Looking More Closely at Bipolar
Being diagnosed with one of the three forms of bipolar disorder can help put your thoughts, feelings, and behaviors into a context that helps you understand yourself and the world around you. Fortunately, bipolar disorders have additional levels that further explain and separate one form of the disorder from others.
Called specifiers, these diagnosis additions describe the presence of specific conditions related to your bipolar. The important thing to remember is that specifiers only happen when bipolar symptoms are present, so they are not separate conditions.
There are nine bipolar specifiers including:
With Anxious Distress
This specifier signifies that, during your periods of mania, hypomania, or depression, you also have anxious symptoms marked by:
- Feeling tense or keyed up
- Restlessness
- Trouble concentrating
- Fear of bad things happening
- Fear of losing control
With anxious distress is an important specifier to note because it is associated with negatives like poor treatment response, longer duration of symptoms, and even higher suicidality.
With Rapid Cycling
As mentioned earlier, being happy one minute and sad the next is not bipolar, but people will often state “rapid cycling” as a justification for their sudden mood changes. Rapid cycling, as a bipolar specifier, is not well understood by the public.
Having bipolar disorder with rapid cycling does not mean you will be in a full manic episode one day and depressive episode the next. The cycling is not that rapid.
With rapid cycling only means you will have at least four separate mood episodes during a 12-month stretch. Since each episode must last the required amount of time, you cannot have multiple episodes in a one-week period.
With Seasonal Pattern (Seasonal Affective Disorder)
Though this is a common problem, seasonal affective disorder is not a separate bipolar disorder. With seasonal pattern is, though, recognized as a specifier of bipolar I or II. Therefore, you can have bipolar I disorder with seasonal pattern to better describe your symptoms.
Seasonal affective disorder (SAD) or bipolar disorder with seasonal pattern is when your symptoms are influenced heavily by the time of year. Typically, people with the condition will become depressed in the winter and manic in the summer.
This specifier adds its own unique sets of challenges and advantages. If you know your symptoms are ready to change, you can employ a set of strategies to soften the blow.
You can also work with your psychiatrist to adjust your medications in a preventative, rather than reactionary, way.
With Psychotic Features
You may only link symptoms like hallucinations, paranoia, and delusional thinking to psychotic disorders like schizophrenia, but these may be linked to bipolar disorders as well.
The “with psychotic features” specifier is used anytime someone shows these signs and symptoms only during a time of a mood episode whereas people with schizophrenia will have psychotic symptoms no matter their mood.
Hallucinations and delusions can present during mania or depression. As these symptoms can pose danger to the person and their loved ones, it is important to recognize and treat these symptoms as quickly as possible.
With Mixed Features
As if the entire diagnosis of bipolar disorders wasn’t already tricky enough, there is the with mixed features specifier. With mixed features essentially means that the manic or hypomanic episodes are not typical of other similar episodes.
Even though these people will meet the criteria for mania or hypomania, they will have depressive symptoms like:
- Low or depressed mood
- Less interest and pleasure in activities
- Feeling or looking slowed down
- Loss of energy
- Feeling worthless
- Thoughts of death
So, rather than being manic exclusively, the person will have all of the normal mania symptoms with several depression symptoms overlapping. The same can be true of someone in a depressed episode having manic symptoms overlapping.
Not only does this make identifying the condition very challenging, but treating the symptoms becomes a delicate situation.
Other Specifiers
Along with these specifiers, one could have bipolar disorder:
- With melancholic features
- With atypical features
- With catatonia
- With peripartum onset
Of this group, with peripartum onset is perhaps the most common and concerning. Like postpartum/ peripartum depression, bipolar with peripartum onset represents bipolar depressive or manic episodes that emerge during or soon after pregnancy.
These symptoms can cause obvious harm to the mother and child is left unidentified and untreated.
Conclusion
Knowing your symptoms and how they fit into a psychological framework is useful universally. Do your best not to jump to conclusions. No mental health disorder is simple or clear-cut. Your depressive or manic symptoms will distort your perceptions and self-monitoring.
Gather information from trusted supports to get a well-rounded picture of your bipolar symptoms and take your findings to a mental health professional. If you think bipolar disorder may be part of your life, an expert is the best person to assess, diagnose, and treat your bipolar symptoms. It’s time to make the call.
