Please note that health information can only support the conversation with a psychotherapist or physician: It should never be a substitute for it!

What is bipolar disorder?

Bipolar disorders, or manic-depressive illnesses, are characterised by marked fluctuations in a person's drive, thinking and moods. For instance, people with bipolar disorders go through depressive phases and phases of euphoric or unusually irritable mood. The latter can be accompanied by a clearly increased drive. If these phases are weak, one speaks of hypomanic episodes, while if they are strong, they are termed manic episodes. In severe manias or depressive episodes , symptoms (signs of illness) of a psychosis are also shown, for example delusions of grandeur or paranoia.

In a hypomanic episode, unusually elevated or irritable mood occurs on at least four successive days.

In addition, at least three of the following characteristics are present: increased activity, restlessness, talkativeness, concentration difficulties, reduced need for sleep, increase in libido, careless behaviour, and increased sociability.

Occasionally, creativity and ability can lie clearly above the normal level. The symptoms are not so strong that social consequences such as job loss or exclusion occur.

In a manic episode, mood is unusually elevated or irritable for at least one week and the symptoms constitute a severe impairment to the sufferer's lifestyle. Initially, however, a manic phase can also bring with it an increased ability.

At least three of the following characteristics have to be present: increased activity, restlessness, need to talk, flight of ideas (constant quick talking with abrupt jumps from one theme to the next), the feeling that thoughts are racing, loss of social inhibitions, decreased need to sleep, inflated self-estimation, distractibility, constant changing of activities, daredevil or reckless behaviour, increased libido.

How frequently do bipolar disorders occur?

One to 3 out of 100 people suffer from a bipolar disorder in the course of their lives. In contrast to purely depressive illnesses, men and women are affected equally often. Frequently, in people with bipolar disorders, further mental illnesses are present, such as anxiety, obsessive-compulsive and addictive disorders, personality disorders or attention deficit / hyperactivity disorder (ADHD).

Bipolar illnesses can affect anybody and predominantly begin in early adulthood, around the age of 18. But also later in life, sometimes triggered by a life crisis or situation of upheaval, this type of mental illness can develop.

Are there different forms or progressions?

With a bipolar I disorder, sufferers have marked manias and depressions; with a bipolar II disorder, depression also occurs, but alternates with weaker manias, the hypomanias.

If a person suffers for over two years from strong mood swings, but which are not as strong as in depressive-manic phases, this is called cyclothymia. This is a weaker form of bipolar disorder. If more than four illness episodes per year are present, one speaks of a "rapid-cycling course".

In bipolar I disorder, several episodes occur in over 90 out of 100 sufferers. In most cases, people with bipolar disorders experience far more depressive than manic episodes. Depressive Episodes often characterize the course of the illness and can lead to severe impairment, loss of funtioning and of quality of life. A person who is suffering from bipolar I disorder experiences on average around eight phases of illness. The progression differs greatly from person to person and depends on various factors – including the age when the illness began, gender, or whether other mental illnesses are present.

The risk of suicide is 20 to 30 times higher than in healthy people. Around 25 to 50 out of 100 sufferers attempt suicide at some point in their lives, and around 5 to 15 out of 100 die as a result of a suicide attempt.

Suicidal thoughts or announcing the intention to commit suicide should always be taken seriously. Eight to 9 out of 10  suicides are announced in advance. In the case of acute suicidal thoughts, therapeutic help should be sought as a matter of urgency. "Acute" means that a person is concretely intending to his own life and is planning how he will do so. However, for the sufferer, getting help is often very difficult.

How does a bipolar disorder emerge?

As yet, no clear cause has been established. Currently, a so-called multifactorial process is assumed. This means that several factors in different combinations come into question as a cause. These include biological causes such as changes in genes and in the neurotransmitter system of the brain or hormonal changes.

Equally, environmental factors such as persistent stress, early experiences of loss or traumatic experiences such as sexual, emotional or physical abuse play a role.

Against the background of such factors, people have differing levels of susceptibility to mental illnesses. If, for example, a burdensome life event is added to these factors, in some people it can be the trigger for a mental illness such as a bipolar disorder.

How do you find out if you are suffering from a bipolar disorder?

In many cases, it is the family members who urge the sufferer to have the "extreme" mood swings checked out. The diagnosis of a bipolar disorder is a "clinical diagnosis", meaning that there is no lab value which could provide information about the presence of the illness.

To determine whether a person really has bipolar disorder, a detailed conversation with a psychiatrist or psychotherapist is necessary. Here it is helpful – as long as the patient agrees – to integrate family members or friends into the diagnosis. In this way, the therapist gains important additional information which he can use to assess the course of the illness so far. Indeed, often, what the sufferer experiences can differ very strongly from the perceptions of those around him.

In addition, an examination (e.g. blood analysis, magnetic resonance imaging) is used to rule out any physical cause of the changes, such as a thyroid disorder.

How is a bipolar disorder treated?

Self-control and self-responsibility by the patient can bring about more than was long assumed. To this aim, people with bipolar disorder generally begin psychotherapy or receive psychoeducation – often with accompanying medication support. The goal is to alleviate current burdens of a phase of bipolar disorder and to prevent future ones. Medications cannot completely prevent re-occurring bipolar episodes, but they can make them milder or prolong the time until the next episode.

Psychotherapy is seen as very effective. This applies above all when they take into account the personal problems and strengths of the patient and integrate his family members. Wherever possible, this should happen from the start of the therapy – provided the patient agrees. Often, a combination of medication and psychotherapy is necessary and useful in order to begin an appropriate therapy.

What can friends and family do?

The different episodes of bipolar disorder are very burdensome for family and close friends. Becoming well informed about the illness, preferably together with the partner or family member affected, makes it easier to cope with the often contradictory remarks and behaviours as well as the strongly fluctuating moods.

In order to cope with psychological crises during a phase of illness, family members need to be both composed and attentive, have to find a balance between affection and isolation, empathy with the sufferer and feedback about what it triggers in them.

Keeping this balance is a lengthy process which requires a great deal of patience. Self-help groups for family members offer support and impulses in order to deal with the illness.

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