Bipolar Disorder involves a swing between high and low energy states. When in a high-energy state, people appear happy because they are motivated and excitable. In a low energy state, people feel sad, and lack motivation and enthusiasm. As the energy level of a manic episode increases, the early happy mood tends to change into a more agitated and psychotic state. The person may feel more terrified than happy, but still has a high energy level. As a depressive mood state increases, people may go from just feeling badly about themselves to actually not being able to leave their bed. Therefore, the happy and sad moods that are thought to make up mania and depression are results of different energy states. They are not necessarily primary features of the disorder.
These high and low energy states are often thought of as places that exist upon a scale of energy levels. Manic moods are characterized by high energy states, while depressive moods are characterized by low energy states. Bipolar moods may shift from depressed to manic and back to depressed again. When looking at this on the energy level scale, there is a smooth shifting of the person's energy state moving up and down the energy scale. Each end of this energy scale can be considered to be a pole, or end point (in the same way that the North and South Poles are the end points of the earth). This is where the term "Bipolar" came from as it means involving movement between two poles.
Mania and Manic Episodes
Because high-energy manic states exist on a scale, it is possible for someone to be a little manic or very manic. People who are very manic are said to be experiencing a manic episode. People who are only a little manic are said to be experiencing a hypomanic episode. The term 'hypo' means "under", so the term "hypomanic" means "less than fully manic."
There are defined criteria (in the Diagnostic and Statistical Manual (DSM)) that must be met to say that someone is experiencing a full manic episode. For example, manic episodes must be present for at least one week long before they can be diagnosed. Manic episodes lasting up to several months are possible.
A variety of symptoms are possible during a manic episode. At least three of the following need to be present before the diagnosis can be made:
- an increased sense of self (the person believes they are much better, smarter or more powerful than anyone else around them). This can also happen as a delusional sense of self (the person truly believes they are the president/king/leader in charge of others)
- decreased need for sleep (for example, feeling fully rested after 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- the person feels a sensation of racing thoughts (often called a "flight of ideas")
- distractibility (for example, the person's attention is too easily drawn to unimportant or irrelevant activity happening around them). This can be reported by the person or observed by others around them
- an increase in goal-directed activities (purposeful behavior that happens either socially, at work or school, or sexually), or physical agitation
- excessive involvement in activities that have a high potential for painful consequences (for example, going on a shopping spree, unprotected sex, gambling, poor business investments, etc.)
Manic episodes typically do not come on all at once. Instead, there is a progression of manic symptoms that happen over a period of time. During the early manic phase of a bipolar condition, a person may become highly energetic, have a million ideas, become very talkative, stay up all night, feel sexually and generally potent, and become very productive. As the manic episode progresses and gains in strength, individuals tend to lose their inhibitions and whatever judgment they might normally have, and pursue one or more risky, but immediately pleasurable behaviors. For example, people in a severe manic episode may become sexually promiscuous., leading to becoming pregnant (or getting someone else pregnant) or becoming infected with a sexually transmitted disease. They may spend impulsively on shopping, travel, gambling, or drugs. This can cause massive credit card debts or a trail of bounced checks and large cash withdrawals from the ATM afterwards. In their enthusiasm to socialize, people with mania may chatter on and on about things that are inappropriate to share with strangers, (personal beliefs, sexual experiences, etc.) They may also display inappropriate anger, or agitation, and even lash out and become violent in some cases. For example, a person with mania in a bar might pick a fight for no reason. In the most severe cases of mania, hallucinations, delusions, and psychosis occur, further complicating the situation. The inappropriate and out-of-control behavior of people experiencing a manic episode makes the costs associated with mania sometimes devastatingly high.