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Bipolar Disorder - A Snapshot of the Diagnosis

A snapshot of the bipolar diagnosis.

Let's start with an analogy: When your car's engine is running and it's in park or neutral, the engine is idling at a fairly steady rate. You don't even have to press on the gas pedal because the delivery of fuel is at just the right amount to keep the engine turning steadily. Now imagine that without touching the gas pedal, the engine starts revving. Its RPMs become increasingly faster and you can't find a way to slow it down. Or, conversely, that same engine begins sputtering and slowing down for no apparent reason. You try giving it more gas but to no avail. It barely keeps turning or it repeatedly stalls and there's little you can do to keep it idling at a steady rate. This is the experience of the person with bipolar disorder, only it's the brain's activity that's accelerating or slowing down.

Alongside the slow/fast continuum we see another aspect of experience involving quality of mood. The two ends of that continuum are depression and euphoria. Most of us know what depression is. The world feels dull, grey, slowed and without much pleasure. We also know what it is to feel up and happy. Just think back on the last time you were in a really good mood. But extend that "up" feeling a bit further and we see emotions of euphoria, unbounded optimism and creativity, strong sexual desire, excessive spending, impulsive travel and intense elevated energy.

So what's wrong with feeling up? After all, don't all of us want some "up"? Yes, but in moderation. When the "up" is part of the experience we refer to as "mania," then your mind is typically moving too fast to be able to benefit from things like good judgment, accurate self-observation and healthy restraint. In other words, though you may feel good, you're not necessarily behaving in ways that are good for you. And what's worse is that often you don't know it, because you're caught up in it.

So bipolar disorder involves three key components: 1) episodes of depression, 2) episodes of moderate mood elevation (typically referred to as hypomania) and 3) the occasional occurrence of full mania or the experience of being "up" where you truly feel out of control. If you only experience depression and hypomania, then you're said to have Bipolar II Disorder, whereas if your hypomania crosses the threshold where your thoughts, emotions and behaviors feel out of control then you're said to have Bipolar I Disorder.

That's it ... simple; or, maybe not. In practice we find that nearly 7 of every 10 people with bipolar disorder are misdiagnosed at least once, and that the average length of time from a person's first bipolar symptoms to correct diagnosis and treatment is 10 years! More about why this occurs in future postings.

For now, if you think you may be bipolar... if you identify with any of what's been said, it's really in your best interest to see a mental health professional. Yes, it will be strange to meet with someone you don't know and talk about very personal stuff. But strange is preferable to not getting the help you may need.

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Russ Federman is co-author of Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar Disorder (New Harbinger Publications), see