By HAYDEN FINCH, PhD
In my first post in this series, I confessed something has really been bothering me – the misuse of the word “bipolar” over the last decade. In that post, we chatted about what a manic episode really is, by definition. And then in my second post, we talked about depressive episodes and the three major types of bipolar disorders. It was real technical.
From a more conceptual perspective, there are four major areas to consider how Bipolar Disorder differs from “bipolar.” They are
1. Symptom intensity
2. Symptom triggers
3. Episode duration
4. Functional impairment
1. Intensity of Symptoms
The first thing to think about when distinguishing between Bipolar Disorder (meaning Bipolar I, Bipolar II, or Cyclothymic Disorder) and “bipolar” (meaning what you overheard the person next to you at Starbucks calling her sister-in-law) is how intense the symptoms are. In Bipolar Disorder, you may hear a person referring to being a major celebrity or owning a major company, they may sleep for only a couple of hours a night, and they may engage in dangerous behavior (like jumping off a building because they suddenly believe they can fly, or having sex with anything that moves). How many “bipolar” people do you know that believe they can “bring the wind, bring the rain, bring the sunshine”? Note, Mary didn’t just get mad at her husband, she beat him up. She isn’t just religious, she’s “incognito for the Lord.” When someone has a manic episode, they aren’t just happy, they’re “on top of the world” and almost appear (and feel) to be intoxicated. The mood change is easily recognized as excessive, and the person appears to have almost haphazard enthusiasm. The person with Bipolar Disorder gets involved in lots of projects — but not just doing things they’ve been planning to do, doing things they have little knowledge of and doing things that might be out of their ability range. They might start writing a novel, seeking publicity for an invention, or engaging in other self-aggrandized behavior without any notable experience or talent. They don’t have insomnia — rather, they feel entirely rested and full of energy with several hours less sleep than is typical. They aren’t just chatty, they are loud, difficult to interrupt, intrusive, and irrelevant. They might shift abruptly from topic to topic, and their speech can be disorganized and their thoughts so crowded that they become distressed by the difficulty expressing everything they’re thinking. The distractibility is so severe they almost can’t hold a conversation at all. They become involved in activities that are not typical for their personality — things like giving away their possessions, engaging in indiscriminate sexual encounters with strangers, etc. Importantly, the symptoms by definition have to “REPRESENT A NOTICEABLE CHANGE FROM USUAL BEHAVIOR.” It seems to me that when people describe being “bipolar,” they’re talking about their usual behavior — they describe usually being irritable or moody. If you’re pretty much always “bipolar,” you probably don’t have Bipolar Disorder.
If you’re pretty much always “bipolar,” you probably don’t have Bipolar Disorder.
2. Triggers of Symptoms
A person with Bipolar Disorder can move in and out of manic, hypomanic, and major depressive episodes with no perceptible trigger. Often, symptoms are exacerbated by increased stress, and sleeplessness can trigger manic episodes. Antidepressant use can also trigger manic episodes in people prone to Bipolar Disorder. By contrast, “bipolar” people tend to be triggered by an acute event — they’re irritable immediately when their husband criticizes them, they’re devastated immediately when they make a mistake, etc. The mood change in “bipolar” people is abrupt and typically relatively short-lived (see below), whereas the mood change in people with Bipolar Disorder is somewhat less abrupt (erupts over a period of days) and longer-lived.
3. Duration of Symptoms
This (and functional impairment, below) is one area that I think is most ignored when people consider whether someone has Bipolar Disorder or is “bipolar.” The diagnostic criteria specify exactly how long the symptoms occur for a person with Bipolar Disorder. For a manic episode, the person feels “up” and has many of those symptoms listed above for AN ENTIRE WEEK. Seven consecutive days, people. For a hypomanic episode, it’s four days. And for a major depressive episode, it’s TWO entire weeks. By contrast, people with “bipolar” describe feeling “up” or irritable for a few minutes or hours at most and feeling “down” for a day or two. If the symptoms haven’t lasted for a super long time, it’s not Bipolar Disorder. I think people start to get confused distinguishing between “bipolar” and Cyclothymic Disorder because Cyclothymic Disorder doesn’t have those specific duration criteria that Bipolar I and Bipolar II have. But for Cyclothymic Disorder, the person is pretty much always hypomanic or depressed, with very little time spent at baseline.
4. Functional Impairment
Finally, we need to consider how much the symptoms interfere with a person’s ability to function. In Bipolar Disorder, the symptoms have to cause major distress or major problems at work, at home, or in your relationships. Major. Go back and look at those videos of Mary. Can you imagine how hard it would be for her to function at work or for her to get her basic chores done? Major problems. The symptoms are obvious to just about anyone who comes into contact with the person. With “bipolar,” the symptoms are problematic, and their family can certainly notice, but they’re typically not at risk of losing their job, they can typically still get most things done around the house, and they’re not jeopardizing the major progress they’ve made in their lives. They’re moody, but still basically functional.
It’s true both Bipolar Disorder and “bipolar” involve mood swings — but in Bipolar Disorder the person’s mood is swinging over a period of days or weeks from EXTREMELY high to very low, whereas in “bipolar” the person’s mood is swinging over a period of minutes or hours from irritable/depressed to back to normal.
Final Thoughts
Boy, that was complicated. Did you follow it? This is why trained, competent professionals should be doing the diagnosing, not Google. There’s a reason we go to school for so long!
The bottom line is this: Overusing “bipolar” minimizes what is a very serious mental illness that causes major problems in a person’s ability to function effectively in their environments and creates misconceptions about what it really means to have Bipolar Disorder. In addition, when a person with Bipolar Disorder overhears someone who clearly does not experience that condition being labeled “bipolar,” it creates shame, which reinforces stigma and interferes with treatment seeking. “Bipolar” is something entirely different and seems to be describing a relatively severe form of “moodiness.” Having different emotions that change over time, sometimes abruptly, can be a normal part of a person’s psychological experience. Even if a person’s erratic moodiness isn’t exactly normal, this is still something very distinct from Bipolar Disorder. It’s true both Bipolar Disorder and “bipolar” involve mood swings — but in Bipolar Disorder the person’s mood is swinging over a period of days or weeks from EXTREMELY high to very low, whereas in “bipolar” the person’s mood is swinging over a period of minutes or hours from irritable/depressed to back to normal. It may not necessarily be problematic to have two similar terms for two very different things (though this is controversial), but we just need to realize that we’re talking about two different things and clarify when necessary whether we’re talking about “bipolar” or Bipolar Disorder.
If after reading this you believe you do have Bipolar Disorder, get yourself a good psychologist (I happen to know a few…) and a good psychiatrist to discuss your treatment options. Even if you don’t have Bipolar Disorder and have decided you are “bipolar,” that’s worth getting checked out, too. Moodiness, in whatever capacity, makes living life difficult, and there’s no sense in struggling through relationships and life if there is an easier way to exist. Again, get yourself a good psychologist who can show you some tricks to manage your mood better.
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
