Bipolar disorder, symptoms, causes and diagnostic errors ...

Bipolar disorder, symptoms, causes and diagnostic errors ...

The Bipolar disorder, also know as manic-depressive illnessIt is a mental disorder that is characterized by producing unusual changes in mood, energy, activity levels, and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder are very exaggerated mood swings, excessive compared to the normal ones that everyone happens from time to time. This disease causes drastic changes that go through feeling extremely depressed and hopeless, at periods of euphoric temper almost without control.


  • 1 What are its causes?
  • 2 Signs and symptoms of bipolar disorder
  • 3 Diagnostic failures in bipolar disorder

What are your causes?

Scientists are still studying the possible causes of bipolar disorder. Most agree that there is no single cause. On the contrary, many factors probably act together to produce the disease or increase the risk.

One of them is the genetic factor, bipolar disorder tends to occur in a higher percentage in certain families. Some research has suggested that people with certain genes are more likely to develop bipolar disorder than others. Children with a father or brother who has bipolar disorder are much more likely to develop this disease, compared to children who have no family history. However, and fortunately, most children with a family history of bipolar disorder will not develop the disease.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar disorder does not always develop the disease, even though identical twins share all the same genes. Research suggests that factors in addition to genes are also at work. It is likely that many different genes and environmental factors are involved.

On the other hand, bipolar disorder has been seen to affect both men and women equally, and the disease usually begins between 15 and 25 years.
The structure of the brain and its functioning

Some brain imaging studies show how the brains of people with bipolar disorder may be different from the brains of healthy people or people with other mental disorders. For example, an MRI study revealed that the brain development model in children with bipolar disorder is similar to that of children with "multidimensional impairment," a disorder that causes symptoms that overlap to some extent with bipolar disorder. and schizophrenia. This suggests that the common pattern of brain development may be related to the overall risk of unstable moods.

Another MRI study revealed that The prefrontal cortex of the brain in adults with bipolar disorder tends to be smaller and does not work as well compared to adults who don't have bipolar disorder. The prefrontal cortex is a brain structure involved in "executive" functions, such as solving problems and making decisions. This structure and its connections with other parts of the mature brain during adolescence, suggesting that the abnormal development of this brain circuit could explain why the disorder tends to appear during adolescence.

Signs and symptoms of bipolar disorder

As we have already mentioned, people with bipolar disorder experience unusually intense emotional states that occur in different periods called "mood episodes." Each episode of mood represents a drastic change in the mood and habitual behavior of a person. An overly cheerful or overexcited state is called a manic episode, and a very sad and desperate state is called a depressive episode. Sometimes an affective episode includes symptoms of mania and depression. This is called a mixed state. People with bipolar disorder can also be explosive and irritable during a mood episode.

There are also extreme changes in energy, activity, sleep and behavior in general, along with these changes in mood. The symptoms of bipolar disorder are the following:

Symptoms of mania or a manic episode include:

  • A long period of "high" feeling, or an excessively happy or outgoing mood
  • Extreme irritability
  • Behavioral changes
  • Speak very fast, jumping from one idea to another, have accelerated thoughts
  • Being easily distracted
  • The increase in activities, such as taking on new projects
  • Being too restless
  • Get little sleep or not be tired
  • Have an unrealistic belief in one's abilities
  • Behave impulsively and perform high-risk behaviors

The symptoms of depression or a depressive episode are:

  • An excessively long period of feeling sad or desperate
  • Loss of interest in activities you used to enjoy, including sex.
  • Behavioral changes
  • Feeling tired and apathy
  • Problems concentrating, remembering and making decisions
  • Being restless or irritable
  • Change of eating, sleeping or other habits
  • Think about death or suicide or attempt to suicide

Bipolar disorder may be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During an episode of hypomania, the person may feel very well and be highly productive. She can't feel something is wrong, but friends and family can recognize mood swings. Without proper treatment, people with hypomania can develop severe mania or depression.

Sometimes, A person with severe episodes of mania or depression may also have psychotic symptoms, such as hallucinations or delusions. Psychotic symptoms tend to reflect the extreme mood of the person. For example, if someone is having psychotic symptoms during a manic episode, he may think he is a famous person, that he has a lot of money, or even that he has special powers. On the contrary, if you have psychotic symptoms during a depressive episode, you may believe that you are broke and without money, or that you have committed a crime. As a result, people with bipolar disorder with psychotic symptoms are sometimes misdiagnosed with schizophrenia.

People with bipolar disorder can also abuse alcohol or substances, have relationship problems, and poor performance at school or at work. It can be difficult to recognize these problems as signs of a serious mental illness.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression tend to appear over time. Between episodes, many people with bipolar disorder are symptom free, but some people may have persistent symptoms.

Diagnostic failures in bipolar disorder

A recent study conducted at the Brown University School of Medicine in Rhode Island has suggested that up to a50% of cases diagnosed with Bipolar Disorder could be false positive.

For this study, researchers conducted interviews with 800 psychiatric patients, using a comprehensive diagnostic test for DSM-based disorders. Respondents also had to answer a questionnaire where they should indicate whether they had been diagnosed with Bipolar Disorder or Manic-Depressive Disorder.

Of the 800 respondents, 146 stated that they had been previously diagnosed as Bipolar Disorder. However, the researchers noted that only 64 of them suffered Bipolar Disorder based on the comprehensive diagnosis they had made.

The researchers consider several hypotheses that can explain the appearance of these results, which suggest an excessive diagnosis of cases of Bipolar Disorder. One of them speculates with a greater propensity of specialists to diagnose Bipolar Disorder versus other stigmatizing disorders and for which there is no clear treatment. Another theory attributes the "fault" to the aggressive publicity of the drugs used in treatments by pharmaceutical companies. In any case, the researchers insist on the need to use standardized and validated methods to obtain reliable diagnoses.

It may interest you: Living with Bipolar Disorder, myths and beliefs

Here is a wonderful infographic about myths and realities of Bipolar Disorder by MyTherapy (free application on Google Play and iTunes)


American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 4th ed rev. Washington APA, 2000

Bertolote J., Mc Gorry PD (2005): Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry Suppl, 48, 116-119.

Malhi GS, Chengappa KN, Gershon S, Goldberg JF. Hypomania: exaggeration or mania? Bipolar Disord2010; 12: 758-63. CrossRefMedlineWeb of Science

J.G. Gunderson Borderline personality disorder. A clinical guide, American Psychiatric Publishing Inc., Washington DC (2001)

Zimmerman, et al. Screening for Bipolar Disorder and Finding Borderline Personality disorder. J Clin Psychiatry, 71 (9) (2010), pp. 1212-1217

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World Health Organization. International Classification of Diseases 10 Version Chapter V (1992)

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