Bipolar disorder, which used to be called manic-depressive disorder, is a mood disorder involving emotional highs and lows. The emotional highs are called manic episodes or hypomania (hypomania means below mania or almost mania). During a manic episode someone may act and feel much the way some- one would after consuming a stimulant like cocaine or methamphetamine, except that they have not taken any drugs. People experiencing this are in exceptionally and unrealistically good moods that are extreme enough to impair judgment and cause risky and aberrant behavior. They typically feel little or no need for sleep, and may stay awake for days without feeling sleepy. They are overly enthused about minor things, express grandiose thoughts, often have rapid or pressured speech, have a diminished sense of risk, and are more likely to go on spending sprees and drug or alcohol binges, and to be sexually impulsive. Manic episodes can be dangerous, both to the person experiencing them and to those around him or her.
Hypomanic episodes are a milder form of manic episodes, and can be hard to distinguish from an ordinary good mood. During a hypomanic episode a person has more energy than usual, often gets more accomplished, and is in a very good mood, and the onset of a hypomanic episode is usually not caused by a positive event. Because hypomanic episodes are not overtly pathological they need to be identified as part of a larger pattern.
There are two forms of bipolar disorder. Bipolar disorder 1 is characterized by the presence of manic episodes. The sufferer may or may not also have episodes of depression. Bipolar disorder 2 is characterized by a pattern of hypomanic episodes alternating with periods of depression. There is also a related condition called cyclothymic disorder, which is similar to bipolar disorder II but has more rapid alternation of mood states.
The key thing about bipolar disorder and cyclothymic disorder is that the sufferer feels strong emotions that are caused not by events and experiences but by the person’s internal biochemistry. Because the emotional states are caused by a chemical imbalance, the right treatment is psychiatric medication, usually mood stabilizers or the newer atypical antipsychotics. Psychotherapy can also help the sufferer to understand and manage the condition, but it cannot substitute for medication.
Thomas B. Hollenbach, Ph.D.
