Four Misconceptions About Bipolar Disorder
Misconceptions about bipolar disorder are still common and contribute to stigma and barriers to proper care
Bipolar disorder is one of the mental health struggles we have the most misconceptions about. We encounter these misconceptions everywhere, from stereotypical characters portrayed as having bipolar disorder in TV shows to the mistreatment directed at ourselves or someone we love. Although these misconceptions may seem harmless at first glance, they contribute to the stigma surrounding bipolar disorder and create barriers to accessing the care and treatment we may need. In this mini-sketch, we’ll address some common misconceptions about bipolar disorder and discuss how we can approach these topics more accurately.
What is bipolar disorder?
Although the term “bipolar disorder” may seem to refer to a single condition, the defining symptoms of bipolar disorder can vary. According to the DSM-5 (APA, 2022), bipolar disorders are defined as a spectrum. When diagnosing bipolar disorders, the mood episodes we may experience are particularly considered. These mood episodes are typically grouped into the following categories:
Manic episode: When we experience a manic episode, we tend to feel an elevated mood. We may experience increased activity and feel more goal-oriented. This elevated state can also make us feel irritable. This type of episode lasts at least one week and usually leads to significant disruption in daily functioning, including relationships, work, or school.
Hypomanic episode: Hypomania is an elevated mood and sense of purpose similar to mania; however, these episodes cause less impairment and last at least 4 days.
Depressive episode: During a depressive episode, we may experience a depressed mood, a loss of interest, or a diminished ability to experience pleasure, lasting at least 2 weeks when we are in such an episode.
Mixed episodes: Sometimes, we may also experience what are called “mixed episodes,” in which we exhibit both manic and depressive-like symptoms simultaneously.
When we experience bipolar disorder, our mood tends to alternate between these different episodes. We also tend to experience additional challenges beyond changes in our mood, both in relation to these changes and sometimes also independently. We may experience changes in our self-concept, including self-esteem and a sense of worth. We may notice that our cognitive functioning also gets affected, such as when we have racing thoughts. We may experience changes in our physical experience, such as fatigue or impaired sleep. Given all of these changes in our cognition, mood, and behavior, DSM-5 groups bipolar disorders into the following categories:
Bipolar I is a diagnosis made when manic episodes occur, either on their own or as part of a mixed episode, with or without depressive symptoms.
Bipolar II, on the other hand, typically involves the presence of hypomania and depressive symptoms but does not include manic or mixed episodes.
Cyclothymia: This diagnosis is given to individuals who experience hypomania and depressive symptoms but do not meet all the criteria for Bipolar II.
Common misconceptions about bipolar disorder
People with bipolar disorder tend to be violent.
There is a misconception that people with bipolar disorder tend to be violent, especially during manic episodes. However, we do not see strong evidence that people with bipolar disorder exhibit violent behavior more frequently than the general population (Verdolini et al., 2018). Yet, the spread of such statements can increase the tendency for society to perceive the behavior of people with bipolar disorder as violent, which can be harmful to these individuals.
People with bipolar disorder go from being happy to sad every other minute.
Although a key characteristic of bipolar disorder is the presence of alternating mood episodes (manic, depressive, hypomanic, mixed episodes…), there is a common misconception in society that when we have bipolar disorder, our mood states shift frequently throughout the day. Although it is possible to feel this way from time to time, when we have bipolar disorder, we typically experience the transition between these episodes over an extended period, as well as periods in between these transitions where these episodes do not specifically characterize our mood.
People with bipolar disorder only experience mania or depression.
Another common misconception about the alternating mood episodes associated with bipolar disorder is the belief that everything we experience when we have bipolar disorder consists solely of manic and depressive episodes. This can sometimes lead to the mistaken belief in society that people with bipolar disorder experience only these two emotional states. However, having bipolar disorder does not prevent us from experiencing the full spectrum of emotions, from feeling angry to feeling joy.
Manic episodes make people happier and more efficient.
When we experience manic episodes, we may feel increased activity and goal-directed behavior. We may feel our sense of self-confidence has increased, and our need for sleep has decreased. These episodes are often stereotyped as bursts of productivity or times full of happiness and fun. In reality, however, the increased energy and goal-directedness we feel during a manic episode can also feel like intense irritability, agitation, and distractibility that make our lives very difficult. This can increase the risk of engaging in behaviors with painful consequences and can significantly harm our social lives and relationships (Del Mar Bonnín et al., 2019).
Takeaways
Bipolar disorder is defined as a spectrum characterized by different types of mood episodes rather than a single uniform experience.
Misconceptions about bipolar disorder are still common and contribute to stigma and barriers to proper care.
People with bipolar disorder are not more likely to be violent than the general population.
Mood changes in bipolar disorder usually occur over extended periods, not minute-to-minute shifts.
People with bipolar disorder experience a full range of emotions, not just mania or depression.
Manic episodes are not simply productive or happy states, as they are sometimes mistakenly portrayed in the media. They can involve significant irritability and agitation that may greatly impair our functioning.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Del Mar Bonnín, C., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., Montejo, L., & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. The International Journal of Neuropsychopharmacology, 22(8), 467–477. https://doi.org/10.1093/ijnp/pyz018
Verdolini, N., Pacchiarotti, I., Köhler, C. A., Reinares, M., Samalin, L., Colom, F., Tortorella, A., Stubbs, B., Carvalho, A. F., Vieta, E., & Murru, A. (2018). Violent criminal behavior in the context of bipolar disorder: Systematic review and meta-analysis. Journal of Affective Disorders, 239, 161–170. https://doi.org/10.1016/j.jad.2018.06.050