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Individuals diagnosed with bipolar disorders experience fluctuations in mood over which they have no control. All of the bipolar disorders cause great emotional distress. Even the state of elevated mood, or "mania," might sound as if it would feel good; but it is, in fact, a painful, pressured feeling that is not at all pleasurable. People with mania find their thoughts running at an unstoppable pace; they cannot sleep, often for many nights at a time. Their speech may become rapid, and they may have grandiose ideas. Often people in manic states spend money they do not have, and make important but disastrous life decisions.

Individuals in the depressed mood state experience loss of interest in activities and people. They also experience loss of appetite, difficulty sleeping, lack of sexual desire, and an extreme loss of general energy. The ability to concentrate and think clearly is also compromised. Work, social, and family relationships are always impaired. Feelings of worthlessness and helplessness are common, as is the feeling that nothing will every improve. While depressed individuals may or may not report feeling "down" or "depressed," the feelings they do experience are very painful.

The handbook used by mental health professionals to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as the DSM-IV-TR. It includes four basic types of bipolar disorder: Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder Not Otherwise Specified.

Bipolar I disorder is characterized by one or more manic episodes, or so-called "mixed" episodes, which involve both manic and depressive feelings alternating rapidly, often within the same day or week. Individuals with Bipolar I disorder may also experience one or more major depressive episodes. Suicide occurs in 10-15% of individuals with this disorder.

Bipolar II disorder is characterized by the occurrence of one or more major depressive episodes, interspersed with periods of mild manic episodes referred to as "hypo-mania." Hypomanic episodes are similar to manic ones, but are far less intense and less severe in their consequences. In fact, individuals may not see their hypomanic episodes as a problem, feeling, instead, that they have bursts of energy in which they can accomplish a great deal.

Cyclothymic disorder is a chronic, low-level disturbance of mood, punctuated by periods of depressive symptoms and periods of hypomanic symptoms. Cyclothymia often begins early in life, and people with the disorder may not know they have it; they may simply think of themselves as sadder and/or less energetic than other people, with occasional bursts of energy.

Bipolar disorder not otherwise specified is the term used in the DSM-IV-TR for individuals who do not meet the criteria for one of the other three diagnoses, but who nevertheless experience patterns of mood swings alternating between depression and mania.

See also Affect; Bipolar disorder; Cognitive-behavioral therapy; Cyclothymic disorder; Depression and depressive disorders; Dysthymic disorder; Lithium carbonate; Manic episodes

Resources books

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Kaplan, Harold I., MD and Benjamin J. Sadock., MD

Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8th edition. Baltimore, MD: Lippincott Williams and Wilkins, 1998.

Barbara Sternberg, Ph.D.

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