Symptoms of Bipolar Disorder – a Mixed Bag

When I studied bipolar disorder in medical school, I thought it was very simple. You got high, you got low, you got better, then you started again.

Then I started to have painful psychological symptoms, so I looked up the books, but no disorder seemed to fit my experience very well.
The official version of the symptoms of bipolar disorder are contained in the DSM-IV (Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition published by the American Psychiatric Association). This, however, didn't throw much light on things, because to quote the Manual itself, 'it is produced for mental health specialists, its use by people without clinical training can lead to inappropriate application of its contents.' Great.

Undeterred, I discovered that the symptoms of highs were elation, feeling invincible, irritated, being busy, talking fast, thinking fast, sleeplessness. My 'depression' was supposed to involve being dejected, pessimistic, taking no fun or joy out of life, having no energy, having poor concentration and/or believing I was bad to the core.

But my experience was something else altogether. I would get angry over nothing, very wound up and do drastic, frantic things such as try to run away from home, or tie a steak to the gate handle (weird, that one!) before trying to punch out my bewildered neighbor.

In between these times I would enjoy one to two month periods where I had tons of energy, plenty of great ideas. I wrote a short book during this time, and when I tired of typing I would push back the furniture and dance alone every night. I lost weight. I never complained about these times – after all, I was having a great time, achieving great things, and I'd dropped a dress size.

If it took a long time to be diagnosed, this was why. My symptoms were a mix of mania and depression. Most clinicians are looking for a classical picture of either elation or melancholia. But mixed states have elements of mania and depression at the same time. They have some colorful names such as 'Black Mania' and 'Depression with Flight of Ideas.'

Mixed states are common, occurring in 40 to 50% of episodes, so in about half of cases, bipolar disorder is difficult even for experts to notice. This is one reason suggested to explain the long time it takes to diagnose bipolar disorder.

There are lists of typical bipolar symptoms available but they are invariably presented under the headings of 'mania' and 'depression'. Manic symptoms include elation, feeling invincible, irritability, busy, talking fast, thinking fast and having lots of ideas, sleeplessness. Depressive symptoms include dejection, pessimism, getting no enjoyment from life, difficulty concentrating, lethargy, belief that 'I am a bad person' and so on.

If you consult these lists, feel free to identify with symptoms of both. The other factor with bipolar disorder is that people tend to self-medicate. Alcohol does have a moderating effect on manic symptoms and so it is not surprising that many people suffering from mania elect to drink. My great-grandfather, a typical manic depressive, drank 'to still the mind.' He was right, to a point.

If you're looking on at someone who may have bipolar disorder but is obviously drinking, their symptoms will be exaggerated bipolar symptoms plus the usual symptoms of alcohol intoxication. Thus the aggression, abusiveness, abruptness of alcohol toxicity will complicate the manic symptoms, such as sleeplessness, irritability, pressure of speech and flight of ideas, social extraversion, and impulsiveness, for example.

If you or a friend sometimes has bouts of weird, frightening or over the top behavior, bipolar disorder could provide an explanation. There are some good screening tests available in the public domain, but to get a definite answer a proper medical assessment is required.

Bipolar disorder is not hard to recognise if you remember the symptoms, and that it comes in episodes of weeks to months; it may be complicated by alcohol or other drug use; and symptoms of depression and mania may occur at the same time.

For you or a friend to get a proper diagnosis, you'll need to be organized. Record all the events that you think might be due to bipolar disorder, then give that information to a medical practitioner. What happens after that is up to the person with the symptoms.