Bipolar disorder is perhaps one of the most interesting mood disorders that people studying clinical psychology can study. The idea that a person can move between two extremes is fascinating and at the same time awful. There is a general perception of bipolar disorder that makes us realize that we could easily suffer from it ourselves, and that there is no one, no matter how intelligent a person could be, to enjoy absolute mental stability.
How many times have you heard that people with bipolar disorder have two personalities? What is the true nature of the mood disorder that causes a person to have “different personalities”? What are the differences between bipolar disorder and an unstable personality ?
Bipolar Disorder – What Is It?
Bipolar disorder is characterized by changes in mood and includes various stages of mania (euphoria), hypomania (euphoria with a shorter duration), or mixed stages that generally vary with depressive episodes. According to the criteria of the International Standard Classification of Diseases (ICD-10) and the U.S. Diagnostic System for Mental and Behavioral Disorders (DSM-5), there are different types of bipolar disorder:
- Bipolar Disorder I: At least one stage of mania or mixed stages (mania and hypomania) that may occur before or after a depressive episode.
- Bipolar Disorder II: Less severe manic symptoms called hypomanic episodes and depressive episodes.
- Mood Swing Disorder (Cyclothymia): Variable hypomania with latent depressive disorders.
This is a relatively common disorder that occurs in people of all ages, regardless of gender, although it is more common among 15-25 year olds. When a bipolar disorder occurs in a person over the age of 60, studies show that the disorder has an organic origin that can also be treated accordingly.
Like much of such a disorder, it affects a person’s functioning and well-being. Suicide rates are really high in people with bipolar disorder – an estimated 15% end up here – and suicide is much more common in the depressive or mixed phase.
Uphills and downhills
The DSM-5-TR develops criteria for different types of manic, hypomanic, depressive, and mixed stages.
A manic episode is a change in mood that lasts for at least a week and involves three or more of the following symptoms:
- Exaggerated self-esteem.
- Reduction of the need to sleep.
- More talkative than usual.
- A flood of ideas.
- Difficulty maintaining attention.
- Psychomotor agitation.
- Excessive participation in enjoyable activities with high potential for serious consequences.
- This mood disorder is so severe that it causes deterioration in work and social relationships, the need for hospitalization, and psychotic symptoms.
A hypomanic episode is a change in mood that lasts for at least four days and is characterized by at least three or more of the above symptoms. Mood swings and fluctuations are noticeable to others, but are not considered severe enough and this disorder has no psychotic symptoms.
A major depressive episode shows the following symptoms for two weeks:
- Significant increase or loss of weight and appetite.
- Insomnia or excessive sleepiness.
- Agitation or psychomotor retardation.
- Great feeling of uselessness or guilt.
- Impairment in concentration or decision making.
- Repeated thoughts of death.
- Either a depressed mood most of the day or general apathy.
A mixed episode includes symptoms of a manic episode and a major depressive episode and they appear almost every day for at least one week.
In not all episodes of this type, the symptoms are due to the psychological effects of medication or treatment. If these symptoms are the effect of a substance or medication, the symptoms cannot be diagnosed bidirectionally, even if the person meets all of the above criteria.
Differences between bipolar disorder and unstable personality
Unstable personality is among all the most serious personality disorders. The lack of emotional regulation of an unstable personality must be distinguished from the imbalance that occurs in bipolar disorder. An unstable personality has the following characteristics:
- Holistic instability that affects the state of mind, self-image, and behavior.
- Inherent and permanent difficulties in creating stable social ties. This does not occur in patients with bipolar disorder.
- Impulsivity, uncontrollable anger, self-aggression, and outward aggression.
- Suicidal behavior, threats or gestures, or self-harm.
- Risky behavior that is usually caused by conflicts between people and relationship problems (fear of rejection).
- Feelings of emptiness and boredom.
Bipolar disorder does not result in different personalities
When the division of the mind affects the highest level of our being – our personality – we are dealing with a dissociative identity disorder (“multi-person disorder ” or “side person disorder ”).
People with dissociative identity disorder experience two or more different identities (up to a hundred), at least two of which control a person’s behavior almost repeatedly. In addition, people with this disorder feel unable to remember important personal information depending on the personality that governs them at any given time.
The majority of people working in the field of mental health believe that additional measures are necessary in addition to pharmacological measures. Individual or group psychotherapies are really helpful in such cases. It is also recommended to reduce pharmacological treatment if their therapeutic effects are not significant.
Diagnostic ratings help with individual treatment. But we must not forget that every person is different, and the state of health is no exception. In this sense, two people with the same diagnosis may experience the same disorder in very different ways.
Belloch, A., Sandín, B., & Ramos, F. (2012). Manual of psychopathology.
McGraw- Hill’s Guide, GDT (2012). of Clinical Practice on Bipolar Disorder.
Clinical Practice Guideline for Bipolar Disorder. Madrid: Ministry of Health, Social Services and Equality. University of Alcalá. Spanish Association of Neuropsychiatry.