Recognizing Bipolar Disorder in Your Loved One

By David H. Averbach, MD, MSIA

Bipolar Disorder, or Manic Depressive Disorder, can have a devastating impact on the individual with the disorder, as well as on the families who have to deal with the individual on a daily basis. Coming from a family with a long history of Bipolar Disorder, I can say that identification of Bipolar Disorder in the individual is the key step in understanding and treating this illness.

Bipolar Disorder is characterized by episodes of manic behaviors, which may be short lived for a portion of a day, to long episodes lasting weeks or even months. The individual’s behaviors during these episodes are devastating to the family unit. Mood swings, irritability, needing little sleep, impulsivity, compulsions such as gambling or higher than normal sexual interest, and paranoia may be present during these manic episodes. These episodes may become so severe that the individual is at high risk of hurting themselves or others. Their intention may be rational, but the behaviors and interaction with others are usually irrational and bizarre.

Depression is usually a component of Bipolar Disorder. Episodes of depression may consist of crying, sadness, hopelessness, excess sleep or poor sleep, overeating or not eating enough, isolation from others, and losing interest in things that they used to find enjoyable. Feeling that life is not worth living and thoughts of suicide may also be present during the depressive episodes. Episodes of depression may last hours, days, weeks, or months, and often occur after a period of mania.

Identification of bipolar symptoms or behaviors is crucial in helping the individual and family cope with the disorder and begin to heal. The earlier the person is identified with Bipolar Disorder, the better the prognosis for managing the illness effectively. Individual and family education, support of the individual by their families, and compliance with treatment are crucial in managing the illness effectively.

It is easiest to illustrate Bipolar Disorder in men by using a common but fictitious case example. John S. is a 37 year old married man with three children. His wife has periodically expressed concern over his behaviors throughout their 10 years of marriage. There were times of mania when he would be impractical and impulsive, such as deciding to paint the outside of their house without the proper thought or tools. He would go through friends rather quickly because of his lack of tact and social awareness. He undertook extensive projects that would keep him up for several nights in a row. He would be irritable, loud, and argumentative for periods of time, and at other times he would appear to be happy and passive. He would also mismanage money and was a disaster to the family when he would do banking. During these episodes, he truly believed that he was right, reasonable, and rational when defending his ideas and impulsivity.

However, when he recovered from an episode, he would usually become depressed and isolated himself from his family and friends. He slept for 80 percent of the day, and during the other 20 percent he was tired and lethargic. His memory would be poor, he felt slowed down, and he lost interest in his hobbies and going out with his friends. At times during these episodes of depression, he had wishes of not being around and thought that his death would be the only option for preserving his family. During one episode, he talked to his wife about a plan he had for suicide, but he said that he did not have any intent to pursue the plan.

Needless to say, the family was always walking on “pins and needles” when they were around him, not knowing what his mood was like that minute, and not knowing when he would flip into a manic or depressive state. The frequency and intensity of his episodes caused chaos in the family. His wife would take the children to her parent’s house when his behaviors begin to get out of hand. Divorce was mentioned but not pursued, in part due to his wife feeling that it was her job to keep him under control. At times he seemed to be sorry for his behaviors that occurred during an episode, but he usually tried to rationalize them and blamed others for causing the behaviors. He also has no history of therapy, psychiatric intervention, or medication use for his behaviors.

This case example shows us the devastating impact that Bipolar Disorder has on the individual and family. It can be seen that the intensity and frequency of the episodes would most likely be much more manageable with early diagnosis, education, and treatment. Even if the person with the disorder refuses to seek help, education and therapy for the family by a trained professional skilled in Bipolar Disorder will help keep the family intact and help with their understanding of the illness and behaviors. Many times, the family member with the disorder will accept help when they are not in an episode, but maintaining therapy or medications during an episode is a significant challenge for the family and professionals dealing with this individual.

In summary, Bipolar Disorder can be well managed if identified accurately and prudently. Always seek professional help by a psychiatrist who can diagnose, educate, and provide treatment options for the individual and family. Remember that the earlier an accurate diagnosis is made the sooner the individual and family can begin to heal.

Dr. David Averbach is board certified in psychiatry and neurology.  He received his medical degree from University of Pittsburgh School of Medicine, and completed his M.S.I.A. in business from Carnegie Mellon University, Graduate School of Industrial Administration.  He is a member of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.