individual to individual. Throw in elements of substance abuse, alcoholism, ADHD, psychosis, PTSD, sleep disorders, eating disorders, various phobias, assorted personality disorders, not to mention physical conditions, and it’s clear that bipolar is not just bipolar. The different regions brains of our brains and biologically systems are wired intricately together so that every cell and message is looped into a multi-pronged response.

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Just a handful of variables leads to infinite complexity

Twelve notes in the chromatic scale yields everything from Beethoven to Elvis. Twenty-four letters produce the alphabet and all of written English. It only takes a few minor variations in our cycles, our personalities, and our environment to ensure that no two bipolar conditions are the same.

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Bottom line: You are unique

And thank heaven for that.