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This Web site is a component of the SAMHSA Health Information Network. |
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Evidence-Based Practices: Shaping Mental Health Services Toward RecoveryIllness Management and Recovery WorkbookHandout 2b:
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| Bipolar disorder is a major mental illness that affects many aspects of a person’s life. |
| 1 in every 100 people develops bipolar disorder at some point in his or her life. |
| People can learn to manage the symptoms of bipolar disorder and lead productive lives. |
Question: What did you know about bipolar disorder before you
had personal experience with it?
How is bipolar disorder diagnosed?
Bipolar disorder is diagnosed based on a clinical interview conducted by a specially trained professional, usually a doctor, but sometimes a nurse, psychologist, social worker or other mental health practitioner. In the interview, there are questions about symptoms you have experienced and how you are functioning in different areas of your life, such as relationships and work.
There is currently no blood test, X-ray or brain scan that can be used to diagnose bipolar disorder. To make an accurate diagnosis, however, the doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of symptoms, such as a brain tumor or an injury to the brain.
| Bipolar disorder is diagnosed by a clinical interview with a mental health professional. |
Question: How long did it take for a mental health professional
to accurately diagnose the symptoms you experienced?
What are the symptoms of bipolar disorder?
It is important to keep in mind that the symptoms of bipolar disorder can be found in other mental disorders. Specifying a diagnosis of bipolar disorder is based on a combination of different symptoms, how long they have been present, and their severity. Symptoms that occur only when a person has used alcohol or drugs are not included.
No one has the exact same symptoms or is bothered to the same degree. You may, however, recognize having experienced some of the following symptoms:
Extremely high moods are called “mania.”
People who have had periods of mania have reported the following symptoms:
Feelings of extreme happiness or excitement. “I was so happy with my life; I felt like I was on top of the world. I thought the whole world loved me and worshipped me.”
Feeling irritable. “I thought I had a brilliant plan for making thousands of dollars. I got very irritated when people asked questions that seemed to doubt me.”
Feeling unrealistically self confident. “I sent a hand written script to Steven Speilberg. I was absolutely sure that he would buy it immediately for his next movie.”
Sleeping less. “I felt like I only needed two hours of sleep a night. I was too excited to sleep any more than that.”
Talking a lot. “People told me I was talking all the time; they couldn’t get a word in edgewise. I couldn’t seem to stop myself because I had so much to say.”
Having racing thoughts. “My head was so full of thoughts I couldn’t keep up with them.”
Being easily distracted. “I couldn’t concentrate on what my English teacher was saying because I was distracted by every other sound—the ticking of the clock, the air conditioner humming, a car driving by, someone walking by in the hall, a bird singing outside the window. It was overwhelming.”
Being extremely active. “Sometimes I would work 20 hours a day on my inventions. Or I would re-arrange every stick of furniture in my house—then change it again the next day.”
Having bad judgment. “I thought nothing bad could happen to me, so I spent everything in my bank account, borrowed from everyone I knew, then ran up all my charge cards. I also had a one night stand with someone that I didn’t know at all—I was lucky he didn’t have AIDS or something.”
Extremely low moods are called “depression.”
“Depression” is defined as including:
Sad mood. “I couldn’t see anything positive in my life. Everything seemed dark and negative.”
Eating too little or too much. “When I am depressed, I lost all interest in food. Nothing looks good and I hardly eat anything. I lost ten pounds the last time.”
Sleeping too little or too much. “I had a lot of trouble falling sleep at night. I would lay awake for hours, tossing and turning. Then I would wake up at 4:00 AM and not be able to go back to sleep. Other people I know with depression have the opposite problem. They feel like sleeping all the time—they spend 12 or more hours a day in bed.”
Feeling tired and low energy. “I dragged myself to work each morning, but I could barely answer the phone once I got there. Everything seemed like such an effort.”
Feeling helpless, hopeless, worthless. “I broke up with my boyfriend because I thought I was a loser and he shouldn’t be stuck with me. He deserved better. It seemed like nothing I did turned out right. I saw nothing but heartache in my future.”
Feeling guilty for things that aren’t your fault. “I started feeling responsible for all kinds of things: my brother’s having cerebral palsy, the car accident that happened in front of my house, even the hurricane that blew the roofs off the buildings down in Florida. Somehow I thought it was all my fault.”
Suicidal thoughts or actions. “When I reached the bottom, I felt that the only way out was to leave this world. I thought my wife and kids would be better off without me. Luckily I didn’t do anything to hurt myself, although I considered it.”
Trouble concentrating and making decisions. “It took me over an hour to read a one page letter from my bank. I couldn’t keep my mind focused. And one day I couldn’t go to work because I couldn’t decide what shirt to wear.”
Symptoms which make it hard to know what’s real are called “psychotic symptoms.”
Some people with bipolar disorder have psychotic symptoms. They have described the following experiences:
Hearing, seeing, feeling or smelling something that is not actually there (“hallucinations”). “I heard different kinds of voices. Sometimes the voices were o.k., just making comments like ‘now you’re eating lunch.’ But sometimes the voices said things like ‘you’re stupid; no one wants to be friends with such a loser.’ Or they might say scary things about other people, ‘he has a knife and wants to kill you.’”
Having very unusual or unrealistic beliefs that are not shared by others in your culture or religion (“delusions”). “I was convinced that I had special mental powers that could stop missiles in their tracks. I thought the FBI was after me because they wanted to control these powers. I even thought the TV was talking about this.”
Confused thinking (“thought disorder.”) “I used to try to tell my sister what I was thinking, but I would jump from topic to topic and she told me she had no idea what I was talking about.”
The major symptoms of bipolar disorder
are mania, depression, and psychotic symptoms. |
No one has exactly the same symptoms or
experiences them to the same degree. |
Question: Which of the symptoms have you experienced? You can use the following
checklists to record your answer.
Symptoms of Mania
| Symptom of Mania |
I had this symptom |
Example |
| Feeling extremely happy or excited |
||
| Feeling irritable |
||
| Feeling unrealistically self confident |
||
| Sleeping less |
||
| Talking a lot | ||
| Having racing thoughts |
||
| Being easily distracted |
||
| Being extremely active |
||
| Having faulty judgment |
Symptoms of Depression
| Symptom of depression |
I had this symptom |
Example |
| Sad mood |
||
| Eating too little or too much | ||
| Sleeping too little or too much | ||
| Feeling tired and low energy | ||
| Feeling helpless, hopeless, worthless | ||
| Feeling guilty for things that weren’t my fault | ||
| Suicidal thoughts or actions | ||
| Trouble concentrating & making decisions |
Symptoms of Psychosis
| Symptom of psychosis |
I had this symptom |
Example |
| Hearing, seeing, feeling or smelling something that is not actually present |
||
| Confused thinking | ||
| Having very unusual or unrealistic beliefs that are not shared by others in my culture |
What causes bipolar disorder?
Bipolar disorder is nobody’s fault. This means that you did not cause the disorder and neither did your family members or anyone else. Scientists believe that the symptoms of bipolar disorder are caused by a chemical imbalance in the brain. Chemicals called “neurotransmitters” send messages in the brain. When they are out of balance, they can cause extreme shifts in your mood. This chemical imbalance can also cause the brain to send messages that contain wrong information.
Scientists do not know what causes this chemical imbalance, but they believe that whatever causes it happens before birth. This means that people have a “biological vulnerability” to develop bipolar disorder, which then develops at a later age.
In addition to biological vulnerability, stress is also believed to play a role in the onset and course of bipolar disorder. The theory of how vulnerability and stress interact with each other is called the “stress-vulnerability model” and is covered in more detail in the handout “The Stress-Vulnerability Model and Treatment Strategies.”
Many questions about bipolar disorder remain unanswered. There are many research projects underway to try to learn more about the illness.
Bipolar disorder is nobody’s fault. |
Scientists believe that bipolar disorder
is caused by a chemical imbalance in the brain. |
Question: What other explanations have you heard about what causes bipolar
disorder?
What is the course of bipolar disorder? What happens after you first develop symptoms?
People usually develop bipolar disorders as teenagers or young adults, approximately age 16 to age 30. People can also have their first symptoms when they are in their 40’s or 50’s. People vary in how often they have symptoms, the severity of the symptoms and how much the disorder interferes with their lives.
Bipolar disorder affects people in very different ways. Some people have a milder form of the disorder and only have symptoms a few times in their lives. Other people have a stronger form of the disorder and have several episodes, some of which require hospitalization.
Bipolar tends to be episodic, with symptoms varying in intensity over time. When symptoms reappear or get worse, this is usually referred to as a “symptom exacerbation” or an “acute episode” or a “relapse.” (More information on this subject is provided in the handout, “Reducing Relapses.”) Some relapses can be managed at home, but other relapses may require hospitalization to protect the person or others.
With effective treatment, most people with bipolar disorder can reduce their symptoms and live productive, meaningful lives.
Bipolar disorder tends to be episodic, with symptoms coming and going at varying levels of intensity. |
Question: What has been your experience with symptom relapses?
Examples of people who have bipolar disorder
Some famous people have developed bipolar disorder:
Patti Duke is an American actress who had her own television series and has starred in movies, including “The Miracle Worker.” She also had a singing and writing career.
Robert Boorstin was a special assistant to President Clinton. His work was highly valued in the White House.
Vincent Van Gogh was one of the most famous painters who ever lived.
Kay Redfield Jamison is a psychologist, researcher and writer. In 2001 she won a MacArthur Fellowship, sometimes referred to as “ the genius award.”
Other people who have developed bipolar disorder are not famous, but are quietly leading productive, creative, meaningful lives:
Ms. X is an attorney in a large law firm and is active in her church.
Mr. Y teaches in an elementary school. He is married and is expecting his first child.
Mr. Z is actively looking for work. He used to need frequent hospitalizations, but has successfully stayed out of the hospital for 3 years.
| There are countless positive examples of people with bipolar disorder who have contributed to society. |
Questions:
Do you know other people with bipolar disorder?
If so, what are some examples of their personal strengths?
What is stigma?
When referring to mental illness, the word “stigma” means the negative opinions and attitudes that some people have about mental illness. Not everyone with mental illness has experienced stigma, although unfortunately, many have.
It is important to know that there are two major laws that protect against discrimination against people with physical or psychiatric disabilities. The Americans with Disabilities Act (ADA) makes it illegal to discriminate in the areas of employment, transportation, communication or recreation. The Fair Housing Act (FHA) prohibits housing discrimination.
Stigma is a complicated problem, and there are no easy solutions. Research has shown that as the general public gets to know more about mental disorders and as they get to know people who have experienced psychiatric symptoms, their negative beliefs go down.
Many organizations, including the National Institute of Mental Health, the Center for Mental Health Services, The National Alliance on Mental Illness, the National Mental Health Association, and the National Empowerment Center, are working on national campaigns to educate the public and create more laws that protect against discrimination. Contact information for these organizations is listed in the Appendix of the “Recovery Strategies” handout.
If you have experienced stigma and/or would like to know more about strategies for responding to stigma, refer to the Appendix at the end of this handout.
Stigma refers to negative opinions and
attitudes about mental illness. |
Question: Have you ever experienced stigma because of psychiatric symptoms?
What are some of the steps you can take to manage your illness?
By reading this handout you are already taking an important step, which is
learning some practical facts about your illness.
Other important steps include:
These steps will be covered in the other educational handouts in the Illness Management and Recovery Program.
What you do makes a difference in your
recovery. |
There are steps you can take to manage
psychiatric symptoms effectively. |
Summary of the main points about bipolar disorder
Appendix: Strategies and Resources for Responding to Stigma
What are some strategies for responding to stigma?
It may be helpful for you to develop some personal strategies for responding to stigma. There are advantages and disadvantages to each strategy. What you decide to do depends on the specific situation.
Some possible strategies include:
Educate yourself about mental disorders
Sometimes people who experience psychiatric symptoms do not know the facts themselves. They may blame themselves for their symptoms or think they cannot take care of themselves or that they can’t be part of the community. You may have had these negative thoughts or feelings. This is called “self-stigma.”
It is important to fight self-stigma, because it can make you feel discouraged and cause you to lose hope in your recovery. One way to fight self-stigma is to educate yourself about psychiatric symptoms and mental disorders, and to be able to separate myths from facts. For example, knowing that no one causes bipolar disorder can help you to stop blaming yourself or others.
Another way to fight self-stigma is to belong to a support group or another
group where you get to know different people who have experienced psychiatric
symptoms. You can locate support groups through organizations such as the Consumer
Organization and Networking Technical Assistance Center (CONTAC) and the National
Empowerment Center. Contact information is provided for these and other helpful
organizations in the Appendix to the
“Recovery Strategies” handout.
The more you know about mental disorders,
the more you can combat prejudice, whether it comes from others or from
within yourself.
|
Correct misinformation in others without disclosing anything about
your own experience
A co-worker might say, “People with mental illness are all dangerous.”
You might decide to reply, “Actually, I read a long article in the paper
that said that the majority of people with mental illness are not violent. The
media just sensationalizes certain cases.”
To fight stigma, you might decide to
correct misinformation without disclosing personal experience. |
Selectively disclose your experience with psychiatric symptoms
Disclosing information about your own experience with psychiatric symptoms is
a personal decision. It’s important to think about how the other person
might respond. It’s also important to weigh the risks and benefits to
yourself, both in the short term and in the long term. Talking this over with
someone in your support system might be helpful.
People vary widely in whether they choose to disclose information about themselves, and if so, how much. You may decide to disclose personal information only to family members or close friends. Or you may disclose information to people only when it becomes necessary. For example, you might need a specific accommodation in order to perform your job.
You may feel comfortable disclosing information in a wide variety of settings. You may even be willing to speak publicly about mental illness for educational or advocacy purposes.
In certain situations, you might decide
to fight stigma by disclosing some of your own experience. |
Become aware of your legal rights
It’s important to educate yourself about the laws against discrimination.
Two major laws that protect against unfair treatment are the Americans with
Disabilities Act (ADA) and the Fair Housing Act (FHA).
The Americans with Disabilities Act makes it illegal to discriminate against people with physical or psychiatric disabilities in employment, transportation, communication, or recreation. The Fair Housing Act prohibits housing discrimination because of race, color, national origin, religion, sex, family status, or disability (physical or psychiatric).
It is worthwhile to take some time to understand the basic principles of these laws and how they might apply to you. If you feel that your legal rights have been violated, there is a range of possible actions you might take, depending on the situation.
Sometimes it is most effective to speak directly to the person involved. For
example, it is usually preferable to approach your employer about the need to
provide a reasonable accommodation on the job. An example of a reasonable accommodation
would be asking to move your desk to a more quiet area in the office to improve
your concentration.
Sometimes it may be more effective to talk to an expert to get advice, support,
advocacy, mediation, and even legal help. For example, if a landlord refused
to rent you an apartment because of psychiatric symptoms you may need to contact
the Office of Fair Housing and Equal Opportunity
(FHEO) in the Department of Housing and Urban Development (HUD) for advice and assistance. If an employer was unresponsive to your request for accommodation on the job, you might want to contact the Equal Employment Opportunity Commission (EEOC).
Contact information for the Office of Fair Housing and Equal Opportunity, the Equal Employment Opportunity Commission and other helpful organizations is provided at the end of this Appendix.
To combat stigma, it is important to
know your legal rights and where to seek help if your rights have been
violated. |
Question:
What strategies have you used to combat stigma?
You can use the following checklist to answer this question.
Strategies for Combating Stigma
| Strategy | I have used this strategy |
| Educating yourself about psychiatric symptoms and mental disorders |
|
| Correcting misinformation without disclosing your own experience with
psychiatric symptoms |
|
| Selectively disclosing your experience with psychiatric symptoms |
|
| Becoming aware of your legal rights |
|
| Seeking out assistance if your legal rights are violated |
|
| Other Strategies: |
Resources
Anti-Stigma organizations and websites:
Chicago Consortium for Stigma Research
7230 arbor Drive
Tinley Park, IL 60477
Phone: 708-614-2490
Otto Wahl’s Homepage and Guide for Stigmabusters
Dept. of Psychology
George Mason University
Fairfax, VA 22030
website: iso.gmu.edu/-owahl.INDEX.HTM
National Stigma Clearinghouse
245 Eighth Avenue
Suite 213
New York, NY 10011
Phone: 212-255-4411
website: community2.webtv.net/stigmanet/HOMEPAGE
Resource Center to Address Discrimination and Stigma
1-800-540-0320
website: www.adscenter.org
Federal agencies:
Equal Employment Opportunity Commission (EEOC)
1801 L Street, NW
Washington, D.C. 20507
Phone: 202-663-4900
To locate the nearest office: 1-800-669-4000
website: eeoc.gov
Office of Fair Housing and Equal Opportunity (FHEO)
Department of Housing and Urban Development
451 7th Street SW
Washington, D.C. 20410
Phone: 202-708-1112
website: hud.gov
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