What is bipolar disorder?
Bipolar disorder is a mood disorder that includes episodes of:
- unusually high, hyperactive or irritable mood (called manic or hypomanic episodes)
- low mood (depressive episodes)
Bipolar disorder is not usually diagnosed until a person has experienced a manic or hypomanic episode. A manic episode lasts for at least seven days. A hypomanic episode is less intense and shorter than a manic episode and lasts for at least four days. Symptoms of hypomania are also less severe than symptoms of mania.
How is bipolar disorder different from everyday mood swings?
Every youth experiences changes in their mood as a result of stressors (something that causes stress) or big life changes. What makes bipolar disorder different is that each mood change lasts longer (from days to months) and interferes with day-to-day functioning.
What are the main symptoms of bipolar disorder?
In addition to changes in mood, the manic and depressive episodes linked with bipolar disorder have many different symptoms. This may include symptoms of psychosis in some youth. The main symptoms of bipolar disorder involve episodes of depression and mania, and, sometimes, symptoms of psychosis.
Symptoms of depression
Depression has a range of emotional, cognitive, behavioural and physical symptoms. These include low mood, feelings of hopelessness, negative thoughts, loss of interest in enjoyable activities, and changes in sleep patterns.
Symptoms of mania and hypomania
Much like the symptoms of depression, the symptoms of mania and hypomania fall into the following categories:
- emotional (feelings)
- cognitive (thoughts, brain function)
- behavioural (actions)
- physical (how your body feels)
Emotional symptoms
During an episode of mania or hypomania, you may feel:
- elevated, euphoric (intense excitement or happiness) or irritable
- grand or on top of the world
Cognitive symptoms
Someone experiencing mania or hypomania may:
- have inflated self-esteem or grandiosity
- suffer reduced concentration
- have racing thoughts
Behavioural symptoms
An episode of mania or hypomania can often involve:
- starting many different activities or projects
- engaging in risky behaviour such as increased spending, substance use, or risky sexual activity
- talking more than usual and more quickly than usual, sometimes not allowing interruptions
- jumping from one topic to another when speaking
Physical symptoms
During an episode of mania or hypomania, you may experience:
- high energy levels
- agitation
- a decreased need for sleep, sleeping much less than usual without feeling tired
Symptoms of psychosis
When someone experiences psychosis, they may develop beliefs that are not based on reality.
- During an episode of mania, their beliefs are typically positive, for example, a person might think they are better than others.
- During depressive episodes, the beliefs are typically negative, for example, a person might believe they are responsible for catastrophic events.
Someone experiencing psychosis may also sense things that do not really exist, for example, hearing voices or seeing things that others do not. They may also speak in a way that is difficult or impossible to follow, or develop new behaviours that seem bizarre.
Types of bipolar disorder
Not everyone experiences bipolar disorder in the same way. Bipolar disorder exists on a spectrum that includes:
- bipolar disorder, type 1
- bipolar disorder, type 2
- other bipolar disorders
Bipolar disorder, type 1
Bipolar disorder, type 1, is diagnosed when a youth has had at least one episode of mania. This means that they have had specific symptoms that last for at least one week, which significantly impair their everyday functioning. Bipolar disorder, type 1, can be diagnosed when symptoms last for less than one week if the youth needs to be admitted to hospital.
Youth with bipolar disorder often also experience depressive episodes. But even if they have one or more episodes of depression, they can only be diagnosed accurately with bipolar disorder, type 1, once they have an episode of mania.
Bipolar disorder, type 2
Bipolar disorder, type 2, is diagnosed after a youth has had at least one episode of hypomania and at least one major depressive episode. This means that they have had a number of specific symptoms over at least four days. Symptoms of hypomania impair a youth's everyday functioning but not to the same degree as mania.
Youth with hypomania do not need to be admitted to hospital, and there are no associated symptoms of psychosis.
Other bipolar disorders
A health-care professional may diagnose another type of bipolar disorder if a youth has major symptoms of bipolar disorder but does not meet all the criteria for bipolar disorder, type 1 or 2.
What causes bipolar disorder?
There is no single known cause of bipolar disorder but rather a number of possible factors. For example, children who have a parent or sibling with bipolar disorder are more likely to develop the disorder themselves.
The risk of bipolar disorder may be higher as a result of various stressors in a youth's environment. These stressors might include the loss of a parent or caregiver, school difficulties, bullying, poverty or early life abuse or neglect. Some substances, such as cannabis, also increase the risk of developing bipolar disorder.
How common is bipolar disorder in teens?
Bipolar disorders affect between 1 and 3 per cent of teens.
Does bipolar disorder occur with other conditions?
Bipolar disorder often occurs with other conditions, especially anxiety disorders. Other conditions that commonly occur with bipolar disorder include:
- substance use disorders
- attention deficit hyperactivity disorder (ADHD)
- disruptive disorders such as oppositional defiant disorder.
How bipolar disorder is diagnosed
Your doctor will assess:
- your concerns and the symptoms that are interfering with your functioning
- current stressors in your life
- medications that you take
- substances that you use
- your development (from pregnancy onwards)
- your family's mental health history
- family stressors
If you have experienced significant symptoms of mania or hypomania, you may meet the criteria for bipolar disorder.
Your doctor may also want to do other tests to check for possible general medical or neurological causes of your symptoms.
If you are diagnosed with bipolar disorder, your doctor will discuss the most appropriate treatment options with you. You may want input from other members of your family or your school.
Your doctor may suggest that you see a therapist or a psychiatrist. They may also recommend medications or lifestyle changes. Most people need medications to properly treat bipolar disorder.
When to see a doctor about bipolar disorder
See your doctor if you have concerns about hypomania or mania.
Go to your nearest emergency department if there are concerns about safety (such as suicidal thoughts or behaviours), aggressive thoughts or behaviours, risk-taking behaviours or psychosis.
