Understanding Bipolar Disorder


– Carolyn Moriarty, LCPC

What is Bipolar Disorder?


Bipolar disorder (BP) is a mental health condition characterized by extreme shifts in mood, energy levels and activity levels. These two extreme states of being are known as mania/hypomania and depression.

There are two subtypes of bipolar disorder: bipolar I (BPI) and bipolar II (BPII). The distinction between these two subtypes is based on the specific type of episodes an individual experiences. For this reason, it is helpful to understand each one individually.


Bipolar I

  • Manic Episodes: BPI is characterized by the presence of at least one manic episode.
    • During a manic episode, a manic episode, individuals may experience symptoms such as abnormally elevated or irritable mood, grandiosity, decreased need for sleep, racing thoughts, impulsivity, and engaging in high-risk behaviors.
    • To fit the criteria of a manic episode, these symptoms must last for at least one week (or reach a point where they require hospitalization).
  • Depressive Episodes: Individuals with BPI may also experience depressive episodes, but it is not a requirement in terms of diagnostic criteria. The symptoms experienced in these episodes mimic those found in major depressive disorder. For example:
    • persistent sadness, loss of interest, changes in appetite and sleep patterns, fatigue, feelings of worthlessness, difficulty concentrating, and thoughts of death or suicide.
  • Hypomanic Episodes: individuals with BPI may also experience one or more hypomanic episodes, which are less severe than full manic episodes.
    • Hypomania involves similar symptoms of increased energy, elevated mood, and increased productivity but does not cause significant impairment in functioning or require hospitalization.


Bipolar II

BPII disorder tends to be associated with less severe symptoms compared to BPI.

  • The essential feature of BPII is the presence of at least one major depressive episode and at least one hypomanic episode.
    • A major depressive episode in BPII will have symptoms similar to those found in BPI and major depressive disorder.
    • During a hypomanic episode, individuals with BPII may feel more energetic, creative, productive, or euphoric. They may engage in goal-directed activities and require less sleep. Hypomanic episodes do not cause the significant disruption and impairment seen in full manic episodes, but they can still lead to problems and disruptions in one’s life.


  • No Manic Episodes:
    • Unlike BPI, individuals with BPII do not experience full-blown manic episodes.
    • The presence of a manic episode would indicate a diagnosis of bipolar I disorder instead.


Why is Bipolar Disorder Often Misdiagnosed?


BP is misdiagnosed for various reasons. Here are some factors that contribute to misdiagnosis:

  • Co-occurring disorders: BP often co-occurs with other mental health conditions, such as substance use disorders, anxiety disorders, or personality disorders. The presence of these comorbid conditions can complicate the diagnostic process, as symptoms may overlap or be masked by other conditions.
  • Variability of symptoms: BP can manifest in different ways and can have a range of symptoms. For instance, some individuals primarily experience depressive episodes while others have manic or hypomanic episodes. This variability in symptom presentation can lead to confusion and misdiagnosis.
  • Misinterpretation of symptoms: Because the presentation of BP can vary across individuals, healthcare professionals may interpret symptoms differently. This may be influenced by personal biases, lack of experience with bipolar disorder, or limited understanding of the diagnostic criteria.
  • Time-limited observation: Mental health professionals have limited time with clients during assessments, which can make it challenging to capture the full spectrum of BP symptoms. 

Accurate diagnosis is crucial for determining appropriate treatment strategies, as treatment approaches may differ between the two subtypes. A mental health professional can evaluate and diagnose BP based on a thorough assessment of symptoms, history, and other relevant factors.



Dialectal Behavioral Therapy (DBT)

DBT has proven to be a particularly effective option in treating BP. DBT is a type of cognitive-behavioral therapy (CBT) that incorporates elements of mindfulness, acceptance, and validation. It focuses on helping individuals regulate their emotions, develop coping strategies for distressing situations, and improve interpersonal relationships.

For individuals with bipolar disorder, DBT help with:

  • Emotional regulation: People with BP often experience intense emotional states. DBT can help them learn to identify and manage their emotions effectively.
  • Distress tolerance: DBT teaches skills to cope with distressing situations and emotions without resorting to harmful behaviors.
  • Mindfulness: DBT incorporates mindfulness techniques, which can help individuals become more aware of their thoughts and emotions without judgment.
  • Interpersonal effectiveness: Since BP can impact relationships, DBT can help individuals improve their communication and interpersonal skills.


Cognitive-Behavioral Therapy (CBT)

CBT is an evidence-based treatment strategy, is also integral in treating those with BP. This strategy works to help individuals identify and change negative thought patterns and behaviors. 



Medications like mood stabilizers and selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help manage symptoms of hypomania/mania and depression.





Seeking Mental Health Support

If you or someone you know is dealing with bipolar disorder, t’s essential to seek professional help from qualified mental health practitioners. Consider scheduling an appointment with Chicago Counseling Center. Our therapists can provide personalized treatment recommendations and support. Meet our team to learn more!

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