Bipolar disorder, as the name of the condition suggests, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. An individual with bipolar disorder experiences cyclical periods of extreme euphoria and activity (mania), which are then typically followed by periods of extreme depression. It is sometimes called manic-depressive syndrome or manic depression because of the mood changes alternating between depressive and manic periods.
Symptoms of Bipolar Disorder
Symptoms of bipolar disorder are different from the normal ups and downs we all experience. Bipolar swings are much more severe ups and downs. Bipolar disorder often results in damaged relationships, poor job or school performance, and may even result in suicide.
Bipolar disorder typically develops in an individual’s late teens or early adult years. Approximately half of all cases start before age 25. Bipolar disorder is not easy to identify when symptoms begin. In fact, the symptoms may seem like separate issues that are not recognized as pieces of a larger problem. Some individuals suffer for years before they are properly diagnosed and treated. Bipolar disorder is not a short-term illness. It must often be carefully managed throughout a patient’s life.
Diagnosis and Classifications of Bipolar Disorder
Psychiatrists, psychologists, and other doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the patient’s symptoms must be a major change from his or her normal mood or behavior.
There are four basic types of bipolar disorder:
- Bipolar I Disorder is defined by manic or mixed episodes that last at least seven days or by manic symptoms that are so severe that the person requires immediate hospital care. Depressive episodes usually occur as well, typically lasting at least two (2) weeks.
- Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes but no full-blown manic or mixed episodes.
- Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when symptoms of the illness exist but do not meet the diagnostic criteria for either Bipolar I or Bipolar II. However, the symptoms are clearly out of the person’s normal range of behavior.
- Cyclothymic Disorder or Cyclothymia is a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
A severe form of the disorder is called Rapid-Cycling Bipolar Disorder. Rapid cycling occurs when the patient has four or more episodes of major depression, mania, hypomania, or mixed states, all within one year. Rapid cycling appears to be more common in those who have their first bipolar episode at a younger age. One study found that people with rapid cycling had their first bipolar episode about four years earlier, typically during the mid-to late-teen years, than those without rapid cycling bipolar disorder. Rapid cycling affects women more than men. Rapid cycling can come and go.
When establishing a diagnosis, a doctor or other health care provider should conduct an interview, a physical examination, and lab tests. Although bipolar disorder cannot currently be identified through a blood test or a brain scan, these tests can help rule out other factors that may contribute to mood problems, such as a thyroid condition, stroke, or brain tumor. If other conditions or illnesses do not cause the mood problems, your health care provider may conduct a mental health evaluation or refer you to a trained mental health professional, such as a psychologist or psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
The doctor or mental health professional should obtain information from you regarding any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professional should also talk to your spouse or other close relatives about your symptoms and family medical history.
Patients with bipolar disorder are more likely to seek medical assistance when they are depressed than when they are in a mania or hypomania state. For this reason, a careful medical history is required to be sure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike those with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania.
Bipolar disorder can worsen over time if left undiagnosed and/or untreated. Episodes may become more severe or more frequent over time without proper treatment. Also, delays in obtaining the correct diagnosis and treatment can cause personal, social, and work-related problems. Proper diagnosis and treatment help those with bipolar disorder lead healthy and productive lives. In most cases, medical treatment can help reduce the frequency and severity of bipolar episodes.
Unfortunately, substance abuse is very common among those with bipolar disorder. The reason for this link is unclear. It appears that some people with bipolar disorder may try to “self-medicate” and treat their symptoms with drugs or alcohol. However, such substance abuse may only trigger or prolong bipolar symptoms, and behavioral control problems during a manic phase can result in a person drinking too much.
Those subject to bipolar disorder may suffer other mental conditions as well. Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, are sometimes diagnosed at the same time as bipolar disorder. Bipolar disorder is also co-diagnosed with attention deficit hyperactivity disorder (ADHD), which has some symptoms that are the same as bipolar disorder, such as restlessness and being easily distracted.
Those with bipolar disorder are also at higher risk for obesity, heart disease, migraine headaches, diabetes, thyroid disease, and other physical illnesses. These illnesses may cause or exacerbate the symptoms of mania or depression. They may also be the result of treatment for bipolar disorder.
Symptoms of Bipolar Disorder
Individuals with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” One state of mind is called a manic episode and usually involves being overly joyful or overexcited. The other state of mind is a depressive episode, which makes the individual extremely sad or hopeless. Sometimes, a mood episode called “mixed state” may involve symptoms of both mania and depression.
Some individuals with bipolar disorder may also be explosive and irritable during a mood episode. Extreme energy, activity, sleep, and behavior changes often accompany these mood changes. Someone with bipolar disorder can experience long-lasting periods of unstable moods rather than shorter episodes of depression or mania.
It would not be unusual for an individual experiencing an episode of bipolar disorder to experience several manic or depressive symptoms for most of the day, nearly every day, for a week or longer. Sometimes, symptoms are so severe that the individual cannot function normally at work, school, or home.
Specific symptoms of mania may include:
- Rushed speech;
- Short attention span;
- Being easily distracted;
- Talking very fast, jumping from one idea to another, having racing thoughts;
- Impaired judgment;
- A long period of feeling “high,” or an overly happy or outgoing mood that may last for days or weeks;
- Extremely irritable mood, agitation, feeling “jumpy” or “wired,”
- Behavioral Changes;
- Increasing goal-directed activities, such as taking on new projects;
- Having “delusions of grandeur” or an unrealistic belief in one’s abilities;
- Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments, and
- Unusual behavior.
When bipolar patients are experiencing mania, they will often participate in substance abuse (drugs and alcohol) and increased (and unsafe) sexual activity. They will also typically display aggressiveness and grandiose, delusional ideas about themselves. In the later stages of mania, the patient may even experience hallucinations, psychotic delusions, and rage.
Symptoms in the other range of depression can include extreme sadness and fatigue and feelings of guilt, hopelessness, isolation, and anxiety. Depression may also cause a decrease in sexual drive, interest in normal activities, and appetite, and a loss of sleep. Depressive states often come with a lack of motivation, pain, and social anxiety. In the later stages of depression, those experiencing a depressive state may become psychotic and suicidal.
Specific symptoms of depression or a depressive episode include:
- Mood changes;
- A long period of feeling worried or empty;
- Loss of interest in activities once enjoyed, including sex;
- Behavioral changes;
- Feeling tired or “slowed down”;
- Having problems concentrating, remembering, and making decisions;
- Being restless or irritable;
- Changing eating, sleeping, or other habits; and
- Thinking of death or suicide, or attempting suicide.
Symptoms of bipolar disorder typically first display in childhood or late adolescence. Studies suggest that many factors contribute to the disease, including genetics, neurobiology, and early childhood environment. The disease is typically diagnosed after other illnesses are first ruled out.
Bipolar disorder is treated with therapy, counseling, and medications such as mood stabilizers and antipsychotic drugs. Lithium is the most common medication prescribed for bipolar disorder.
Is Being Bipolar a Disability?
You may qualify for long-term disability benefits if your bipolar disorder impairs your ability to work.
In other words, if an individual’s mental residual functioning is so restricted that he or she is unable to meet the demands of simple repetitive work activities or if his or her functional capacity is so restricted that he or she is not able to perform or be trained to perform other jobs, a medical-vocational disability allowance is possible.
Evidence of Bipolar Disorder
Claimants with bipolar disorder should remember that disability claims are typically won or lost mainly based on medical records. This means that the fewer your medical records, the more likely you will lose your claim. You should try to maintain a consistent and ongoing schedule of treatment. In an ideal situation, this means treating with a psychiatrist or psychologist, with no more than a 90-day gap between treatments. Although a mental health counselor is a licensed medical health professional, some insurance companies do not accept the opinions of counselors as substantial evidence as they are not “accepted medical sources” as defined by some disability policies.
Appealing a Denial of Benefits for Bipolar Disorder
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your bipolar disorder. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your bipolar disorder and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and discuss how to help you through the appeal process.