About Bipolar Disorder
Written by Dr. Pamela Heilman, PsyD, LCP
About Bipolar Disorder
In any given year, approximately 5.7 million American adults (about 2.6 percent of the population) have bipolar disorder (International Bipolar Foundation). It is estimated that people with bipolar disorder have an increased risk of suicide compared to the general population, with some research suggesting that up to 20% of individuals with bipolar disorder (especially if left untreated) end their life by suicide (Dome, Rihmer, & Gonda, 2019).
Correct diagnosis of bipolar disorder is essential for developing an appropriate treatment plan. Proper diagnosis involves doing a thorough clinical interview which is likely to include various assessments and coordination of care with other providers.
Bipolar I disorder is diagnosed when an individual meets criteria for at least one manic episode. When an individual meets criteria for at least one hypomanic episode and one depressive episode, bipolar II is diagnosed. More information on diagnosing bipolar disorder can be found in my Monday Facebook blog post.
Evidence-based treatment for bipolar disorder involves a combination of medication and Cognitive-Behavioral Therapy. Other effective treatment interventions may include ACT and DBT strategies.
Some of the medications that have been found to be effective in treating bipolar disorder include: lithium, anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers (Fast & Preston, 2006). It will be important to work with your doctor to determine what medication regimen will work best for you. Your therapist can work with you to help identify important questions to ask regarding your medication. Important facts about your medication include: what drugs you are taking, specific symptoms they are treating, recommended dosage, any potential interactions, and their side effects (Fast & Preston, 2006). Additionally, it is important to consult with your doctor prior to taking any supplements. There are certain over-the-counter supplements which can cause serious problems for individuals with bipolar disorder. For example, anything that reduces depression such as SAM-e and St.-John’s-wort, can potentially provoke a manic episode (Fast & Preston, 2006).
When managing mental or physical health problems, lifestyle changes are often necessary. If an individual is diagnosed with diabetes or heart problems, it is important to develop a healthier lifestyle. The same is true when managing mental health issues such as depression, anxiety, or bipolar disorder.
Cognitive-behavioral therapy (CBT) includes the following strategies: psychoeducation, identification of triggers, thoughts, feelings, and behaviors associated with symptoms, and implementation of proactive measures and coping strategies. Cognitive-restructuring is a CBT strategy that involves identifying distorted thinking that exacerbates problems. Your therapist will spend time helping you to develop more balanced, realistic thoughts. Significant time is also spent identifying and altering behavior that exacerbates symptoms.
Development of a wellness plan is a preventive strategy that increases awareness of symptoms and how to manage them effectively. Items that are typically included are: symptoms, triggers, warning signs, medications, support system, and lifestyle changes. Once this plan is developed, your therapist may help you identify trusted individuals with whom you can share this plan. Many clients need the assistance of support people to help them recognize warning signs and problematic behaviors.
Regular risk assessment is part of treatment for bipolar disorder. This includes assessing for suicidal thoughts, plans, or intentions, as well as self-harm urges or other risk-taking behaviors. Safety plans entail steps that can be taken when a client feels unsafe. These are often developed in treatment as part of the wellness plan.
Various Acceptance and Commitment Therapy (ACT) strategies can also be useful in therapy. Clients can experience feelings of guilt and shame about what happens during various mood episodes. Learning and practicing self-compassion can be an important part of their treatment. Additionally, assisting clients in identifying their values and behaviors that honor those values can help clients adhere to their wellness plan.
Clients often benefit from distress tolerance strategies. Urge-delay is a strategy that can be used to help clients refrain from engaging in self-destructive behaviors. The clinician may guide the client in creating a coping card containing healthy alternative behaviors. When a client experiences a self-destructive urge, they are instructed to set a timer, usually for at least 20 minutes, and then choose from the healthy behaviors listed on their card.
Grief and Bipolar Disorder
Many clients experience grief associated with their diagnosis of bipolar disorder. Part of treatment should allow clients to grieve losses associated with their diagnosis. These losses can be personal and professional. Individuals may mourn the loss of their former identity prior to the diagnosis.
It can be daunting to receive a diagnosis of bipolar disorder. The good news is that it is very treatable. With the help of a proper medication regimen and treatment plan, individuals can lead productive and fulfilling lives.
Listed below are some resources that may help supplement treatment for bipolar disorder.
Depression and Bipolar Support Alliance (DBSA): https://www.dbsalliance.org/
International Bipolar Foundation: https://ibpf.org/about-bipolar-disorder/
If you or someone you care about is thinking of harming themselves, it is imperative to seek immediate assistance. Options include:
American Psychiatric Association. (2022). Bipolar and Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Fast, J.A. and Preston, J. (2006). Take charge of bipolar disorder: A 4-step plan for you and your loved ones to manage illness and create lasting stability. Grand Central Life & Style Hachette Book Group.
Healthline. (2022, July 26). Suicide and bipolar disorder: Symptoms, Treatment, and Prevention. https://www.healthline.com/health/suicide-and-bipolar
International Bipolar Foundation (n.d.) What is bipolar disorder. https://ibpf.org/about-bipolar-disorder/