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Bipolar disorders

 

 

Bipolar disorder involves strong mood swings with an alternation between being completely down and depressed to having an explosive surplus of energy. The word bipolar therefore refers to suffering from problems in two poles (outer edges). If you or someone you know have bipolar disorders there are ways to get help. 

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In this article you can learn about bipolar disorder, and some of the options to get help.

The British Psychological Association published the report in 2010 Understanding Bipolar Disorder: Why some people experience extreme mood states and what can help [BPS, 2010][1] . Here you read a summary of how we can understand bipolar disorder, and what can be helpful.

 

About the diagnosis of bipolar disorder

A person with a bipolar disorder can range from depressed, depressive moods characterized by sadness, energy deficiency and hopelessness to go into excited, manic moods characterized by extreme energy levels and limitlessness for better or worse.

In the Understanding Bipolar Disorder-report it is pointed out that it is relatively common to experience depression and also periods of agitation and high activity levels.

When we have such mood swings or mood swings, it is also common that they affect our self-esteem and our view of ourselves. For example, it is common that at times we have great faith in our own abilities and what we can achieve, while other times we can be completely unsuccessful.

For some people, however, episodes of extreme moods can be so severe that either you or someone around you seeks help for the problems. In mental health care, such conditions are often understood as a mental disorder: more specifically, a bipolar disorder.

 

For many, the diagnosis is temporary

Bipolar disorder often occurs in late adolescence or early adulthood, and around 1 to 1,5% of the population is diagnosed with bipolar disorder during their lifetime.  

Despite widespread assumptions both within mental health care and in the general population that bipolar disorder has a chronic course, it turns out that around 60% of those who are diagnosed do not get new ones. relapse, and that half of those who are diagnosed are able to return to their normal lifestyle (work, social life, etc) during a 2-year period.

One of the reasons why bipolar disorder has an undeserved bad reputation may be that the focus has been on people with the most severe cases of bipolar disorder, while the significant amount of people who manage to live well with their extreme mood swings is more often overlooked. There is a clear tendency that many people with symptoms of bipolar disorder, whether they have been diagnosed or not, have a lot of energy and can be both very creative and very productive.

 

A continuum of bipolarity

Understanding Bipolar Disorder-the report says that it can be useful to look at the mentioned problems as part of a continuum, a spectrum, where we all have fluctuations in mood, but where people in one outer edge of the spectrum experience few ups or downs, and where people in the other end of the spectrum tends to experience repeated extreme mood swings.

There can be both advantages and disadvantages to being high up in the bipolar spectrum, where the extreme mood states are considered an expression of a bipolar disorder. The report states: 

For example, people who experience extreme mood swings can tend to be very creative, have periods of high energy, and can often be people who perform very well. But the same people can also have some problems, for example, in periods of excitement you can do things that you later regret, such as spending too much money.

It is also emphasized that experiencing extreme moods can be perceived in different ways by those who feel this way. Some people find it helpful to think about themselves as suffering from an illness, while others prefer to think that these mood swings are part of their personality that sometimes gets them in trouble, but which they do not want to be without.

 

 

  1. Torn: A family's fight against bipolar disorder

    Film: Youtube

  2. Up / Down: A documentary about bipolar disorder

    Film: Youtube

 

Causes of bipolar disorder

Both social, psychological and biological conditions can help explain why some people develop a bipolar disorder, according to the report from the British Psychological Association.

 

Social factors in bipolar disorder

People in difficult life situations are more likely to experience all kinds of mental health problems. The same applies to people who have had a difficult childhood, the report emphasizes.

Having a supportive network of family and friends may make mood swings less likely to return. The same is true with the opposite sign: For people who live close to family members who are either highly critical or overprotective, they are more likely to have more long-term difficulties.

Including the family in the therapeutic work around the person with bipolar disorder is therefore recommended, and regardless of taking into account the person's current life situation when offering help.

 

Psychological factors in bipolar disorder

Psychological factors are highlighted in the understanding of bipolar disorder, by the report of the British Psychological Association.

When people are depressed, they tend to see the negative in everything, including themselves, and this can lead to a vicious circle that prevents depression from escaping. Conversely, when people are very active and experiencing excitement, it is natural to want to look at this as "the real me" and to just "run on" to do even more. It has been documented that these thinking styles are particularly marked in people with such strong moods that it qualifies for a bipolar disorder.

Learning to become aware of one's own thought patterns and thinking styles, and based on this knowledge to implement measures, can be preventive in relation to how much damage the bipolar disorder should be able to do.

An example would be to use cognitive techniques to stop oneself from thinking self-destructive thoughts. Another example might be that one can learn to recognize when the mind is raging away, and instead of indulging in manic behavior, to take action on how to rest.

 

Biological factors in bipolar disorder

Hereditary and biological factors play a role in bipolar disorder.

Those who have siblings or parents diagnosed with bipolar disorder are even more than ten times more likely to get the diagnosis compared to someone from a family without the occurrence of bipolar disorder.

Although various research findings have been made that give some indications of different brain functions in people with bipolar disorder, the report points out that there is still a long way to go before one can fully understand how genetic conditions affect the development of bipolar disorder.

 

Help and treatment for bipolar disorder

The Understanding Bipolar Disorder report further provides the following advice for the help and treatment of bipolar disorder. 

 

Assessment of the difficulties

The person with the mood swings himself, or his / her family and friends, are usually the first to notice the problems, and who take the initiative for the person to seek help from their doctor. The doctor will then be able to refer on to the specialist health service if he / she considers the difficulties to be so significant that there is a suspicion of a bipolar disorder.

It is important that a thorough assessment is made that covers the person's life situation, his / her view of the problem, coping strategies, strengths, and available support in the person's social network.

Assessment of suicide risk will be important in people with strong mood swings, as people with bipolar disorder have a higher risk of suicide.

 

Help to lead oneself

Over time, many people will learn to recognize danger signs that their mood may go up or down, and what they can do to prevent further deterioration. The opportunity to talk to a mental health worker or in a self-help group can be a great help in this process of getting to know yourself and your signals better. 

 

Psychological treatment

Psychological treatments may include psychoeducation, cognitive behavioral therapy, interpersonal therapy, and family-focused therapy. All these forms of therapy can give the person the opportunity to discuss their experiences within a predictable, calm and non-judgmental framework. The therapy can help them find out what is causing the problems, and can help the person to develop strategies to prevent further development of the problems.

It is important to tailor the treatment to suit the individual, as no two people with bipolar disorder are exactly alike. Part of the psychological treatment will therefore lie precisely in mapping out what is particularly important to work with for the person in question seeking help, and in adapting the treatment hereafter.

 

Orange glasses

A new exciting study done by PhD candidate and psychiatrist Tone Elise Gjøtterud Henriksen has also shown very promising treatment results when using orange glasses. The reason is that people with bipolar disorder can react strongly to blue light. By wearing orange glasses that dimmed this light, the manic periods dramatically decreased in duration.

 

Medications

Treatment through medication is common for people with bipolar disorder. The report from the British Psychological Association says:

Medications given in treatment for bipolar disorder can be divided into three categories: mood stabilizers, anti-depressants (for depression), and neuroleptics (for mania). Doctors usually recommend that people take medication every day, even when they are feeling well, and sometimes for years after an episode.

Medication is useful for many, but not for all people diagnosed with bipolar disorder, which is important to consider in treatment.

Each person must weigh the pros and cons of taking medication. For example, medications can help prevent problems from returning, but they can also have unwanted side effects that can negatively affect aspects of life that are particularly highly valued by the individual, such as periods of creativity. The use of medication can also for some people create difficulties related to their own identity.

In other words, the report from the British Psychological Association emphasizes that medication can be useful for many, but that it should not be the only solution at all - and that this solution does not suit everyone either:

Traditionally, medicine has often been the only type of help offered. Some people, but not all, find this helpful. For those considering using medication, a "try out" approach may be necessary to determine which medications may be helpful (if one finds such medications) and, if so, at what dose. There is a growing degree of research evidence that conversational therapy (especially cognitive behavioral therapy) and self-help (especially assisted self-help or affiliated with a self-help group) can also be very useful. 

 

Recovery

Focus on recovery (or recovery) is also recommended in the face of people with bipolar disorder. Recovery can be understood in many ways, but will usually involve an emphasis on what provides quality of life and a meaningful life despite the difficulties that result from bipolar disorder. It will be different from person to person what contributes to giving a good, meaningful and active life, and a close dialogue with the person and their network will therefore be crucial.

 

 

Different forms of help

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][2] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][3] .

     

  3. Support / self-help groups

     

    find-help-mental-health-problems

     

    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][4] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][5] .

     

  5. Online communities and forums

     

    find-help-mental-health-problems

     

    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][6] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

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References & Footnotes
  1. BPS, 2010: British Psychological Society (2010). Understanding Bipolar Disorder. Retrieved 9th of February 2021 from: https://nhsforthvalley.com/wp-content/uploads/2014/01/Understanding-Bipolar-Disorder.pdf
  2. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  3. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  4. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  5. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  6. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.