According to the National Alliance on Mental Illness (NAMI), in any given year, about one out of every 17 American adults suffers from a serious mental illness like bipolar disorder. More than 6 million adults in the United States live with bipolar disorder.

Despite the prevalence of bipolar disorder and mental health issues in general, close to 60 percent of individuals battling mental illness did not receive any form of mental health services within the past year. There may be many reasons that an individual does not get proper mental health treatment, one of which being a lack of knowledge about the specific disorder and when to seek help. Bipolar disorder is often misunderstood and incorrectly diagnosed. Bipolar disorder is typically diagnosed by age 25, the National Institute of Mental Health (NIMH) reports, and symptoms may be present in childhood.

Bipolar disorder is a mood disorder with extreme mood swings from manic to depressive, though sometimes both are experienced at the same time. These patterns of drastic moods are beyond an individual’s typical range of emotions and generally last several days or even weeks.

There are two main types of bipolar disorder, bipolar I disorder and bipolar II disorder, and a third category for bipolar symptoms that do not quite fit into either bipolar I or bipolar II yet still are considered bipolar features. This third category is defined in the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5) as bipolar-related or other specified bipolar disorder. Cyclothymic disorder is another form of bipolar disorder with milder manic or depressive symptoms lasting at least two years. Rapid-cycling bipolar disorder is when symptoms may be more severe, and mood shifts may be shorter and more frequent – at least four manic or depressive episodes in one year.

There are four main types of bipolar symptoms that may include the following characteristics:

  • Mania: elevated moods, increased self-confidence, more risk-taking behaviors, heightened energy and focus levels, less need for sleep, restlessness, change in appetite, increased activity levels, goal-oriented behaviors, delusions, hallucinations, irritability, aggression, impulsivity, trouble concentrating and keeping thoughts organized, and talkativeness
  • Depression: overwhelming sadness, social withdrawal, lack of pleasure in activities enjoyed before, trouble feeling pleasure at all, emotional numbness, thoughts of suicide, difficulties concentrating and making decisions, excessive feelings of guilt, changes in sleep patterns and appetite, fatigue and lack of energy, and feeling hopeless, worthless, and shameful
  • Hypomania: less intense version of mania usually indicated by heightened pleasure, energy, activity levels, and increased productivity and focus
  • Mixed features: when both depressive and manic or hypomanic symptoms appear at the same time, such as high energy with extreme sadness; also likely marked differences in sleep and eating patterns, and potential suicidal thoughts or behaviors

Bipolar symptoms may be difficult to differentiate from the side effects of drug or alcohol abuse at times, as both may impact and increase the negative consequences of each other. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that individuals suffering from bipolar I disorder abused or were dependent on substances just over 60 percent of the time, while those battling bipolar II were dependent on or abused substances almost half of the time. Medical and mental health professionals working together can provide comprehensive treatment models to benefit individuals who abuse substances and also experience mental illness by first understanding and providing a proper diagnosis.


Bipolar I


It is the mania and manic episodes that differentiate bipolar disorder from major depressive disorder. Bipolar I disorder is considered the “classic” form of the disorder, by the journal Psych Central, and bipolar disorder is often also termed manic-depressive disorder.

For a diagnosis of bipolar I disorder, an individual has had at least one full-blown manic episode at some point in their lifetime. NAMI reports that a manic episode is a noticeable mood elevation during which at least three of the mania symptoms last at least seven days or require hospitalization before that point. Someone battling bipolar I disorder may instead suffer irritable moods instead of heightened moods if at least four symptoms are noticeable for the same period of time. Heightened moods, energy levels, and delusions of grandeur may encourage an individual to engage in high-risk behaviors, spend money freely, abuse drugs or alcohol, or be sexually promiscuous.

Mania may lead to a psychotic break from reality where an individual may experience delusions or hallucinations. This requires immediate medical care and supervision to keep the individual and others safe from harm. Stimulant drugs, such as cocaine, methamphetamine (meth), or amphetamines, may increase manic symptoms and can trigger a manic episode or psychosis.

Almost a half-million individuals diagnosed with bipolar disorder in the United States sought emergency department (ED) care between 2010 and 2011, and the majority of these visits were by people between the ages of 15 and 24 years old, the Center for Disease Control and Prevention (CDC) publishes. Individuals may experience hypomanic symptoms for a longer period of time instead of extreme mania or psychotic symptoms and still suffer from bipolar I disorder as well. The general rule of thumb is that when these symptoms affect daily life functions and are noticeable by family and friends as being outside of the “normal” realm of emotions, they may indicate a mental health disorder that can be treated.


Bipolar II

While bipolar I is indicated primarily by episodes of mania, bipolar II may be more recognizable by major depressive episodes. An individual with bipolar II disorder has not experienced a full-blown manic episode, although hypomanic symptoms and mood swings from high to low are still present, the journal Therapy in Practice highlights.

At least five depressive symptoms are present for a period of at least two weeks for a bipolar diagnosis, to be given the Anxiety and Depression Association of America (ADAA) states. Depression can  be debilitating and may result in self-injurious or suicidal behaviors.

An individual with bipolar II disorder may also suffer from an anxiety or panic disorder, or have a problem with drugs or alcohol. Substance abuse may seem to temporarily soothe depressive symptoms and artificially elevate moods; however, in the long run, it will actually make them worse and interfere with medications or potential mental health treatments.

Substance abuse and bipolar disorder often co-occur, as individuals may use drugs or alcohol to self-medicate symptoms of bipolar disorder. Similar brain regions may be affected by addiction and bipolar disorder, and genetic vulnerabilities may exist for both disorders. The journal Current Psychiatry reports that around 60 percent of individuals diagnosed with bipolar disorder will also, at some time in their lives, develop an addiction involving drugs or alcohol. Psychiatric Times reports that those battling bipolar II disorder may spend more than half of their lives in a state of depression, which may increase the risks for self-destructive behaviors. About half of those diagnosed with bipolar disorder attempt suicide and close to 19 percent succeed.


Other Types of Bipolar Disorder


Sometimes, bipolar disorder may be not be as obvious to recognize, perhaps if there is an absence of extreme mania or a major depressive episode. Periods of hypomania or milder depression may extend for months or even years, however. These periods often affect how these people interact with the world, work or school production levels, and interpersonal relationships. When these moods and mood shifts are chronic and reoccurring for at least two years, a diagnosis of cyclothymic disorder may be made.

Often mania and depression may occur simultaneously, and an individual may present what are known as mixed features. According to the American Psychiatric Association (APA), if an individual mostly experiences mania, then three depressive symptoms must be present in the week of a manic episode for the mixed features specifier to be used, or three symptoms during the four days of a hypomanic episode. In someone who primarily experiences depression, three manic symptoms in the two weeks of a depressive episode are needed.

When moods shift beyond what is considered to be “normal,” and an individual’s everyday life is negatively affected, bipolar disorder may still be diagnosed even if the individual doesn’t exactly fit into the bipolar I or bipolar II diagnostic criteria. Usually, for someone suffering from a bipolar disorder, the changes in mood may be slow and occur over a period of time. An individual battling bipolar disorder may even have periods of normal moods and ranges of emotions in between episodes of mania or depression.

Sometimes, however, the mood swings may be more intense and shift more quickly or suddenly, as may be the case in rapid-cycling bipolar disorder. Emotions may go up and down rather quickly and shift from mania to depression within the same week. Someone suffering from rapid-cycling or mixed bipolar episodes may be the most at risk when abusing mind-altering substances, according to Psych Central.

While drugs and alcohol may initially change the brain chemistry involved in helping to regulate moods and in feelings of pleasure, these changes can increase future problems and may actually heighten bipolar symptoms, making treatment more difficult. Brain chemistry is disrupted by drugs and alcohol. When someone is addicted to a psychoactive substance, intense withdrawal symptoms may occur when the substance is removed, resulting in drug cravings, a potential loss of control over drug usage, increased depression, more extreme mood swings, anxiety, and potentially psychosis. Substance abuse may trigger bipolar symptoms, and bipolar symptoms may increase the odds that an individual will abuse substances.


Integrated Treatment

Integrated treatment plans can help manage both addiction and bipolar symptoms. Antidepressant medications may be helpful to reduce suicidal thoughts and the symptoms of a depressive episode, helping to regulate the unpredictable moods bipolar disorder may create.

The main treatment for bipolar disorder of any type is a form of Cognitive Behavioral Therapy called Dialectical Behavior Therapy, or DBT. This therapy method is a research-based form of treatment that follows a specific treatment model with both group and individual sessions, education and life skills training, and regular meetings between treatment providers to ensure the treatment is going as intended. DBT helps individuals to accept that change is necessary, but also that their thoughts and feelings are valid. This helps to boost an understanding and acceptance of the self in order to modify self-harming or destructive actions.

With proper care, symptoms of bipolar disorder can be managed. Most effective treatment programs will use a combination of medication and therapies to help individuals reach and maintain recovery.