Bipolar disorder: definition and statistics

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All of us experience emotions such as anger, sadness or joy. Usually we feel that we control our emotions and we are able to manage them on a daily basis. People affected by bipolar disorder, however, experience their emotions with disproportionate intensity and often find it challenging to control them. The frequency, duration and intensity of these emotions can vary from person to person and affect how people think and function. The affected person may therefore encounter difficulties fulfilling their professional, family and social goals.

Definition

Bipolar affective disorder is a severe chronic mental illnesses characterized by episodic manic and depressive mood swings. Mania presents itself as exaggerated elation and the people affected are usually overactive, euphoric or irritable. This phase is followed by an episode of depressed mood, sadness, feelings of emptiness, hopelessness and low energy. Additionally, severe forms of mania can lead to psychosis. The core symptoms of psychosis are roughly divided into three categories:

1. Positive symptoms

Examples – psychosis positive symptoms
Hallucinations “I can hear sounds, conversations, or voices even though I’m alone in a quiet room. Other people say they won’t hear anything, but I’m sure of it.”
  “I see people or things change colors, shapes.”
  “Some food tastes like it’s poisoned.”
Delusions “I am a victim of unjustified persecution.”
  “There are people who are after me and won’t leave me alone.”
  “I possess exceptional skills that differentiate me from other people.”
  “I have a close relationship with higher powers.”
  “The well-being of all people on this planet depends on me.”

2. Negative symptoms

Examples – psychosis negative symptoms
Lack of motivation “It is very difficult for me to get out of bed in the morning.”
  “I can’t handle some of my tasks.”
  “Sometimes I have no drive to go out or do anything at all.”
  “I often feel depressed and without motivation.”
Social withdrawal “I lost interest in contact with other people.”
Depressed mood “I have the feeling that I can’t really be happy anymore, I can’t really communicate.”
  “I speak much less than before and in general terms.”
  “It feels like I don’t care about anything”.

3. Cognitive symptoms

Examples – psychosis thinking impairment
Thinking impairment “Sometimes I can’t finish thinking a thought.”
  “I have too many thoughts in my head at the same time.”
  “Sometimes I can’t concentrate for long.”
  “Sometimes I jump from one topic to the next.”
  “My memory doesn’t work the way it used to.”

DSM-5 classification

DSM-5 classifies bipolar affective disorder on the spectrum between depressive disorders and schizophrenia spectrum disorders. Accordingly, this mood disorder is a category which includes 3 different conditions:

  1. Bipolar 1 type is characterized by both manic and depressive episodes. The manic episode must last for at least 14 days and is often very pronounced. This form of bipolar disease affects women and men equally. It is estimated to occur in 1% – 2% of the population.
  2. Bipolar 2 type is characterized by depressive episodes and at least one manic episode. Mania is less pronounced in this case. People affected usually experience a milder form of mania, hypomania. It is estimated to occur in roughly 4% of the population.
  3. Cyclothymic disorder is a type of  bipolar disorder in which phases of mild depression and mild mania (hypomania) occur periodically and frequently alternating over a period of at least two years. Since Cyclothymia is a mild form of the disorder, those affected rarely seek help. Up to 5% of the population are affected by this form of bipolar disorder.

Bipolar disorder symptoms

People with bipolar disorder go through periods of extreme moods – episodes:

  1. Mania (or Hypomania) – an episode of great excitement and energy
  2. Depression – an episode of persistent feeling of sadness and loss of interest

During an episode, the symptoms last every day for most of the day. Often, episodes may last for several days or even weeks.

Manic episodes:

Manic episodes must include three or more of the following symptoms:

  • Feeling of very intense happiness and pleasure or, on the contrary, excessive irritability.
  • Hyperactivity, restlessness, and agitation.
  • Euphoria, which is an exaggerated sense of well-being and self-confidence.
  • Accelerated talkativeness and speech rate.
  • Decreased need for sleep; the person may feel rested after only 3 hours of sleep, for instance.
  • Racing thoughts; for example, the person may experience an overflow of ideas and find oneself “lost” in thought.
  • Lack of judgment, poor decision-making; the person might engage in risky behaviors that provide instant pleasure.
  • Distractibility; the person is unable to fix attention on a subject.

The symptoms of bipolar mania can vary from person to person. Usually, they last anywhere from a few days to several weeks.

Major depressive episodes:

A depressive episode must include five or more of the following symptoms:

  • Excessive tiredness, fatigue or loss of energy.
  • Depressed mood, sadness, feelings of emptiness, hopelessness.
  • Loss of interest or feeling no pleasure in almost all professional and social activities.
  • Sleep problems; either insomnia or sleeping too much.
  • Eating problems; decreased or increased appetite, which can cause weight loss or gain.
  • Decrease or loss of sexual interest.
  • Onset of a discomfort such as headache, back or stomach pain.
  • Feelings of worthlessness excessive guilt or failure.
  • Decreased ability to think or concentrate on a task.
  • Indecisiveness, difficulty making decisions.
  • Restlessness or slowed reaction.
  • Thinking about, planning or attempting suicide.

How long do bipolar episodes last?

Individual bipolar episodes last for different lengths of time. They often come and go irregularly. For some, an episode lasts for a few days, for others it takes several months and in rare cases even years. On average, however, an episode lasts about 4-12 months in those receiving treatment. During this time, manic and depressive episodes can even occur simultaneously. During mixed bipolar episodes a person shows symptoms of both mania and depression at the same time.

Rapid bipolar cycling is a form of the disorder in which episodes occur in rapid succession. For example, the acceleration of thinking, language and motor skills that is typical in a manic phase can often be seen, even though those affected simultaneously suffer from a depressed mood and have suicidal thoughts. With this particular form of bipolar disorder, at least 4 episodes of mania, hypomania or depression occur within 12 months.

Rapid cycling is a complicated form of the disorder because medication cannot work effectively due to the frequent change of episodes. A total of 15%-20% percent of bipolar patients experience rapid cycling.

Between acute episodes there are often relatively long periods in which those affected mostly feel healthy. This baseline can last for several months or even years. The phases with stable mood are on average about 2-3 years long.

How many people have bipolar affective disorder?

chart number of people with bipolar disorder 1991-2017

Number of people affected by bipolar disorder globally 1990 to 2017

Bipolar disorder affects approximately 0.06% of world population. An estimated 46 million people had bipolar disorder in 2017, with 52% being female and 48% male.

20 countries with the highest incidence of bipolar disorder:

Country% of population affected
by bipolar disorder (2017)
New Zealand1.21%
Australia1.14%
Northern Ireland1.14%
Brazil1.11%
England1.11%
Paraguay1.08%
Sweden1.06%
Denmark1.01%
Finland1.01%
Lebanon1.00%
Spain0.98%
Bermuda0.97%
Iceland0.97%
Andorra0.96%
France0.96%
Malta0.96%
Belgium0.95%
Greece0.95%
Italy0.95%
Netherlands0.95%
Source: Our world in data

Managing bipolar symptoms

Bipolar disorder is a chronic but mostly manageable disorder. Most people with the disorder can be treated using a combination of different treatments such as medication to prevent or treat symptoms of mania or depression, and psychotherapy. For example, cognitive-behavioral therapy (CBT) was proved to be effective in patients with bipolar disorder. CBT has proven to decrease the relapse rate and improve symptoms of depression and mania severity, as well as psycho-social functioning. Some food supplements such as CBD, vitamins B1, B6, and B12, have also been shown to decrease the symptoms of bipolar disorder and alleviate side effects caused by some bipolar medications.

Finally, learning to recognize the triggers of an episode of depression or mania, as well as lifestyle adjustments such as regular exercise, planning activities, good diet and sufficient sleep also proved to be very effective in managing symptoms of both mania and depression.

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