Bi-polar disorder (BPD), also known as manic depression, is a lifetime disorder in
which excessive swings in mood, energy and activity levels are commonplace and seriously
impair the ability to undertake day-to-day tasks. It can interfere with one’s personal,
social and professional life. The mood swings appear to become more extreme as the
Approximately one percent of the population develop bipolar disorder and currently
there is no clear idea as to what causes it. The disorder does not seem biased towards
either gender, striking indiscriminately. The age of onset appears to be late teens
to late twenties; approximately half of the diagnosed cases occur before the age
of twenty five.
There are several classifications of this disorder, these being:
Bi-polar (i) disorder: defined by manic or mixed episodes that last at least seven
days, or by manic symptoms that are so severe that the person needs immediate hospital
care. Usually, the person also has depressive episodes, typically lasting at least
two weeks. The symptoms of mania or depression must be a major change from the person's
Bi-polar (ii) disorder: defined by a pattern of depressive episodes shifting back
and forth with hypo-manic episodes, but no full-blown manic or mixed episodes.
Bi-polar disorder (NoS): diagnosed when a person has symptoms of the illness that
do not meet diagnostic criteria for either bipolar (i) or (ii) but the symptoms are
clearly out of the person's normal range of behaviour.
Cyclothymia: is a mild form of bipolar disorder. People who have cyclothymia have
episodes of hypo-mania that shift back and forth with mild depression for at least
two years. However, the symptoms do not meet the diagnostic requirements for any
other type of bipolar disorder.
Rapid-cycling bi-polar disorder may be diagnosed when a person has four or more episodes
of major depression, mania, hypomania, or mixed symptoms within a year. Sometimes
people experience more than one episode in a week, or even within one day. Rapid
cycling seems to be more common in people who have severe bipolar disorder and may
be more common in people who have their first episode at a younger age. One study
found that people with rapid cycling had their first episode about four years earlier,
during mid to late teen years, than people without rapid cycling bipolar disorder.
Rapid cycling BPD appears to affect more women than men.
Elated or manic phase
A long period of feeling ecstatic, high, or an overly happy or outgoing mood
Extremely irritable mood, agitation, feeling restless, jumpy on edge or tense
Talking very fast, jumping from one idea to another, having racing thoughts
Being easily distracted
Increasing goal-directed activities, beginning new projects or assuming more responsibilities
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviours,
such as spending sprees, impulsive sex, and impulsive business investments
A long period of feeling low, worried or empty
Loss of interest in activities once enjoyed, including sex
Feeling tired or bogged down
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death, making plans for, or attempting suicide
The Cognitive Behavioural Psychotherapist will collaborate with the patient and assess
all maintaining factors; including thoughts, behaviours, emotions and physical symptoms
associated with the problem and develop a working formulation which will be utilised
to provide a framework to understand bipolar disorder and to guide the course of
A number of techniques will be employed to test predictions and beliefs which will
behavioural strategies to demonstrate the link between behavioural changes and relapse
and cognitive interventions aimed at identifying and challenging unhelpful thoughts
and beliefs, possible thinking errors and misinterpretations. These may then be challenged
through a combination of verbal reattribution, Socratic questioning and behavioural
Final stages of the therapeutic interventions explore relapse prevention strategies.
It must be understood that this disorder has lifetime prevalence, so that CBT (or
any other intervention for that matter) will not cure the disorder for once and for
all but can greatly aid the sufferer to manage and reduce the impact of this disorder.