Bipolar & Related Disorders (College Board AP® Psychology): Study Guide

Symptoms of bipolar & related disorders

• Bipolar disorders are characterised by alternating episodes of mania (or hypomania) and depression

  • Episodes can last days, weeks, or months, and the disorder involves at least one manic or hypomanic episode

• Two disorders include:

  • Bipolar I

  • Bipolar II

Mania

• Mania is a state of abnormally elevated or irritable mood and increased energy

• During a manic episode, the person experiences:

  • Elevated or expansive mood: unusually high, euphoric, or irritable; feeling invincible, special, or extraordinarily powerful

  • Decreased need for sleep: feeling rested after only a few hours; not feeling tired despite sleeping very little

  • Inflated self-esteem or grandiosity: unrealistically high opinion of one's abilities or importance

  • Racing thoughts and flight of ideas: thoughts move rapidly from one topic to another with little connection

  • Increased talkativeness: speaking rapidly and pressured, difficult to interrupt

  • Distractibility: attention shifts rapidly between irrelevant external stimuli

  • Increased goal-directed activity: taking on many projects simultaneously, restless activity

  • Impulsive, risky behavior: excessive spending, sexual indiscretion, reckless driving, substance use

• Mania causes marked impairment in social or occupational functioning and may require hospitalization

  • Some people experiencing mania have psychotic features where hallucinations and delusions may occur

Hypomania

• Hypomania is a less severe form of mania

  • The same elevated mood and increased energy are evident, but not severe enough to cause marked impairment or require hospitalization

    • E.g. the person may feel unusually productive, energetic, and confident during a hypomanic episode

• Hypomania does not include psychotic features

Bipolar I disorder

• Bipolar I disorder is characterized by:

  • at least one full manic episode lasting at least one week, or be severe enough to require hospitalization

  • major depressive episodes, though this is not required for diagnosis

• Bipolar I is the most severe form of bipolar disorder, as the manic episodes can be highly disruptive and dangerous

Bipolar II disorder

• Bipolar II disorder is characterized by:

  • at least one hypomanic episode

  • at least one major depressive episode, but no full manic episodes

• The key difference between Bipolar I and Bipolar II is the severity of the elevated mood episodes:

  • Bipolar I = full mania (more severe, more impairing)

  • Bipolar II = hypomania (less severe, less impairing) + depression

• Bipolar II is often misdiagnosed as MDD because the hypomanic episodes may go unnoticed

Causes of bipolar disorders

• Bipolar disorders are best explained by interacting biological, psychological, and social factors.

Biological and genetic causes

• Genetic factors: bipolar disorder is highly heritable and is among the most genetically influenced of all psychological disorders

  • Identical twin concordance rates are higher than fraternal twin rates

  • Having a first-degree relative with bipolar disorder significantly increases risk

  • Genes involved in the regulation of neurotransmitters and circadian rhythms are implicated

• Neurochemical factors: bipolar disorder involves dysregulation of multiple neurotransmitter systems, including serotonin, dopamine, and norepinephrine

  • During manic phases, dopamine activity is elevated

  • During depressive phases, dopamine is reduced

  • Acetylcholine (another neurotransmitter) also appears to play a role

• Brain structure: people with bipolar disorders show differences in the size and function of brain regions involved in emotion regulation

  • E.g. the prefrontal cortex and amygdala

Psychological, social, and cultural causes

• Psychological factors:

  • Cognitive patterns similar to those in MDD contribute to depressive episodes

  • During manic phases, overconfidence and reduced self-monitoring are characteristic

• Social factors: stressful life events can trigger episodes in biologically vulnerable individuals

  • This is consistent with the diathesis-stress model

• Cultural factors: cultural norms influence how manic and depressive episodes are interpreted and whether they are recognized as symptoms of disorder

Treatment

• Bipolar disorders are typically treated with mood-stabilizing medications, e.g. lithium

  • Drugs are often combined with psychotherapy

• Antidepressants alone are generally avoided in bipolar disorder as they can trigger manic episodes