Bipolar disorder is a biological illness that causes unusual shifts in your mood, level of energy, and ability to function in different aspects of your life (for example, working or going to school, taking care of yourself, and maintaining relationships). This illness used to be called manic depression, because it was thought that people with the illness would fluctuate only between episodes of highly elevated, euphoric moods and episodes of major depression. More recently, doctors have realized that the illness is not quite that black and white—that there are many moods that actually occur on a spectrum, some of which are included on the diagram below. Rather than just experiencing episodes of depression or mania, people with bipolar disorder can in fact experience various moods and symptoms that fall in between these two extremes, and this is why the illness was renamed bipolar disorder, implying that symptoms occur on a spectrum between the two poles of mania and depression.



We all have times in our lives when we feel sadness, we may have trouble coping, or we feel overwhelmed. The mood shifts that occur with bipolar disorder, however, are very different from the normal ups and downs that everyone experiences at times. The symptoms of bipolar disorder are much more severe and can result in damaged relationships, poor performance at school or in the workplace, and even suicide or other life-threatening behaviors.

For some people, the mood changes brought on by bipolar disorder can be dramatic. They can go very quickly from feeling euphoric or “high,” or feeling extremely irritable, to feeling sad and hopeless. For others, however, the changes are not so severe or easily identified and can involve mild to moderate levels of mania, known as hypomania. For still others, both depression and mania can occur at the same time, leading to a tumultuous, chaotic experience of feeling extremely energetic but sad and hopeless at the same time. This is known as a mixed episode.

Usually, people experience periods of “normal” mood between these episodes (this is called euthymia), when they are neither manic nor depressed. While many people return to a fully functional level during these periods, many also continue to experience some symptoms, such as low mood (which, when lasting two years or more, is referred to as dysthymia), anxiety, or problems sleeping. This can continue to have an impact on relationships and on functioning in areas such as work and school.

Like diabetes, heart conditions, and many other physical conditions, bipolar disorder is a lifelong illness that requires careful and constant management with medication and other treatments, such as psychotherapy. When bipolar disorder is treated effectively, people can lead a healthy, productive life. I will break down bipolar disorder into smaller parts over the next three days so you can become more familiar with the illness and the specific symptoms people experience.


Excerpt from Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life by Sheri Van Dijk, MSW