Bipolar disorder is a mood disorder whose main symptoms are alternating episodes of depression, with all the symptoms of depression and manic or hypomanic phases.
Patients with bipolar disorder have the following depressive symptoms:
- Extreme negative affectivity: sad, despairing, anxious and hopeless.
- An absence of positive affectivity.
- It is a disorder that affects basic functions, including sleep, appetite, libido, etc.
- There is also a slowing down in psychomotor activity.
Bipolarity: the specific nature of the manic phases
The phases of bipolar disorder referred to as the manic or hypomanic phases are particularly recurrent in people with bipolar disorder.
They have various levels of intensity and are defined by recurring disproportionate feelings such as elation, euphoria and anger. An increase in energy from psychomotor agitation leads to a reduced need for sleep and risk-taking behaviors (taking risks with money, for example with reckless spending and/or sexually risky behaviors).
Between these episodes, there are phases when patients have no symptoms. Episodes can last for a few weeks to a few months, with depressive episodes often lasting longer than manic episodes.
There is no ‘one’ bipolar disorder, but many
It is important to realize that there is no ‘one’ bipolar disorder, but instead many bipolar disorders.
Many patients find that they do not fit the strict ‘textbook’ definition of this disorder, and their diagnosis may be missed if not detected by a professional aware of the existence of a spectrum of bipolar disorders.
As with many psychiatric disorders, there is in fact a spectrum of several disorders that can vary in terms of the predominance of the different phases, the intensity of symptoms, the speed at which the cycles alternate, and even the duration of the stable phases between mood fluctuations (mania or depression).
Bipolar disorders: a chronic illness
Bipolar disorder is a chronic illness that cannot be cured, but which can be treated over the long term.
New episodes of bipolarity are possible throughout a patient’s life. It is, however, often possible to be able to get episodes and symptoms completely under control with the right treatments. Even though the treatments cannot make the disease itself go away, they serve a long-term objective of making the symptoms go away. If treatment is stopped, the disorder returns.
Bipolar disorder is a serious illness, especially given the disabilities caused by the mood fluctuations, together with high risk of suicide: around 5% of patients with bipolar disorder die from suicide.
Bipolar disease should not be trivialized. Bipolar disorder is an illness that causes significant suffering for patients and their loved ones. It is not simply a question of atypical psychological functioning or personality type. It is a condition that requires care, medical treatment and psychotherapeutic management.
Proportion of the population with bipolar disorder
This all depends on how we define it. Cases of typical, ‘textbook’ bipolar disorder, with episodes of depression and mania that are well characterized, represent around 1 to 2% of the population. If we take into account the broad spectrum of bipolar disorder, for example patients who have depressive episodes and atypical reactions to anti-depressants but no clear-cut manic episodes or extreme mood swings (in other words, there are mood fluctuations but they are not of the same intensity as a depressive or manic episode), the population prevalence is likely to be over 5%.
In recent years, we have seen an increase in the incidence of bipolar disorder in literature, not so much because of an ‘epidemic’ of bipolar disorder, but rather because diagnosis is becoming more accurate and we have shifted away from the idea of a single disease towards a spectrum of diseases. Many patients who were previously undiagnosed as having bipolar disorder are now diagnosed.
