Learn / Finding Treatment for Bipolar Disorder
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Bipolar disorder is a serious diagnosis. Without proper treatment, it can be extremely destabilizing—both for the person who has the condition, and for those around them. If you have this diagnosis, it’s vital to get the care you need. For some clients, inpatient rehab is a helpful place to start.
About 2.8% of the population has been diagnosed with bipolar disorder1 (once called manic-depressive disorder). And 83% of those cases are classified as severe. However, these numbers do not account for cases that go undiagnosed. It’s also frequently misdiagnosed as schizophrenia or borderline personality disorder (BPD). Without a proper understanding of your condition, it’s unlikely for clients to get appropriate treatment for their mental health.
If you think this diagnosis may fit your experience, it’s important to learn more about it. Make sure you talk to a mental health professional before you pursue a particular plan of care.
This condition is characterized by “intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes,”2 according to the American Psychiatric Association. “These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well.”
While its exact etiology is unknown, experts believe this condition can be caused by a combination of factors. You may have a genetic predisposition to bipolar disorder,3 even if previous generations of your family were never diagnosed. It may also be related to a neurochemical imbalance. Some experts believe it can be caused or exacerbated by adverse life experiences.
The term “bipolar” may lead casual observers to believe that the associated mood swings are simple. That’s far from the truth. Mania4 isn’t just happiness; it can include sleeplessness, anxiety, irritability, and disproportionate anger. It can also cause impulsivity, which may lead to excessive spending, promiscuity, or substance misuse. Similarly, depressive episodes aren’t simply bouts of sadness. Symptoms mimic those of major depression, and may include fatigue, oversleeping, trouble concentrating, over- or undereating, and suicidal ideation, in addition to sadness.
Clients with bipolar disorder are also prone to a third emotional state, called hypomania. Hypomania is often characterized as a less severe version of classic mania. Clients still present with energy, impulsivity, and other signs of mania; however, their symptoms are less overwhelming. And unlike mania, “hypomania5 does not cause a major deficit in social or occupational functioning.” By definition, it lasts for at least four days, whereas mania lasts for at least a week.
Based on the frequency and severity of the client’s mania, hypomania, and depression, bipolar disorder may be classified in one of three ways.
According to experts at Creative Care Calabasas, “bipolar I is the most severe form of the mental health condition.” To qualify for this diagnosis, clients must experience mania for at least one week. Their behavior “must represent a change from the person’s usual behavior and be clear to friends and family. Symptoms must be severe enough to cause dysfunction in work, family, or social activities and responsibilities.” Clients with this type of bipolar disorder also experience depressive episodes that may last for weeks at a time. In severe cases, hospitalization can be necessary.
Bipolar II is more often associated with depressive episodes. Clients with this condition experience similar swings, but their mania is both less severe and less frequent. Some experience depressive episodes interspersed with hypomanic episodes, without ever showing symptoms of mania.
Clients with cyclothymic disorder also cycle between depression and hypomania. This condition includes less severe symptoms than other forms of bipolar. It can also take much longer to get an accurate diagnosis. Clients must experience mood swings for at least two years, without ever meeting the exact criteria for bipolar I or bipolar II.
It’s important to remember that bipolar disorder is a medical diagnosis, and not a reflection of a person’s character. Like any other diagnosis—from diabetes to depression—it can have a huge impact on the rest of your life. Conversely, the events of your life may make your symptoms more or less severe. Clients may have difficulty navigating regular activities as a result of this condition.
Trauma is linked to the development of many psychiatric conditions, including depression, anxiety, and a number of mood disorders. Bipolar is no exception. Experts agree that “childhood trauma6 in all its subcomponents appears to be highly associated” with this condition.
And after developing bipolar disorder, various life events may bring on severe mood swings. Both traumatic events and extremely positive experiences may be risk factors.7 Research has found that “bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion.”
When even positive events can trigger your symptoms, it may be difficult to maintain an upward trajectory. For that reason, bipolar disorder interferes with some clients’ ability to work.
One study found that “Occupational disability is one of the most problematic impairments for individuals with bipolar disorder due to high rates of unemployment and work impairments. Current evidence indicates that social stressors at work8—such as social isolation, conflict with others, and stigmas—are common experiences for employed individuals with bipolar disorder.”
These social stressors can make or break a clients’ success in the workplace. And for people with bipolar, even more than for other clients, social support is hugely impactful throughout the healing process.
Strong relationships are uniquely important for people with this condition. Data suggests that social support9 may be directly linked to the severity and frequency of clients’ symptoms.
Some rehab programs have a unique focus on the social aspect of healing. Gould Farm, for instance, is a therapeutic community that treats clients with bipolar disorder. Residents receive clinical care from a team of healthcare providers, and also participate in community efforts. This treatment model is designed to help clients “learn new skills, and others re-discover their strengths, building confidence and self-esteem.”
According to experts, “empathy and understanding from another person can make it easier to cope with bipolar disorder.10 Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode.” A loss of social support, on the other hand, can trigger either mania or depression.
When your diagnosis has such a great impact on so many aspects of life, it can be hard to disentangle your symptoms from your healthy emotional reactions. And remember, not all healthy reactions are positive. For example, it’s perfectly healthy to experience anxiety if you have to switch jobs. Clients with bipolar disorder may struggle to stay present with that anxiety, instead of tipping into a manic episode. This difficulty can lead to unhealthy coping mechanisms, such as substance misuse.
There is a high prevalence of substance use disorders among people with bipolar disorder.11 This may be an attempt to self-medicate by regulating unstable moods, and/or response to symptomatic impulsivity.12
Also, experts believe there may be “a shared neurobiology between bipolar disorder and addictions.”13 If this is true, it would mean that people with a diagnosis of bipolar are neurologically predisposed to substance use disorders. Much more research is needed on this subject, however.
Because bipolar disorder may be related to neurochemical imbalances,14 substance use of any kind may have a direct impact on your symptoms. That’s true of both substance misuse and appropriate use of prescription medications. For this reason, it’s absolutely vital for clients to receive care from clinicians who have experience with this diagnosis.
If you have both bipolar disorder and a substance use disorder, you may benefit from rehab for co-occurring disorders. These programs address each client as a whole person, rather than treating each symptom individually. And, they may have a higher success rate. According to the experts at Skyland Trail, “research indicates that people who address multiple psychiatric diagnoses simultaneously experience better long-term outcomes than those who try to address each diagnosis separately.”
Bipolar disorder is a chronic condition. Once you receive this diagnosis, it will probably continue to apply for the rest of your life. That being said, bipolar can absolutely go into remission, and some clients go for long periods of time between manic, hypomanic, or depressive episodes. With appropriate care and management, you can significantly improve your quality of life.
While there are a number of ways to treat bipolar disorder, most clients benefit from a combination of therapy and medication.15 During treatment, you’ll work closely with your providers to decide which options are best for you. Certain modalities have been found to be extremely effective.
Talk therapy is a powerful way to begin healing from almost any mental health diagnosis. With this approach, you’ll develop a one-on-one relationship with a provider. Therapy sessions will take place more often during inpatient treatment—sometimes even daily. Outside of rehab, it’s quite common for clients to meet with their therapists once a week. However, your specific clinician may suggest you see each other either more or less often.
This modality allows clients to work through difficult feelings in a safe context. Therapy can work as a release valve, in which you can express extreme feelings without jeopardizing other relationships. It’s your therapist’s job to hold space for you, no matter what you think or how you feel. You can safely and ethically set aside any concern that they’ll judge you negatively for having mood swings.
Research has demonstrated that therapy is extremely important for people with this condition. Experts write that “psychotherapy, when added to medication for the treatment of bipolar disorder, consistently shows advantages over medication alone as a treatment for bipolar disorder.16 There are many different types of psychotherapy. If you attend an inpatient program, the team at your facility will help you choose which modality best suits your needs.
Cognitive behavioral therapy (CBT) teaches clients how to change their own thought patterns using practical, repeatable strategies. For example, you might learn to recognize when your own thoughts are distorted or divorced from reality. In those moments, CBT skills can help you ground yourself in the present moment, and respond from a calmer place.
Data suggests that this type of therapy is especially helpful for clients with certain conditions. Specifically, it “has a positive impact on patients with bipolar disorder17 in terms of reducing depression levels, improving mania severity, decreasing relapse rates and increasing psychosocial functioning.”
Medication can be hugely beneficial for people with this diagnosis. Specifically, psychiatrists often prescribe lithium, lamotrigine, or antidepressants such as Prozac. Because bipolar disorder is thought to be a neurochemical imbalance, these treatments may be necessary even if talk therapy proves helpful.
However, it’s also important to consider the relationship between bipolar and substance use disorders. Even with a prescription in hand, some clients may be tempted to fall back into unhealthy patterns. In order to avoid this, it’s absolutely vital that you stay in close communication with your mental health team about your medication use. For some clients, having access to a prescription of any kind may be a trigger. If that’s the case for you, be sure to ask your therapist about substance-free alternatives.
With extreme emotions, introspection can be difficult. Some clients with bipolar disorder struggle to find clarity, or even to ask for help. If these symptoms resonate with your experience, know that you have the right to reach out. It’s important to get the care you need.
Because bipolar disorder touches on so many aspects of life, it can be difficult to imagine what healing would look like. Remember that, no matter how severe your symptoms may be, no emotion lasts forever. You can and will feel differently. And, with the right support, you can even feel consistently better. It is absolutely possible for clients with bipolar to live rich and meaningful lives.
To learn more about inpatient treatment for this condition, you can browse our list of luxury rehabs specializing in bipolar disorder.
Treatment for bipolar disorder often includes a combination of medication, psychotherapy, and lifestyle adjustments. Medications like mood stabilizers are commonly prescribed, and therapies such as cognitive-behavioral therapy (CBT) and family therapy help with managing symptoms and improving overall well-being. Some people start treatment at an inpatient rehab.
The duration of treatment for bipolar disorder varies depending on individual needs and response to interventions. It typically involves long-term management to stabilize mood and prevent relapse. Treatment may span several months to years, with regular follow-up appointments and adjustments to the treatment plan as necessary.
While therapy alone may not be sufficient for managing bipolar disorder, it plays a crucial role in the overall treatment plan. Therapy, such as cognitive behavioral therapy, helps individuals develop coping skills, improve self-awareness, and enhance relationships. Combined with medication and other interventions, therapy contributes to a comprehensive approach for bipolar disorder treatment.
Bipolar disorder. (n.d.). National Institute of Mental Health (NIMH).
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Causes—Bipolar disorder. (2021, February 11). Nhs.Uk.
Table 11, dsm-iv to dsm-5 manic episode criteria comparison—Dsm-5 changes—Ncbi bookshelf. (n.d.).
Dailey, M. W., & Saadabadi, A. (2021). Mania. In StatPearls. StatPearls Publishing.
Aas, M., Henry, C., Andreassen, O. A., Bellivier, F., Melle, I., & Etain, B. (2016). The role of childhood trauma in bipolar disorders. International Journal of Bipolar Disorders, 4(1), 2.
Miklowitz, D. J., & Johnson, S. L. (2009). Social and familial factors in the course of bipolar disorder: Basic processes and relevant interventions. Clinical Psychology: Science and Practice, 16(2), 281–296.
O’Donnell, L., Himle, J. A., Ryan, K., Grogan-Kaylor, A., McInnis, M. G., Weintraub, J., Kelly, M., & Deldin, P. (2017). Social aspects of the workplace among individuals with bipolar disorder. Journal of the Society for Social Work and Research, 8(3), 379–398.
Johnson, L., Lundström, O., Åberg-Wistedt, A., & Mathé, A. A. (2003). Social support in bipolar disorder: Its relevance to remission and relapse. Bipolar Disorders, 5(2), 129–137.
Owen, R., Gooding, P., Dempsey, R., & Jones, S. (2017). The reciprocal relationship between bipolar disorder and social interaction: A qualitative investigation. Clinical Psychology & Psychotherapy, 24(4), 911–918.
Levin, F. R., & Hennessy, G. (2004). Bipolar disorder and substance abuse. Biological Psychiatry, 56(10), 738–748.
Swann, A. C., Dougherty, D. M., Pazzaglia, P. J., Pham, M., & Moeller, F. G. (2004). Impulsivity: A link between bipolar disorder and substance abuse. Bipolar Disorders, 6(3), 204–212.
Stokes, P. R. A., Kalk, N. J., & Young, A. H. (2017). Bipolar disorder and addictions: The elephant in the room. The British Journal of Psychiatry, 211(3), 132–134.
Maremmani, I., Perugi, G., Pacini, M., & Akiskal, H. S. (2006). Toward a unitary perspective on the bipolar spectrum and substance abuse: Opiate addiction as a paradigm. Journal of Affective Disorders, 93(1), 1–12.
Bipolar disorder | nami: National alliance on mental illness. (n.d.-a).
Swartz, H. A., & Swanson, J. (2014). Psychotherapy for bipolar disorder in adults: A review of the evidence. Focus (American Psychiatric Publishing), 12(3), 251–266.
Chiang, K.-J., Tsai, J.-C., Liu, D., Lin, C.-H., Chiu, H.-L., & Chou, K.-R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLoS ONE, 12(5), e0176849.
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