Bipolar spectrum disorder is a mental health illness that is hallmarked by unusual and extreme variations in mood.
These variations are characterised by episodes of mania or hypomania and depression.
The bipolar spectrum describes several diagnostic categories that are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5). These are:
- Bipolar I disorder, characterised by at least one life-time manic episode.
- Bipolar II disorder characterised by at least one life-time hypomanic episode and one life-time major depressive episode.
- Cyclothymic disorder (cyclothymia), characterised by at least 2 years of numerous periods of sub-threshold hypomanic and depressive symptoms (whereby full criteria for hypomania and major depressive episode are not met).
- Other unspecified bipolar and related disorder, where although numerous bipolar symptoms are present these are insufficient to meet DSM – 5 diagnostic criteria for the previous 3 sub-types.
What Consitutes an Episode?
Manic Episode (DSM – 5)
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormal and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or for any duration if hospitalisation is required).
B. During this abnormal period of mood disturbance and increased goal-directed activity, three or more of the following (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep.
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractability.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psycho-motor agitation (purposeless, non-goal directed activity).
- Excessive involvement in activities that have a high potential for painful consequences.
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation in order to prevent harm to self or others, or there are psychotic features (detachment from reality).
D. The episode is not accounted for by the effects of a substance or another medical condition.
Hypomanic Episode (DSM – 5)
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormal and persistently increased goal-directed activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During this abnormal period of mood disturbance and increased goal-directed activity, three or more of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep.
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractability.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psycho-motor agitation (purposeless, non-goal directed activity).
- Excessive involvement in activities that have a high potential for painful consequences.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and change in functioning are observable by others.
E. The mood disturbance and change in functioning are not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalisation.
F. The episode is not accounted for by the effects of a substance or another medical condition.
Major Depressive Episode (DSM – 5)
A. Five (or more) of the following symptoms have presented during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant (5% of body weight in a month) weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
- Hypersomnia or insomnia nearly every day.
- Psycho-motor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness nearly every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not accounted for by the effects of a substance or another medical condition.
Treating Bipolar Spectrum Disorder
Bipolar disorder affects 1 to 2% of the population. Bipolar illness is generally considered to have a biological and genetic basis with medications used as the first-line course of treatment for bipolar I and often (but not always) factoring into treatment for bipolar II.
In addition to biological drivers, psychosocial (psychological and social) triggers have also been identified as playing a significant role in both the onset and maintenance of bipolar episodes. Onset, duration, and intensity of both depressive and manic episodes has been associated with stressful life events. These stresses may result from one major event such as a relationship breakup or may be the result of a buildup of life stresses and hassles. Even perceived positive changes such as moving to a new house, promotion/changing work roles, or becoming a parent can be psychosocial stressors that trigger a bipolar episode.
Individual response styles will either increase or decrease a person’s ability to cope with stressful life events. Understanding and managing potential day to day triggers that build up over time will also reduce the impact of stress in one’s life.
Psychotherapy offers clients an opportunity to consider strategies that might help them more effectively manage and cope with life stresses. Interpersonal Social Rhythms Therapy (IPSRT) is an evidence-based therapy successful in the treatment and management of bipolar disorder. IPSRT recognises intimate links between mood and life-events, mood and disruptions in routine, and the circadian biology that controls sleep/wake cycles.
Structured psychotherapy is often recommended for the treatment of bipolar disorder and may be offered in addition to pharmacotherapy or, in some cases of bipolar II disorder may be utilised successfully as a standalone treatment.
Author: Dr Nicole Hess, B Psych (Hons), MPPSY, PhD.
Having recently completed a Master of Professional Psychology (MPPSY), Nicole Hess is trained to provide psychological assessment and evidence-based therapies. She works with children, adolescents and adults in individual therapy.
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