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What are the symptoms of bipolar disorder?

Bipolar disorder is characterized by a manic episode followed by either a depressive or hypomanic episodes. People caught in a depressive episode experience at least two weeks of feeling sad, empty, or hopeless. They lose interest in activities they once enjoyed and may lose weight, have difficulty sleeping, or may spend more than half the day in bed. They may feel both exhausted and agitated, worthless, excessively guilty, and lose their ability to concentrate or make simple decisions. And most dangerously, they may lose their will to live, and even seek ways to end their life. People in the midst of a manic episode experience at least a week of persistently elevated or irritable mood. They may be expansive — seeing themselves as possessing special powers or abilities. They may shout at or start arguments with people they don’t know. They may lose their need for sleep — feeling fully rested after only 3 hours. They may be so talkative that people have trouble interrupting them. They may experience their thoughts as racing, so much so that they are incapable of keeping their mind focused on one thing. They may be so active that friends and family are worried about them. And they may be so impulsive and reckless that they put their physical and financial health at risk. Depressive and manic episodes can vary in frequency, intensity, and duration. Bipolar I disorder is characterized by intense manic episodes. At their worst, people may require hospitalization. Bipolar II disorder is characterized by more brief (4 days), less intense episodes of mania, which is called hypomania.

How common is bipolar disorder?1

Up to 6 out of every 1000 people are estimated to have Bipolar I disorder. It is slightly more common in men than in women.

What is treatment for bipolar disorder like?

For all disorders, the CBT therapist starts by educating clients about their diagnosis, helps them set goals, and socializes them to CBT by teaching them essential thinking and behavioral skills. Therapists use many of the same interventions for these clients as with clients who are depressed but also provide clients with bipolar disorder tools to recognize the warning signs of mania and cope with its effects. CBT therapists also helps clients manage their medication with their psychiatrist, communicating the effects, both positive and negative, that medication has on their life. Therapists teach clients with bipolar disorder strategies to help regularize their sleep, as too much time in bed can trigger depression; too little can trigger mania. Therapists focus on identifying some of the hyper-positive thinking (“I can do no wrong”) and the impulsivity (“I want what I want when I want it and I want it now”) that can characterize their thinking. CBT therapists teach ways to delay gratification, maintain awareness of their actions, slow down, plan activities, be more conscious of the consequences of their actions, and distance them from the emotional tug of mania. The tools for depression focus on enabling clients to see the best in themselves, their personal world, and their future. They learn to take constructive action to their own benefit in the absence of motivation, interest, and energy. And they learn that such action can increase motivation, energy, and interest.

For health and mental health professionals

Learn to treat personality disorders more effectively at our CBT for Personality Disorders workshop. 1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. doi:10.1176/appi.books.9780890425596.744053