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Bipolar disorder

Individuals with bipolar disorder experience significant fluctuations in their mood including manic or hypomanic episodes (‘highs’) and depressive episodes (‘lows’). The term ‘bipolar’ refers to the way that mood can change between the two extremes. Different types of bipolar disorder are diagnosed depending upon which combination of mood states are experienced. Psychological approaches have been demonstrated to complement purely medical management of bipolar disorder (lam et al, 1999; Otto et al, 2009).

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Information Handouts

What Is Bipolar Disorder?

Signs and Symptoms of Bipolar Disorder

Diagnoses of bipolar and related disorders are made based on the presence of episodes of hypomania, mania, or depression. Summary diagnostic criteria are given below.

  • To meet criteria for Bipolar I disorder an individual must have experienced at least one lifetime manic episode.

  • To meet criteria for Bipolar II disorder an individual must have experienced at least one hypomanic episode and one depressive episode; and must never have experienced a manic episode.

  • To meet criteria for cyclothymic disorder the individual must have experienced numerous sub-threshold episodes of hypomanic and depressive symptoms that do not meet full criteria for a hypomanic, manic, or depressive episode; have never met full criteria for a manic, hypomanic, or depressive episode; and experience cyclothymic periods most of the time.

A manic episode is characterized by the experience of at least four of the following symptoms for a period of at least a week, and to a degree severe enough to cause a marked impairment in the individual’s functioning:

  • a period of elevated, expansive, or irritable mood that is abnormal for the individual

  • increased goal-directed activity or energy

  • increased self-esteem or grandiosity

  • decreased need for sleep

  • increased talkativeness, or pressure to keep talking

  • flight of ideas or the subjective experience that thoughts are racing

  • difficulty concentrating or distractibility

  • excessive reckless behavior

  • increased activity or physical restlessness

  • loss of social inhibitions resulting in inappropriate behavior

  • marked sexual energy/​indiscretions

A hypomanic episode is characterized by the experience of at least five of the following symptoms for at least four consecutive days, and to a degree where there is an unequivocal change in functioning:

  • a period of elevated, expansive, or irritable mood that is abnormal for the individual

  • persistently increased activity or energy

  • increased talkativeness or pressure to keep talking

  • difficulty concentrating or distractibility

  • decreased need for sleep

  • excessive reckless behavior

  • increase in activity or psychomotor agitation

  • inflated self-esteem or grandiosity

  • flight of ideas or the subjective experience that thoughts are racing

  • increased sociability or over-familiarity

  • increased sexual energy

A depressive episode is characterized by the experience of at least five of the following symptoms for at least two weeks:

  • depressed mood most of the day, nearly every day

  • diminished interest in previously pleasurable activities

  • fatigue or loss of energy

  • sleep disturbance

  • feelings of worthlessness, self-reproach, or excessive guilt

  • diminished ability to think or concentrate

  • recurrent thoughts of death or suicide, or suicidal behavior

  • changes in appetite, with corresponding weight change

  • psychomotor agitation or retardation

  • loss of confidence and self-esteem

Evidence-Based Psychological Approaches for Working with Bipolar Disorder

Bipolar disorder is best seen as a multifaceted condition with broad biological, social, and psychological components. Medical management is crucially important, but psychological interventions can also play a helpful role: particularly in the long-term management and prevention of relapse, building resilience, and improving quality of life. A 2014 review concluded that “The evidence demonstrates that bipolar disorder-specific psychotherapies, when added to medication for the treatment of bipolar disorder, consistently show advantages over medication alone on measures of symptom burden and risk of relapse … those who receive bipolar disorder-specific psychotherapy fare better than those who do not”(Swartz & Swanson, 2014). Interventions that have been researched include:

  • psychoeducation

  • cognitive behavioral therapy for bipolar disorder

  • interpersonal and social rhythm therapy (IPSRT)

  • family-focused therapy

  • mindfulness-based interventions

Resources for Working with Bipolar Disorder

Psychology Tools resources available for working therapeutically with bipolar disorder may include:

  • psychological models of bipolar disorder

  • information handouts for bipolar disorder

  • exercises for bipolar disorder

  • CBT worksheets for bipolar disorder

  • self-help programs for bipolar disorder

References

  • Lam, D. H., Jones, S. H., Hayward, P., & Bright, J. A. (1999). Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods, and practice. Malden, MA: Wiley.

  • Otto, M. W., Reilly-Harrington, N. A., Kogan, J. N., Henin, A., Knauz, R. O., & Sachs, G. S. (2009). Managing bipolar disorder: A cognitive-behavioral approach—therapist guide. New York: Oxford University Press.

  • Swartz, H. A., & Swanson, J. (2014). Psychotherapy for bipolar disorder in adults: A review of the evidence. Focus, 12(3), 251–266.

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