【Creative Cultivation Program】Bipolar Disorder: The Roller Coaster of Life

We often complain that life is too dull and lacks ups and downs. However, some people yearn for what we call a peaceful life. Patients with bipolar disorder are like riding an emotional roller coaster. Sometimes they are full of energy, in high spirits, their language skills are greatly improved, and they are so cheerful and excited that it feels like they are having a party; sometimes they are deeply depressed, pessimistic and world-weary. Not only do they lose interest in everything, but they also cannot escape the torture of endless painful emotions. This article will take you into the bipolar world of patients with bipolar disorder by introducing the types, prodromal symptoms, causes of the disease, and treatment methods of bipolar disorder.

What is Bipolar Disorder

Bipolar disorder (BD) is a group of serious mood disorders characterized by unstable emotions or moods. It has a long disease cycle and a high relapse rate. It is characterized by both manic or hypomanic episodes and depressive episodes.

During a manic episode, a person has a markedly abnormal, persistent elevated mood, is extremely easily irritated, or has an abnormally, persistent increase in activity or energy that is severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others. Hypomania differs from a manic episode in that hypomania is not severe enough to require hospitalization and does not usually cause marked impairment in social or occupational functioning.

During a depressive episode, the patient may feel tired or lack energy almost every day, feel worthless, have excessive guilt, have recurring thoughts of death, and have suicidal thoughts and attempts.

Bipolar disorder can occur at any age. It is most common in young people under 25, but it can also occur in children and older adults. Bipolar disorder is often diagnosed in adolescence or early adulthood, several years after symptoms begin.

Types of Bipolar Disorder

Some people may ask, why do some patients not show symptoms as exaggerated as described above? In fact, not all patients with bipolar disorder have the same bipolar type. The frequency, intensity, and duration of symptom attacks are different, so they will also show different symptoms.

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorder mainly includes three subtypes: bipolar I, bipolar II, and cyclothymic disorder.

To be diagnosed with bipolar I, you must have experienced at least one manic episode, which must last at least seven days and may be severe enough to require immediate hospitalization. A manic episode can be preceded or followed by a hypomanic or neutral depressive episode, but you can still be diagnosed without one.

To be diagnosed with bipolar II disorder, a person must have had at least one hypomanic episode (lasting at least four days) and one major depressive episode (lasting at least two weeks), and must never have experienced a manic episode.

To be diagnosed with cyclothymic disorder, a person must have multiple hypomanic episodes that do not meet the criteria for a hypomanic episode, and multiple depressive episodes that do not meet the criteria for a major depressive episode, over a period of at least two years. During those two years, the person must have had at least half of their time in hypomanic and half of their time in depressive episodes, and never be symptom-free for more than two months.

In addition to the three types of bipolar disorder mentioned above, there are also bipolar disorder caused by substances/medication, bipolar disorder caused by other medical diseases, and unspecified bipolar and related disorders.

Take manic episodes for example. Some people may show inflated self-esteem, become talkative, and have a reduced need for sleep (for example, they feel well rested after only sleeping for 3 hours), while others may engage in uncontrolled shopping, rash sexual behavior, etc. In addition, the hypomanic and depressive symptoms of cyclothymic disorder are not as obvious as those of type I and type II. It is not easy to determine whether a person has bipolar disorder based on a single phenomenon; similarly, due to the existence of symptom-free periods, patients diagnosed with bipolar disorder may not always show bipolar symptoms. Mental illness cannot be diagnosed simply through biological tests. In addition to routine head CT scans and blood tests, rigorous psychological testing and psychiatric examinations are also required for a confirmed diagnosis.

Experiencing an emotional roller coaster in one day, am I bipolar?

In fact, mood changes are different from general emotional ups and downs. First of all, we need to distinguish between the concepts of mood and emotion. Mood refers to a spontaneous, calm and lasting emotional state, while emotion refers to a reaction to internal or external events. The difference between mood and emotion is like the difference between climate and weather. Climate is long-term, such as cold winter, while weather is short-term, such as raining on a certain day. The current mood is spontaneous and has no obvious triggers, which means that you don’t know why your mood is like this now; emotions are caused by specific events, such as feeling angry and sad after being deceived by someone.

Bipolar disorder is a mood disorder. The mood changes of patients are generally stable, and the manic phase and depressive phase each last for a long time. According to DSM-5, there is a mood attack pattern called rapid cycling pattern. Four attacks in a year can be identified as rapid cycling pattern, which also shows that mood changes are a relatively slow process.

So if your emotional state is one where you experience extreme joy and sorrow and are unstable within a short period of time, it is basically a manifestation of poor emotional stability. You don't need to worry too much, just improve your ability to control your emotions.

What causes the disease?

At present, the clinical pathogenesis of bipolar disorder has not yet been clearly defined. Some scholars believe that it is related to psychological, physiological, genetic and other factors.

Studies have shown that the risk of bipolar disorder in children whose parents do not have the disorder is 0-2%, while the risk of bipolar disorder in children whose parents have the disorder is 4-15%. Stressful life events, such as the suicide of a family member, may be a factor in the onset of the disease. In addition, family members or caregivers often vent their emotions and are unable to communicate calmly, forcing the patient to be overly involved in the emotions of family members, causing the patient to often feel hostile and blamed. Such environmental factors are also closely related to the onset of the disease.

Identifying prodromal symptoms of bipolar disorder

In 2004, the World Health Organization listed bipolar disorder as the 12th most common moderate to severe disabling disease for all ages in the world, and its lifetime prevalence in the United States is 4%. For this kind of mood disorder, can we achieve early identification, early treatment, and early recovery?

Before the onset of bipolar disorder, there are many prodromal symptoms (the earliest signs of onset before the main symptoms appear in the early stages of certain diseases, also known as early symptoms). In 2007, American scholars studied the prodromal symptoms of 52 children and adolescents with bipolar disorder, their caregivers, and 42 adults with bipolar disorder before manic or depressive episodes. The results showed that about 88.5% of patients had prodromal symptoms. Common prodromal symptoms include: decreased learning or work ability (65.4%), irritability (61.5%), accelerated thinking (59.6%), high energy (50.0%), mood swings (57.7%), depressed mood (53.8%), and inattention (51.9%).

So who is more likely to recognize these prodromal symptoms?

The journal Neurological Diseases and Mental Health published an academic paper titled "A Comparative Study of the Ability of Bipolar Patients and Their Families to Recognize Prodromal Symptoms of Bipolar Disorder" in Volume 22, Issue 9 on September 20, 2022, which studied the ability of family members and patients to recognize bipolar prodromal symptoms.

Studies have shown that patients are more likely to notice their own depression than their family members. As for changes in external behavior, such as slow movements, loss of weight or appetite, loss of pleasure or interest in things, family members are more likely to notice early abnormal changes than the patients themselves because they are familiar with the patients' usual life patterns and routines.

At present, the important reason why the recognition of BD prodromal symptoms lags behind other mental disorders is that most of the prodromal symptoms of BD are non-specific - not only bipolar disorder has these symptoms, but other mental disorders also have the same symptoms, such as circadian rhythm disorders, decreased thinking ability, mood swings, irritability, etc. This makes BD patients easily misdiagnosed as major depressive disorder, borderline personality disorder, and schizophrenia at first. Incomplete and in-depth mental examinations and incomplete medical history collection can also easily lead to misjudgment. In addition, since the threshold of hypomania/mania has not yet been reached, inaccurate diagnosis and wrong intervention strategies may affect the treatment effect and even aggravate symptoms. There is also a situation in clinical practice where the patient was previously diagnosed with depression, but then suddenly his mood improved. In this case, it is necessary to consider that the patient may not have a sudden improvement in his condition, but a bipolar attack.

As relatives and friends, we are the easiest to identify prodromal symptoms in people around us. If we are sensitive to the symptoms we or our relatives and friends have, we must pay enough attention and make detailed observations and records so that we can give the most accurate description when we see a doctor, minimize misdiagnosis, and allow patients to receive correct and scientific treatment in a timely manner.

How to deal with someone with bipolar disorder?

First, acceptance. You must never judge the patient's subjective feelings based on your past life experience, thinking that the patient is just temporarily depressed or has weak willpower. You should try to update your knowledge system and look at the problem from the patient's perspective. Discrimination, prejudice, and rejection from close people will increase the patient's sense of shame, making them ashamed to seek help.

Second, understanding. The companion should be in a relatively neutral position, neither overly worried nor overly neglectful, but should take the initiative to understand the patient's situation and re-establish a trusting relationship with the patient. The companion should judge the patient's condition objectively through communication as much as possible, rather than making subjective and blind judgments. For patients, communication, trust, equality and understanding are very important.

Third, encouragement. The disease hurts the patient's self-esteem. The companion should pay attention to observe, see the various efforts made by the patient, and give the patient affirmation and encouragement. This can effectively help them rebuild their self-confidence, enhance their sense of self-worth, and better cope with the challenges brought by the disease.

Fourth, support. During the relapse period and treatment stage, the patient may not be able to work or study normally. The companion should provide the patient with a relaxed and comfortable environment and tell the patient "I support you no matter what." When the patient can do something during the stable period, do not put too much pressure on him and always remember not to let the patient be in a state of psychological overload.

During the companionship period, the companion will inevitably feel worried and anxious. However, the patient is sensitive and fragile, so the companion needs to try not to pass on negative emotions to the patient, otherwise it will easily deepen the patient's self-blame and mental stress.

Everyone is an ordinary person. Many people may not have known anything about bipolar disorder before, but as a companion, you need to devote a lot of energy and have heavy obligations, so the companions themselves also need scientific guidance. In addition to the patients, the companions should have another focus in life to relieve stress. If you can't actively relieve stress, choosing a psychological counselor to talk and consult regularly is also a very good way.

I hope every patient understands that it is not your fault to be sick. Don't blame yourself or be nervous. Take it slow at your own pace. The onset of bipolar disorder is very long. For this reason, it is crucial for the companion to understand the patient. What the patient needs is not to tell them what to do, but to say "I support you no matter what." Letting go of prejudice and constantly learning about bipolar disorder is an important way to build trust between the patient and the companion, and it is also the greatest encouragement for the patient.

References

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