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What Causes Bipolar Disorder?

Bipolar disorders tend to run in families. The several dozen different genes that are linked with Bipolar Disorders may or may not be activated in the absence of environmental triggers. 

Below are some of the top stressors that can flip these genes the wrong way:

·  Drug use, including recreational drugs like cocaine or marijuana, but also drugs that doctors prescribe like stimulants and antidepressants.

·  Growing up in a dysfunctional chaotic home environment; particularly when there is verbal, physical, or sexual abuse.

·  Medical problems - Infectious diseases including HIV that adversely affect the brain, head injuries, and chronic autoimmune inflammatory disorders such as Lupus.

·  Anything that disrupts sleep, including shift work, the blue UV light that is emitted from our computers and laptop screens as well as our cell phones, and travel across 2 or more time-zones.

Mania by definition lasts longer – at least a week – while hypomania lasts at least 4 days. A full-blown manic episode may have psychotic features, which include delusional thinking, paranoia and/or perceptual disturbances, the latter being auditory, visual, or tactile hallucinations. With hypomania there is an absence of psychosis. Otherwise, the symptoms for hypomania and mania are similar, albeit mania is significantly more debilitating and dangerous.

Bipolar spectrum disorders tend to start in late adolescence to early adulthood. Adolescents with bipolar disorder may not have their first manic or hypomanic episode until several years after the onset of the disorder.

Misdiagnoses include Major Depressive Disorder and Borderline Personality Disorder. There are times when a bipolar person may present with many of the classic features of ADHD. Eventually they will cycle up or down and no longer appear to have ADHD. Frequently, bipolar disorders are retrospectively diagnosed when antidepressant or ADHD stimulant medications worsen matters by precipitating a hypomanic or manic episode.

“Bipolar” means two poles: mania and depression.  However, people with this disorder live most of their lives in between these extremes, which can still cause significant problems. There are mixed states, where hypomania, mania and depression overlap. One can be severely depressed, and simultaneously feel very anxious, agitated, irritable, and be horribly sleep deprived.

35% of bipolar affective disorder patients have obsessive-compulsive thinking and behavior.  This is also the most common anxiety disorder that is encountered with bipolar patients. They experience unwanted persistent and distressing intrusive thoughts with obsessional thinking.  They tend to focus on themselves and their symptoms of distress without actively engaging in any problem-solving.  When they are in a depressed state, they will ruminate on negative thoughts.  However, as they cycle upward into hypomania/mania, they will ruminate on positive thoughts.  For those patients who are experiencing a manic episode, symptoms of psychosis may also be evident. Bipolar disorder is a mood disorder where people cycle through periods of high and low energy. The low energy states are called depression.

What really marks the difference between mania and hypomania is just how risky and destructive that impulsivity gets. During mania, one’s behavior will often result in outcomes that are difficult to remedy or may be beyond repair. There is a greater likelihood that a person emerging from hypomania will be able to remedy or correct their mistakes or lapses in judgement.

Here are some examples of mania versus hypomania:

* Mania:  You fly to Las Vegas with your life savings and throw everything down on a roulette wheel. You meet a woman at the bar and three hours later you are married.

* Hypomania:  Spending $300 on home decorations you don’t need but saving the receipt to return the items.

* Hypomania:  Yelling at a coworker but patching it up with an apology the next day.

* Mania:  While you are at work, your supervisor calls you into their office and catches you off guard with some negative feedback. You hurl profanities and kick a hole in the drywall while issuing some serious threats.

* Hypomania:  Driving so fast you get a speeding ticket. When the police officer pulls you over, you can put the brakes on your underlying frustration and anger, be respectful and cooperate.

I realized how hurtful it is to feel so polar about my life every day. It is almost as if when I wake up in the morning, I can tell within the first couple minutes if I am going to have a positive “high” day for a dreadful “low” day. When I am in my highs, I am productive, confident, ambitious, sociable, and strong-mentally and physically. I feel happiness and pleasure. I sometimes feel impulsive but usually, this is for the best. I will impulsively plan trips/travel, I will schedule appointments I had previously been avoiding. I will meet with friends and family for lunch or coffee, get my homework done, and enjoy my work. I will be excited about my romantic relationship and be outwardly affectionate with my partner… Things like this. The only notable downside to my highs is that I tend to be more open to spending money, which I am able to do appropriately.

When I experience my lows (which are more frequent than the “high days”), I struggled to wake up in the morning and get out of bed, I dread everything on my to do list, I dread making food for myself, eating, brushing my teeth, I second guess/doubt my romantic relationship, I absolutely hate school and work. I do not want to talk to people, do not want to laugh or smile. I feel sad, pointless, and dead. I love to sleep through these days.

On some days, I feel that it is a bit difficult to point out whether or not I am having a high or low day. I think of these days as days I merely exist in. I am neutral. I am saddened to realize that the majority of my life lately is just existing-not feeling pleasure and happiness, loving, enjoying, doing, and thriving-as I feel when I am in a “high”. I am sad to be neutral so often and to think I should be happy, but not to actually feel it. I am sad when I wake up and realize I will not be experience a high day. I actively miss them when they are gone. 

A steady oceanic breeze fills your sails; then without any provocation the wind suddenly abates and you find yourself adrift in the open ocean. That’s what it’s like to live with a bipolar disorder. The two extremes interwoven so tightly together that it’s hard to untangle your conflicting emotions. This inner confusion is so pervasive that if it’s left unchecked, it can have lasting consequences.

Allow me to pose a rhetorical question. Can you be totally cured of a bipolar disorder? No, you can not. Although, You CAN treat it. You CAN reclaim your life. You CAN find an inner sense of tranquility. I admonish anyone that’s reading this to focus on the CANS and filter out the CAN NOTS.

After I was diagnosed with bipolar two, I threw myself into a state of denial and self depreciation. Poor decisions often addled by substance abuse sent me down a dark path. After hitting rock bottom on numerous occasions, I finally reached out to get professional help. The pivotal first step is admitting that you need help and subsequently asking for it. Eventually you’ll develop a knowledge base and healthy coping strategies that will be utterly transformative to your life.

I often refer to my bipolar disorder as my Dark Passenger. A constant unseen force... BUT you get to decide the specific role that the Dark Passenger plays in your life. Imagine that you’re sitting in a car with your Dark Passenger. Where is he sitting? Is the Dark Passenger sitting in the back seat? Or maybe he’s in the passenger seat? Is the Dark Passenger in the driver’s seat gripping the steering wheel? Or maybe you’ve successfully hogtied your Dark Passenger and threw him into the trunk of your car. Maybe you can’t even hear him anymore.

To everyone that’s reading this, I wish you the utmost success in your journey. I hope that you find the strength and fortitude to ask for help. Take the necessary steps to demote your Dark Passenger. He belongs in the trunk of your car, not at the steering wheel.

When there are thoughts, impulses, or plans to harm oneself, or end one’s life, it is critical to get help now.  For immediate help, Dial 911 or go to the nearest Emergency Room, or call 988 for the Suicide and Crisis Hotline.