Important Things to Know if Someone You Love has Bipolar Disorder

About three million Americans live with some form of bipolar disorder. Here are some facts that you may find helpful. 

There are two primary types of bipolar disorder. 

  • Bipolar I is diagnosed when a person has had one or more manic episodes and one or more depressive episodes. Sometimes people are mis-diagnosed with depressive disorder because they have several depressive episodes before they have a manic episode. Others may be diagnosed with depressive disorder because they don’t recognize (or report) their earlier manic episodes. To get an accurate diagnosis, it’s essential that the psychiatrist consult with the family as well as the individual with the condition. 
  • Bipolar II has depressive episodes as its major feature—these episodes and mood changes are the most severe part of this condition. To be diagnosed with bipolar II, someone must also have experienced at least one hypomanic episode—a less severe type of mania, in which the person has no psychotic symptoms. 

Family member input is critical to a diagnosis. When family members share their experience of their relative’s symptoms, the mental health care provider has a more complete picture of the situation. Often, people with bipolar disorder don’t recognize (or report) their manic or hypomanic episodes, which can lead to a misdiagnosis of depressive disorder.

Getting an accurate diagnosis takes time. 90% of people whose illness begins with a single manic episode will have future episodes. The peak age of onset is 15-19 years; the earlier the illness strikes, the more likely it is to be severe, psychotic and misdiagnosed as schizophrenia. 

Lessening or preventing mania is possible. Good sleep is critical. Manic episodes in people with bipolar disorder can be triggered by lack of sleep and irregular sleep patterns. It’s important that you and your relative know about this connection—being careful to get enough sleep may help prevent or lessen an episode of mania. 

Denial is often part of the condition. Once a manic episode is fully happening, it’s often difficult to get your relative into treatment. Often, people in manic episodes deny that they have a condition and that they need help. They’re often reluctant to give up the energy and excitement of their condition. That disconnect from reality is a characteristic of their condition. People with mania often don’t recognize they have a mental illness until they’ve been through several hospitalizations or episodes of depression.

Maintaining stability is a lifelong challenge. Many people with bipolar disorder are symptom-free for lengthy periods between episodes. It’s important not to confuse these stable periods with being “cured”—the condition has not disappeared, so the person still needs to take care of their mental health. These periods between episodes tend to shorten as people get older. Others who do not have long periods of wellness, often experience mood changes that can make it hard to work and to interact with people. About a third of people with bipolar I disorder have “rapid cycling,” which can be very hard to manage. People with bipolar disorder also are at higher risk for suicide, especially if they’re male, use alcohol or drugs and experience psychotic depression. People with bipolar disorder generally have less mood instability when they follow a regular pattern of eating, sleeping, physical activity and a low level of emotional stress. Maintaining the stability of these aspects of life is an important strategy for all people with bipolar disorder.