Line #58 UsefulNotes/BipolarDisorder


1	->''"And when you're up, you're up\
2	and when you're down, you're down\
3	and when you're only halfway up,\
4	you're neither up nor down."''
5	-->--'''The Grand Old Duke of York,''' ''Traditional Nursery Rhyme.''
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7	Also known as Manic Depression.
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9	Most of the time, when a character is portrayed as having bipolar disorder, they are usually shown as being uncontrollable, {{hair trigger\| temper}} {{Mood Swinger}}s - swinging from affable and pleasant to suicidal or raging in the space of minutes. Or, in contrast, a character will be called bipolar if they are moody, but are never shown actually suffering from their mood swings. Either way, as the disorder is only rarely portrayed in the media beyond these and other unrealistic, simplified forms, most people are unaware that in reality, bipolar disorder is a complex, multifaceted illness.
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11	In the most basic sense of the term, bipolar disorder is defined by the presence of mania. This means that someone who is depressed for the vast majority of the time but has had a single manic episode is as bipolar as the rapid cycler who goes through different moods in months, weeks, or even days. As you can see, this definition still leaves a lot of room for all the forms bipolar disorder can take.
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13	Bipolar disorder is essentially a cycling disorder. Someone with it is assumed to always be in a state of flux, cycling from one mood state to another - technically meaning that someone can never recover from bipolar disorder, but only be 'in remission.' These cycles can speed up and slow down abruptly, ranging anywhere from one episode of mania/depression every few years to one every other ''minute'' (this is called Ultradian cycling, and is so rare it is suspected that it may be its own illness altogether.) Moreover, the extent and severity of the moods that a sufferer goes through can vary. The DSM lists three different varieties of bipolar disorder:
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15	* '''Bipolar I Disorder''', which is defined by the presence of full-blown manic episodes - depression is not required for diagnosis, but almost always occurs;
16	* '''Bipolar II Disorder''', where milder ''hypomanic'' episodes occur instead, but often with longer and more severe depressions;
17	* and '''Cyclothymia''', which has hypomanic episodes and milder episodes of depression called dysthymia.
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19	A good metaphor for the inner life of a bipolar individual is a roller coaster. At various points in the track, the rider can be moving fast or slow, and up and down, in various combinations. A bipolar person has no control over when their mood swings occur, but swings can be triggered by things like overstimulation, drug use, and positive or negative experiences. While a "normal" individual may experience such highs and lows, in the bipolar individual emotional shifts are far more [[MoodWhiplash sudden]] and extreme, and are only tangentially related to the events experienced by the bipolar individual: The upsurge after a promotion at work may trigger an immediate crash into depression, the loss of a job may trigger a counter-surge of [[JustIgnoreIt devil-may-care optimism]]. For the most part the symptoms of bipolar disorder are governed by semi-regular cycles, and many who are aware they have the disorder take steps to preserve routine and keep this modicum of stability.
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21	!!Suicide
22	People diagnosed with Bipolar disorder are statistically more likely to attempt or commit suicide than those with most other disorders, including regular depression. This is not limited to just the depression, or "down" part of the cycle. Those experiencing a manic episode, or "up" are also at risk as they are more likely to be impulsive during these times and not think about consequences when in the heat of the moment.
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24	!!Challenges For Diagnosis
25	While becoming less of an issue as public awareness and professional understanding of the disorder rises, there are many challenges to diagnosing bipolar disorder. By its fluid, intermittent nature it is easy for the disorder to be mistaken for other issues, or missed entirely until an extreme manic phase reveals the true nature of the problem.
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27	There are several gender specific issues in the diagnosis of Bipolar disorder, not least that the HystericalWoman trope frequently leads to dismissal of even blatant symptoms in women. Even in a professional context, extreme bipolar disorder is difficult to differentiate from borderline personality disorder, clinical depression, or even abnormally extreme PMS. [[note]]Yes, this can be a thing. The fact that hormonal shifts are yet another of the many triggers for a phase shift doesn't help matters any.[[/note]]
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29	While women are more at risk of having symptoms misdiagnosed or dismissed, bipolar men in both Eastern and Western cultures can are more likely to go completely undiagnosed. A facade of [[TheStoic stoicism]] is a hallmark of depression in many men, and the manic phase can be taken as a HotBlooded BrokenAce "getting their act together" for a time- both of which are seen as positive attributes in men. This often leads to the man working hard to cover his UnmanlySecret of inner emotional turmoil, sometimes even from himself: many men self-medicate with drug abuse, alcoholism, and [[LookingForLoveInAllTheWrongPlaces other high risk, "manly" behaviors]] to try to "snap themselves out of it".
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32	The cyclical nature of the disorder can also mask the disorder in both genders if a doctor only sees an individual at particular points in their cycle [[note]]IE they only feel confident enough to bring up emotional issues in an "up" phase, or bad enough to go to the doctor in a down phase.[[/note]].
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35	Finally, in both genders, there is a tendency to either [[TheUnfettered give in completely to ones own chaotic emotions and impulses]], often on the misguided advice to BeYourself [[note]]the problem being that a bipolar person has shades of "me", and not all of them are [[EnemyWithin healthy to indulge]][[/note]] or decide that their fluctuating emotions cannot be trusted and attempt to [[EmotionSuppression suppress them entirely]]. Both of these can further mask the disorder as impulse control issues, or antisocial behaviors.
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37	!The Various States of Bipolar Disorders
38	But what exactly do we mean by mania and depression? In the context of bipolar disorder, these are both abnormal and often disabling mood states, much more severe than anything a healthy person would go through for any prolonged period of time. They do not merely affect mood, but impact every part of how a sufferer thinks, perceives and interacts with the world, and in many cases even biological rhythms like sleep cycles, metabolic rate, blood pressure, and even body temperature. The name "bipolar" is actually somewhat of a misnomer: there are several states commonly experienced by bipolar individuals, with the manic and depressive states only being the two most extreme and recognizable.
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42	!!Hypomania
43	The best comparison of hypomania for those who are not bipolar is an adrenaline rush or extreme stimulant use. If you have ever had any sort of "mountain top experience", had way, way too much caffeine, or chain-smoked cigarettes, you have had an experience similar to a brief bout of hypomania-except that hypomania typically lasts anywhere from [[HourOfPower several hours to several days]].
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45	Hypomania is essentially very similar to TheMadnessPlace trope- it is characterized by intense focus on tasks, HyperAwareness; high mood and energy; extreme levels of optimism, creativity, productivity, and inner motivation; [[{{Determinator}} high mental endurance]], and reduced sleep cycles. This, to some, may sound desirable, or even pleasant. Indeed, it is true that many successful artists, inventors, and entrepreneurs have been formally diagnosed as bipolar, and one of the most common motivations for bipolar individuals who stop taking their medication is missing the "rush" of hypomania.
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47	The catch, however, is that [[DeadlyUpgrade humans don't handle being overclocked and run at full capacity for days on end any better than computers do]], and that the '''''entire''''' [[TheMadnessPlace madness place trope]] applies, including [[NoSocialSkills the issues it causes with relationships]] and neglecting their own health in the name of pursuing their goals. This is particularly true when it spills over from hypomania into full mania.
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49	!!Mania
50	Mania is described by the DSM as at least a week (or any amount of time that requires hospitalization) of "severely elevated mood and energy."
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52	If hypomania is comparable to having had too much caffeine, a full manic state would be comparable to the effects of a high dose of amphetamines or cocaine- but with the effects lasting for days. The manic individual has a very short attention span for anything outside of whatever they are currently fixated on, including things like [[ForgetsToEat eating]] and [[TheInsomniac sleeping]]. They have little impulse control with regard to their fixations- many find themselves spending everything they have on a whim that they rapidly forget about; compulsively pursuing a task to completion with no regard to whether it is [[{{Workaholic}} productive]], [[JustOneMoreLevel unproductive]], or [[PolishTheTurd simply inane]]; or giving in completely to hedonistic behavior. The manic frequently experiences what is known as "Megalomania"- the feeling that they are [[AGodAmI invincible and can accomplish any task]].
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54	Much of the HollywoodPsych behavior [[TheSchizophreniaConspiracy attributed to Paranoid Schizophrenics]] is actually result of a person with both paranoid schizophrenia (or just simple paranoia) ''and'' bipolar disorder [[note]]the two conditions are known to share certain genetic markers[[/note]] a week of living with racing thoughts and [[TheInsomniac no sleep]] gives plenty of time to build a RoomFullOfCrazy, and would make it hard for ''anyone'' to tell reality from their own delusions or [[WordSaladPhilosophy construct coherent sentences]]. It’s no wonder they have to [[StringTheory plot everything out with string]] to keep track of it all. To make matters stranger, even a diagnosed individual aware of their condition [[ThroughTheEyesOfMadness may not be aware]] that they've transitioned from a hypomanic phase into a full manic phase: the same tunnel vision that gives them focus prevents them from noticing or caring about things like that they haven't slept in three days, so it's easy for those with more extreme bipolar disorder to begin with a perfectly reasonable task in mind and end deep in the madness place.
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56	While Bipolar II Disorder normally does not have manic episodes, mania '''can''' be caused by antidepressants. Since bipolar II is often misdiagnosed as major depression, this naturally tends to lead to unexpected and unpleasant issues once the antidepressants take effect.
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58	!!Depression
59	What goes up, must come down.
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61	When a Bipolar person does crash, the landing is often hard. The depressive state can be thought of as the natural result of the manic state's overclocking of the mind and body- [[HeroicRROD after running for so long at full tilt, it takes time to recover]] during which time they are BroughtDownToNormal. Given the contrast to high of the manic state, it's little wonder the bipolar person is left feeling dejected, burnt out, and uninspired, and often [[MyGodWhatHaveIDone regretting impulsive decisions]] and [[TheAtoner damaged relationships]] of the manic phase. This leads many to self-medicate with stimulants and alcohol, to artificially extend or trigger the manic phase and blunt the misery of the depressive phase.
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63	Some bipolar individuals also experience depressive phases prior to their manic phases- this is hypothesized to either be the body and mind "charging up" for the manic phase, or possibly a minor depressive phase triggering a [[DisproportionateRetribution much larger counter-mood swing]].
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65	!!Mixed States
66	Most with Bipolar Disorder actually spend most of their time in something vaguely resembling a neutral, relatively normal, state. It’s only when the metaphorical roller coaster hits an extreme extreme hill or drop that a series of manic and depressive phases occur. In many cases, the name "bipolar disorder" is a [[NonIndicativeName misnomer]], because the experiences are not a simple matter of pure off and on.
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68	A mixed state is a bipolar episode in which a person experiences mixed aspects of mania and depression at the same time. It can range from experiencing energy without joy, which leaves them feeling like they're going too fast, to being [[CryLaughing happy and sad]] at the same time, to being [[WhileRomeBurns content to do nothing at all]]. These states tend to be the most dangerous and unpleasant for the bipolar individual: the prolonged MoodDissonance one experiences can be a grating MindScrew, [[note]]sometimes bordering on self imposed MindRape[[/note]] and the inherent issues of combining a [[TranquilFury misanthropic mood and low energy]], [[TheUnfettered emotional burnout and intense focus on a goal]], or [[DeathSeeker lack of concern for one’s own life]] and SuicidalOverconfidence are obvious.
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Context UsefulNotes / BipolarDisorder