What is bipolar personality disorder

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What is Bipolar Disorder?

Bipolar disorders or manic-depressive illnesses are characterized by pronounced fluctuations in a person's drive, thinking and mood. People with bipolar disorder go through phases of depression and phases of euphoria or an unusually irritable mood. The latter go hand in hand with a significantly increased drive. If these phases are weak, one speaks of hypomanic episodes, and in full expression of manic episodes. In severe manias, symptoms (signs of illness) of a psychosis are added, for example megalomania or paranoia.

In a hypomanic episode
an unusually uplifted or irritable mood occurs on four consecutive days.

At least three of the following characteristics are also present: increased activity, restlessness, talkativeness, difficulty concentrating, decreased need for sleep, increased libido (love affair), reckless behavior, increased sociability.

At times, creativity and performance can also be well above the normal level. The symptoms are not so pronounced that there are social consequences such as job loss or exclusion.

In a manic episode If the mood is unusually lively or irritable for at least a week and the symptoms represent a severe impairment of lifestyle. Initially, however, a manic phase can also lead to increased performance.

There must be at least three of the following characteristics: increased activity, restlessness, urge to talk, flight of ideas (constant rapid talking with abrupt jumps from topic to topic), the feeling that thoughts are racing, loss of social inhibitions, reduced need for sleep, excessive self-assessment, distractibility, Constant change of activities, foolhardy or reckless behavior, increased libido.

How common is bipolar disorder?

About 3 in 100 people will develop bipolar disorder at some point in their life. In contrast to the purely depressive illnesses, women and men are affected equally often. Often people with bipolar disorder have other mental illnesses, such as: B. Anxiety, obsessive-compulsive and addictive disorders, personality disorders or attention deficit hyperactivity disorder (ADHD).

Bipolar diseases can affect everyone and mostly begin in early adulthood around the age of 18. But even in later life, a life crisis or upheaval can trigger such a mental illness.

Are there different shapes or courses?

At aBipolar I disorder sufferers have pronounced manias and depression, in one caseBipolar II disorder There are also depression, but alternating with less pronounced manias, the hypomanias.

  

If a person suffers from severe mood swings for more than two years, but these are not as pronounced as in depressive-manic phases, this is calledCyclothymia. This is a mild form of bipolar disorder. If there are more than four episodes of illness per year, one speaks of one"Rapid cycling course" (from English: rapid = fast, cycling = recurring traversal).

How does bipolar disorder develop?

A clear cause could not yet be determined. Currently one assumes a so-called multifactorial event. This means that several factors in different combinations can be considered as the cause. Which includesbiological causes such as changes in genes and in the brain's messenger system or hormonal changes.

Likewise canEnvironmental factorshow persistent stress, early experiences of loss or traumatic experiences such as sexual, emotional or physical abuse play a role.

Against the background of such factors, people are differently susceptible to mental illness. Comes z. If, for example, a stressful life event is added, this can be the trigger for a mental illness such as bipolar disorder in some people.

How do you find out if you have bipolar disorder?

In many cases, it is the relatives who urge that the “extreme” mood swings be examined. The diagnosis of bipolar disease is a "clinical diagnosis", which means that there is no laboratory value that could provide information about the presence of the disease.
 
In order to determine whether you really have bipolar disorder, a detailed psychotherapeutic discussion is necessary. Here it is helpful - if the person concerned agrees - to include relatives or friends in the diagnosis. This provides therapists with important additional information that they can use to better assess the course of the disease to date. Because often the experiences of the person concerned differ very strongly from what his immediate environment has perceived.

In addition, an examination (e.g. blood analysis, magnetic resonance tomography) rules out the possibility of a physical cause, such as a malfunction of the thyroid gland, for the changes.

In theBipolar I disorder more than 90 out of 100 people have multiple episodes. Manic episodes are much less common than depressive episodes in most people. It is therefore often the depression that determines the course of the disease. A person with bipolar I disorder experiences an average of eight phases. The course is very different from person to person and depends on various factors - including the age when the illness began, gender or whether there are other mental illnesses.

The risk of suicide is 20 to 30 times higher than that of healthy people. About 25 to 50 out of 100 people will attempt suicide at some point in life, and about 15 to 20 out of 100 will die as a result.

Thoughts of suicide or announcements of suicide (suicide) must be taken seriously in any case, 8 to 9 out of 10 suicides are announced in advance. In the case of acute suicidal thoughts, therapeutic help must be sought urgently. “Acute” means when someone specifically intends to kill himself and plans how he wants to do it. However, it is often very difficult for the sick person to get this help.

How is Bipolar Disorder Treated?

Self-regulation and self-responsibility on the part of patients can achieve more than has long been assumed. For this, people with bipolar disorder usually start psychotherapy - often with accompanying medical support. The aim is to alleviate current symptoms of a bipolar phase of illness and to prevent future ones. Medication cannot completely prevent recurring bipolar episodes, but they can lessen it or extend the time to the next episode.

Psychotherapeutic procedures are considered to be very effective. This is especially true if you consider the personal problems and strengths of the person concerned and include their relatives. If possible, this should be done at the start of therapy - provided the patient agrees. A combination of drug and psychotherapeutic treatment is often necessary and useful in order to begin appropriate therapy.

What can friends and family do?

The different episodes of bipolar disorder are very stressful for relatives and close friends. Finding out about the disease, preferably together with the affected partner or family member, makes it easier to deal with the often contradicting statements and behaviors as well as the strongly fluctuating moods.
 
In order to master the mental crises during a phase of illness, relatives need calmness and attention at the same time, they have to balance between affection and demarcation, compassion for those affected and feedback about what this triggers in them.

Maintaining this balance is a long learning process that requires a lot of patience. Self-help groups for relatives offer support and impulses to cope with the challenges of the disease.

Helpful information and links:

Marneros, A. (2004). Handbook of Unipolar and Bipolar Disorders. Stuttgart: Thieme.

Benkert, O., Graf-Morgenstern, M. & Hautzinger, M. (2008). Psychopharmocological guide for psychologists and psychotherapists. Heidelberg: Springer Medicine Verlag.

Bock, T. & Koesler, A. (2006). Bipolar disorder. Understand and treat mania and depression. Bonn: Psychiatrie-Verlag.

German Society for Bipolar Disorders (DGBS), German Society for Psychiatry and Psychotherapy, Psychosomatics, and Neurology (DGPPN) (2020). S3 guideline for the diagnosis and treatment of bipolar disorders. Available at: https://www.awmf.org/uploads/tx_szleitlinien/038-019l_S3_Bipolare-Stoerungen-Diagnostik-Therapie_2020-05.pdf (as of May 2020)

Dr. Daniel Schöttle (specialist in psychiatry and psychotherapy), Prof. Dr. Thomas Bock (psychological psychotherapist), Cordula S. (experienced with bipolar illness)

Date of creation: 08/19/2011
Date of the last content revision: 04/29/2021
Date of the next content revision: 04/29/2022