Bipolar disorder: what it is, symptoms, types and myths

If you have found your way here, it is likely that bipolar disorder touches you closely, whether because you have just received a diagnosis, because you suspect that someone you love may be living with it, or simply because you want to understand it better without settling for what is said superficially. We want to start by telling you something important: talking about bipolar disorder is not talking about a label that defines a person, but about a health condition that can be understood, treated and accompanied. Behind this term there are people with projects, affections, talents and a whole life. In this article we explain to you, calmly and without unnecessary jargon, what it is, how it shows itself, what types exist and, above all, why there are many reasons for hope.

What bipolar disorder is

Bipolar disorder is a mental health condition that affects the way mood, energy and the ability to function day to day are regulated. What characterises it is the alternation of clearly distinct mood phases: on one hand, episodes in which energy and mood rise above what is usual, which we call manic or hypomanic episodes; and on the other, episodes in which mood falls deeply, the depressive episodes. Between those phases there are usually periods of stability, in which the person feels well and goes about their life normally.

It is essential to understand that this is not about having a good day or a bad day. We are talking about phases that are sustained over time, that involve a notable change from how the person usually is and that come to interfere with their rest, their work, their studies or their relationships. That alternation between opposite poles is what gives the disorder its name.

What a manic or hypomanic episode consists of

During a manic episode, the person experiences a very elevated, expansive or, at times, especially irritable mood. They may feel that they have almost inexhaustible energy, that ideas crowd in and race very fast, and that they need very little sleep without feeling tired. It is common for them to speak faster than usual, to embark on many projects at once or to make impulsive decisions that at another time they would not make, such as disproportionate spending or risks they do not gauge well.

Hypomania is similar, but in a milder and less intense form. It can go more unnoticed and even be experienced, at first, as a phase of great productivity and good humour. That is precisely why it is sometimes hard to identify, since it does not always cause obvious distress at the time. These are some signs that tend to appear in these phases:

• A greatly reduced need for sleep without a feeling of tiredness.
• Acceleration of thought and speech.
• A marked increase in energy and activity.
• Excessive self-esteem or confidence, with a sense that everything is possible.
• Impulsive or risky behaviours that are unusual for the person.

What a depressive episode consists of

The other pole is the depressive phase, and it is usually the one that causes the most suffering. Here mood dims: a deep sadness or a sense of emptiness that does not go away appears, and often the interest in things that used to be enjoyed is lost. Energy vanishes, it becomes enormously hard to get the day started and the simplest tasks feel like a mountain.

It is also common for sleep and appetite to change, for difficulties in concentrating or making decisions to appear, and for the person to judge themselves harshly, with thoughts of guilt or of not being worth enough. In depressive episodes, ideas that life is not worth living or thoughts of self-harm can arise. If this happens, it is not a weakness or something to be ashamed of: it is a sign that help is needed as soon as possible, and further on we tell you who to turn to.

The types of bipolar disorder

Not everyone with bipolar disorder lives it in the same way. That is why different types are described, according to what the phases are like and how intensely they present. Knowing them helps to understand that this is a condition with nuances:

• Bipolar type I: characterised by the presence of at least one manic episode, which tends to be intense and may require urgent care. Depressive phases usually appear too, although the defining feature is mania.
• Bipolar type II: combines depressive episodes with episodes of hypomania, that is, those milder phases of elevated mood that do not reach the intensity of mania. Being more discreet does not make it less serious: the depressive part can be very disabling.
• Cyclothymia: consists of milder but sustained mood swings, with ups and downs that do not reach the severity of the previous episodes, but that equally affect wellbeing and daily functioning.

None of these types is a sentence. They are ways of organising the information so that professionals can offer the most suitable support to each person.

It is not simply being a very changeable person

One of the most widespread misunderstandings is using the word bipolar in everyday life to describe someone who changes their mind, who has a bad temper or who goes from laughter to anger in a matter of minutes. This, as well as being inaccurate, contributes to a stigma that does harm. It is worth dismantling some common myths:

• It is not having normal mood swings. We all have better and worse days; bipolar disorder involves sustained phases that significantly alter the person's life.
• It is not being unstable or unreliable. Many people with bipolar disorder, with the right support, lead full lives, maintain stable relationships and build solid professional careers.
• It is not a question of willpower. You do not come out of an episode simply by trying harder, just as a physical illness is not cured by willpower.
• It does not define the person. It is a part of their experience, not the whole of who they are.

Possible causes and factors

A very understandable question is why bipolar disorder appears. The honest answer is that there is no single cause, but a combination of factors that interact with each other. It is known that there is a biological component, related to the way certain brain systems involved in mood regulation work. There is also a genetic weight: having relatives with this condition increases the probability of developing it, although it does not determine it, since many people with a family history never present it.

Added to this are factors of the environment and of life experience. Sustained stress, difficult events, lack of sleep or major life changes can act as triggers of an episode in people with that predisposition. Understanding this helps to let go of guilt: no one chooses to have bipolar disorder, in the same way that no one chooses to have any other health condition.

How it affects life and relationships

Bipolar disorder does not stay locked inside the mind of the person who lives it: it unfolds at work, in studies, in the couple, in the family and among friends. During a depressive phase it can be hard to keep up the pace at work or simply to reply to a message, and the people close by sometimes interpret it as lack of interest when in reality it is deep exhaustion. During a manic phase, impulsive decisions or conflicts can strain bonds and create situations that are hard to repair.

All of this can leave the person with a feeling of guilt or of not being understood, and those around them bewildered and powerless. That is why it is so valuable to have information and a space of support: when the family and close people understand what is happening, living together becomes much kinder and relationships have the chance to grow stronger instead of breaking.

The importance of a professional approach

We want to be clear on this point because it is essential. Bipolar disorder usually requires medical and psychiatric follow-up in addition to psychological support. The assessment of a medical professional is what allows an accurate diagnosis to be made and a treatment plan adjusted to each person to be established. It is not for an informative article, nor for anyone who is not your doctor, to indicate what treatment to follow, and that is why here we do not recommend any specific medication.

What we do want to convey to you is that asking for professional help is not a sign of irreversible seriousness, but the step that opens the door to stability. With a coordinated approach, many people manage to reduce the frequency and intensity of episodes and regain control over their lives.

The role of psychotherapy

Psychotherapy is a fundamental pillar of support, and it works in a way that complements medical follow-up. From the psychological practice we help the person and, when possible, their environment, to understand what is happening and to manage it better day to day. These are some of the aspects in which it is especially useful:

• Psychoeducation: getting to know the disorder well, understanding its phases and learning to tell them apart is one of the most powerful tools for facing it.
• Routines and lifestyle: looking after sleep, keeping stable schedules and organising the day help to sustain the stability of mood.
• Detecting signs of relapse: learning to recognise the first hints of an episode makes it possible to act in time and ask for help before the phase settles in.
• Managing emotions and stress: developing strategies to face difficulties reduces the impact of the triggers.

Psychotherapy also offers a safe space to talk about guilt, about the fear of relapse and about the grief that sometimes comes with the diagnosis, and to rebuild confidence in oneself.

How to support a loved one

If you love someone living with bipolar disorder, your support matters, and a lot. You do not need to have all the answers or become their therapist. What helps most is usually simple: listening without judging, informing yourself to understand what is happening to them and accompanying without trying to fix everything. Avoid phrases like they should try harder or cheer up, because they do not depend on willpower. Instead, let them know that you are there and that you are not alone in this.

It is just as important that you take care of yourself. Accompanying someone can be exhausting, and to be able to support another person you also need your own supports and your moments of rest. Seeking professional guidance as a family member is not selfishness: it is a way of accompanying better and of caring for the relationship.

When to ask for help

If you notice mood phases that recur and that interfere with your life, or if you recognise in yourself or in someone close the signs we have described, it is a good time to consult professionals. There is no need to wait until you are in crisis to seek help; the sooner support begins, the easier it is to regain balance.

And if thoughts of harming yourself or that life is not worth living appear, please, do not carry that weight alone. In Spain you can call 024, the suicidal behaviour helpline, available twenty-four hours a day, and in an immediate emergency 112. Asking for help in that moment is the most courageous and most caring thing you can do for yourself.

To go deeper, our article on how to recognise depression and getting to know our therapy for depression may help you.

Bipolar disorder is a treatable condition, and with the right support you can lead a full life, with projects, bonds and wellbeing. At ER Psicología we accompany this process with rigour, warmth and without judgement, alongside the medical follow-up that each person needs. If you feel the moment has come to take the step, we gently invite you to book a first appointment with no obligation, in Tres Cantos, in Colmenar Viejo or online. We will be glad to listen to you and to walk alongside you.