Bipolar Disorders: Managing Extreme Highs and Lows


Published: 08 December 2022

An estimated 1 in 50 (1.8%) Australian adults experience a bipolar disorder each year (Healthdirect 2020).

The exact causes of bipolar disorders are not yet clear. However, there is evidence to suggest they are linked to a combination of genetic, neurological, biological, and environmental factors (SANE 2022).

What are Bipolar Disorders?

In the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorders are defined as a group of brain disorders that cause extreme fluctuations in a person’s mood, energy, and ability to function (APA, as cited by Truschel 2020).

People with bipolar disorder will experience periods of mania and depression.

During mania, feelings of excitement, overactivity, delusions and euphoria will be present. In depressive periods, a person will feel sad and hopeless (Truschel 2020).

The term ‘bipolar’ reflects the nature of the condition: a fluctuation between extreme highs and lows. These extreme emotional states may occur at distinct times or periods (Truschel 2020; APA 2020).

People with bipolar disorders will have periods of regular moods as well. Treatments are available for bipolar disorders; people with these conditions can still lead full and productive lives (APA 2020).

person with a bipolar disorder undergoing therapy
An estimated 1 in 50 (1.8%) Australian adults experience a bipolar disorder each year.

Types of Bipolar Disorder

Bipolar I Disorder

  • A manic-depressive disorder
  • It can exist both with and without psychotic episodes.

(Truschel 2020)

Bipolar II Disorder

  • Consists of both depressive and manic episodes, which will:
    • Alternate between states
    • Are typically less severe
    • Generally, will not inhibit a person’s ability to function.
  • It is not unusual for people who have bipolar II disorder to have co-occurring mental health conditions such as an anxiety disorder.

(Truschel 2020; APA 2021)

Cyclothymic Disorder

  • Is milder, consisting of mood swings
  • Cyclical
  • Causes brief but frequently occurring episodes of hypomania and depression.

(Truschel 2020; APA 2021)

As per the DSM-5, there are seven possible diagnoses for adult bipolar disorder:

  1. Bipolar I disorder
  2. Bipolar II disorder
  3. Cyclothymic disorder
  4. Substance/medication-induced bipolar and related disorder
  5. Bipolar and related disorder due to another medical condition
  6. Other specified bipolar and related disorder
  7. Unspecified bipolar and related disorder.

(APA 2022)

Bipolar Disorder DSM-5 Diagnostic Criteria

The first step to diagnosing a bipolar disorder is to seek the opinion of a mental health professional.

Manic Period

A manic period is defined as an elevated, expansive or irritable mood alongside increased activity and energy that lasts for at least one week and is present for most of the day, nearly every day (Black Dog Institute 2022).

Mania will be severe enough to disrupt work, family life, social life and daily responsibilities (APA 2021).

During mania, three or more of the following symptoms must be present:

  • Increased self-esteem or grandiosity
  • Decreased need for sleep
  • Increased talkativeness
  • Having racing thoughts
  • Being very easily distracted
  • Increased goal-directed activity
  • Increased psychomotor agitation
  • Engaging in risky activities that may have the potential for painful consequences.

(Black Dog Institute 2022)

A hypomanic period is quite similar to a manic period. However, the symptoms will be less severe. Symptoms only need to last four days in a row to be considered a hypomanic episode (APA 2021).

Hypomanic symptoms do not lead to the major problems that mania is associated with. Generally, a person will still be able to function (APA 2021).

Depressive Period

person with bipolar disorder in depressive period

A depressive period is a period of two weeks in which a person presents at least five of the following symptoms. This must include at least one of the first two symptoms in the list:

  • A depressed mood during the day, nearly every day
  • A loss of interest or pleasure in activities
  • Significant weight loss or change in appetite
  • Carrying out purposeless movements, such as pacing or tapping
  • Being fatigued or showing a loss of energy
  • Feelings of guilt or worthlessness
  • Having a reduced ability to concentrate
  • Indecisiveness
  • Suicidal ideation, plan or attempt.

(APA 2021)

Treatment for Bipolar Disorders

The impact bipolar disorders can have on a person’s life should not be underestimated. Suicide risk is significantly higher among people living with bipolar I disorder (APA 2021). Thankfully, there are treatments widely available for people who have bipolar disorders.

Bipolar disorders require long-term management. They are generally treated with a combination of medicines - such as mood stabilisers, antidepressants or antipsychotics - as well as counselling, psychotherapy and/or community support (Healthy WA 2015; Rush 2022).

If you or someone you know needs help now, call Lifeline on 13 11 14. If someone is in immediate danger, call Triple Zero (000).


Test Your Knowledge

Question 1 of 3

Which one of the following is in the DSM-5 diagnostic criteria for an episode of mania?


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