By HAYDEN FINCH, PhD
Friends, I have to be honest. Something is really bugging me, and has been for a long time. I hear people on TV, in the grocery store, and in my office say they’re “bipolar.” I even hear physicians tell me someone is “bipolar.” And even though I have a PhD and have treated many people with Bipolar Disorder, I have to confess I have almost no idea what it means to “be bipolar.” Well, let me clarify. I think I know what people mean when they say someone is “bipolar” — they mean someone is moody or unpredictable, or they are expressing a different emotion now than they were 5 minutes ago, or from day to day you just have no idea how they’re going to react. This sure isn’t what I mean when I say someone has Bipolar Disorder. The distinction is important because the greater discrepancy between Bipolar Disorder and “bipolar” there is, the less meaning the term Bipolar Disorder has. Also, misusing the term compromises understanding of what is a very serious mental illness. The same goes for “I’m so OCD” and all the other colloquial uses of mental health conditions. I think the word is misused mostly out of confusion and lack of information rather than a desire to be insulting. So let’s get it straight — what is Bipolar Disorder, how does it differ from “bipolar,” and how do you know which (if either) you have?
To answer these questions, we first need to review the diagnostic criteria for Bipolar Disorder (there are none for “bipolar,” and that’s sort of the point) and then consider differences between Bipolar Disorder and “bipolar” in
1. Symptom intensity
2. Symptom triggers
3. Episode duration
4. Functional impairment
Truthfully, there are multiple bipolar disorders, so there’s no such thing really as Bipolar Disorder (which makes “bipolar” even less meaningful). The main three are Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.
Diagnostic Criteria: Manic Episode
The first thing to know is bipolar disorders reflect different types of “mood episodes.” One type is a manic episode. A manic episode is a very specific, distinct period of persistently elevated, expansive (extreme self-importance, exaggerated behaviors, grandiosity), or irritable mood AND persistently increased goal-directed activity or energy lasting at least one week and present most of the day, nearly every day. [Read that last part again: AT LEAST ONE WEEK AND PRESENT MOST OF THE DAY, NEARLY EVERY DAY. Note how different this is from people we describe as “moody” or “bipolar,” whose moods change erratically from moment to moment.] At the same time, you’ve gotta show at least three of these things:
- Inflated self-esteem or grandiosity (Not just high self-esteem and feeling good about yourself, but you think you are the absolute bomb, there’s never been anything better, and you actually think you are better than you really are. This can border on delusional.)
- Decreased need for sleep (like WAY decreased — think: feeling completely rested after about 3 hours of sleep without needing coffee or cocaine to wake yourself up)
- More talkative than usual or pressure to keep talking (we’re not just talking chatty here, we’re talking can’t shut up if you had to)
- Flight of ideas or subjective experience that thoughts are racing (again, you’re not just having ideas, your thoughts are going so fast you can’t keep up with them, and the people you’re talking to probably think you are making absolutely zero sense)
- Distractibility (Again, different than your normal distraction — here we’re talking about bouncing from idea to idea to idea indiscriminately and problematically. You can’t get anything done because you’re so distracted by everything.)
- Increase in goal-directed activity (you’re not just busier than usual, you are an abnormal level of busy, and much of your activity might be nonsensical or purposeless)
- Excessive involvement in activities that have a high potential for painful consequences (think wildly reckless spending, sexual promiscuity, foolish investments)
Do you see how Mary is somewhat different than folks on TV who claim to be “bipolar”? Now, it’s imperative to note that there’s a TON of variability among people with Bipolar Disorder, so not everyone is going to resemble Mary. This is why it takes a qualified mental health professional to make the diagnosis.
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
