Mental illness is shrouded in myth. The silence surrounding psychiatric distress has left these conditions to exist largely in shadow, fuelling stigmas and shame. So when The New York Times published “Patient Voices: Bipolar Disorder” to demystify the lived experiences of those living with bipolar disorder, the premise was promising. The stories, told by five men and women diagnosed with bipolar disorder, tell tales of extreme manias manifesting in outlandish grandiosity, wild spending sprees, and psychosis . The narratives are harrowing and they are moving, giving voice to the deep pain, disorientation, and dysfunction that so often plague those with bipolar illness.

But the narratives are also limited in scope and in many ways conform to what we expect bipolar disorder to look like—after all, what could suggest bipolar disorder more than a woman running naked down the street to meet God? We do not find the voice of those whose bipolar disorder includes no mania at all, but is defined primarily by deep depressive episodes punctuated only by the temporary elevation of hypomania. We do not find the voice of those whose bipolar disorder manifests in the oscillating and enduring hypomanic and depressive symptoms of cyclothymia, never crossing the threshold into fully diagnosable states. Nor do we find the stories of those whose bipolar symptoms cannot be adequately captured in an existing classification and are therefore described as “other specified bipolar.”

The absence of these stories is in many ways understandable; it took until 1994 for the Diagnostic and Statistical Manual of Mental Disorders  (DSM) to differentiate between bipolar I and bipolar II, and the distinction is still trickling its way down into public consciousness. But recognizing the heterogeneity of bipolar disorder is critical to validating the varied experiences of those struggling with these complicated illnesses and understanding the need for individualized bipolar disorder treatment.

The Varied Manifestations of Bipolar Disorder

Bipolar disorder, perhaps more so than any other illness, starkly demonstrates that the field of psychiatry is a constantly evolving being. Rather than acting as a static source of authority, the psychiatric community continuously integrates new learning and philosophies as expertise is gained, refining our understanding of what mental illness looks like and how it is to be treated. Over time, this flexibility has provided the space for multiple articulations of bipolar disorder to be recognized as discrete illnesses.

The term “bipolar disorder” was originally developed in the mid-1900s to differentiate bipolar depression from unipolar depression and to conceptualize bipolar depression and mania as a “unitary illness, reflecting dysregulation along a single dimension.” By 1980, “bipolar disorder” had come to supplant the diagnosis of “manic depression” in the DSM, as it was thought to reflect “the defining feature of mood polarity rather than simply pointing to the consequences of polarity.” Today, no bipolar diagnosis requires the presence of both mania and depression and “bipolar disorder” itself no longer defines a specific illness, but acts as an umbrella term for a number of bipolar disorder subtypes:

Bipolar I Disorder

Bipolar I is the best known of bipolar types, but is frequently misunderstood as “manic depression.” In fact, bipolar I is defined solely by the presence of a manic or mixed episode, which may or may not be accompanied by depressive episodes.

Bipolar II Disorder

Unlike bipolar I, a bipolar II diagnosis requires the presence of two separate kinds of mood episodes: hypomania and depression. Because hypomania does not have the acute presentation of mania and because it is often (but not always) experienced as pleasurable, bipolar II is sometimes erroneously thought to be less destructive than bipolar I. However, people with bipolar II disorder tend to have deeper and more prolonged periods of depression while also experiencing more rapid mood switching, which some researchers believe contribute to high rates of suicidality amongst those with the disorder. Many people also suffer from delayed and incorrect treatment after being initially misdiagnosed with unipolar depression.

Cyclothymic Disorder

People with cyclothymic disorder switch between depressive and hypomanic symptoms that lack the severity and persistence of major depressive, full manic, or hypomanic episodes.  By definition, symptoms must last for at least two years, with no more than two months between mood episodes. While the episodes themselves never reach the severity necessary to meet depressive or hypomanic diagnostic criteria, the disorder can cause profound distress and instability.

Other Specific Bipolar

Other specific bipolar, formerly known as not otherwise specified (NOS), includes any presentations of the illness that do not meet diagnostic criteria for bipolar I, bipolar II, or cyclothymia. Typically, this is due to falling below the threshold for severity and/or duration of depressive, manic, hypomanic, or mixed episodes. Despite this, other specific bipolar can cause significant instability and seriously impact function.

Toward Individualized Bipolar Disorder Treatment

In the past two decades, increasing recognition of the diversity found within bipolar disorder has led to the creation of new pharmacological therapies designed to treat the varied symptomatologies of those living with these illnesses. A growing body of research is also calling into question outdated thinking has typically regarded bipolar I as the most damaging type of bipolar disorder, spurring the mental health community to provide better and earlier psychotherapeutic and psychosocial treatment for all bipolar types. While acuity of presentation may indeed vary, suffering does not; people with any type of bipolar disorder can experience deep emotional and behavioral disturbances as the result of their illness and may require intensive treatment.

So what does intensive bipolar disorder treatment look like? There are as many answers as there are manifestations of the disorder itself. There is no single way to treat bipolar disorder because bipolar disorder is not a single illness, but a set of multidimensional conditions that manifest differently in each person. As such, it is vital to seek out a treatment program that will design an individualized treatment plan to address your specific symptoms while harnessing your unique strengths.

What to Look for in a Bipolar Disorder Treatment Program

A high-quality, individualized treatment program will begin with a comprehensive psychological assessment to gain full diagnostic clarity and correct potential misdiagnosis. This assessment also gives clinicians insight into your personality, your goals, and the ways bipolar disorder has affected your life. With this information in mind, a treatment plan will then be crafted that seeks to both address acute symptoms and create a solid foundation for ongoing wellness.

For people with bipolar disorder, pharmacological therapy is typically a vital cornerstone in any treatment plan, and you will work with your psychiatrist to develop a medication regimen that addresses your symptoms most effectively with the fewest possible side effects. But bipolar disorder treatment isn’t just about medication; while psychotropics can provide great relief of symptoms, bipolar disorders are typically chronic illnesses that must be continuously managed throughout your life. As such, it is imperative that you gain the skills and insight to understand the role of bipolar disorder in your life, identify destabilizing triggers, learn how to cope with distress, and begin to repair the damage your illness may have done to your sense of self. Through a personalized mix of individual, group, and holistic therapies delivered by expert clinicians, you can immerse yourself in the work of healing using cutting-edge methods proven to help people with bipolar disorder recover and begin to redefine yourself outside of your illness.

While people with bipolar disorder have an infinite variety of experiences, the goals of treatment tend to be remarkably similar: stability, improved relationships, enhanced self-regulation, and an expanded capacity for joy. With the right treatment plan, you can uncover new paths to healing that will bring these goals into reach and allow you to fulfill your true potential.

Bridges to Recovery offers comprehensive, residential treatment for people struggling with mental health disorders as well as co-occurring substance abuse and eating disorders. Contact us to learn more about our renowned Los Angeles-based program and how we can help you or your loved one start the journey toward lasting wellness.

Image Source: Unsplash user Caleb Frith

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