An episode of illness is really just a reference to the experience, intensity and duration of symptoms. Episodes vary in severity and occur when a person is ill. To have a diagnosis of bipolar disorder, you must have experienced at least one episode of hypomania, mania or mixed symptoms. Once an episode occurs there is a high risk of further episodes.
If you experience depressive symptoms for at least two weeks and if as a result your work and relationships have suffered, the chances are you are experiencing an episode of major depression. Technically at least one of these symptoms must include:
- depressed mood, which may include sadness, emptiness, tearfulness or irritability, or
- a loss of interest or pleasure in things, which lasts nearly all day, nearly every day.
In turn a variety of other emotional and behavioral symptoms may cluster around these, such as sleep disturbances, restlessness, feelings of guilt or worthlessness and difficulties in concentration - to mention just a handful. In the case of bipolar, these symptoms may also be accompanied by psychotic symptoms such as delusions (false beliefs) and/or hallucinations (false sensory perceptions).
A manic episode is defined as an excessively happy, elevated or irritable mood that lasts for at least a week. At least three of the following symptoms must be present, or four if the mood is irritable:
- you need less sleep than normal.
- your thoughts are racing and you find it hard to articulate.
- you talk more than usual and you feel a pressure to keep talking.
- you find it easy to get distracted and find it hard to distinguish between what’s relevant and what isn’t.
- you feel you have very special qualities or talents that you actually don’t have.
- you become highly goal focused. This may take the form of work or study, or may be sexually focused.
- you indulge in pleasurable activities with no thoughts of the consequences to yourself or others. This may range from spending money to being sexually promiscuous.
Like a depressive episode, mania may be accompanied by psychotic symptoms.
The prefix ‘hypo’ means low, or under. So an episode of hypomania refers to symptoms similar to mania but which are either milder or briefer. Symptoms of hypomania are generally much less disruptive than mania and may not affect everyday activities. Even so, your behavior will be rather more extreme than say a normal happy mood, and will almost certainly be noticed by others. To be classified as a hypomanic episode you must have experiences the symptoms for at least four days. Psychotic symptoms are not associated with hypomania.
Getting your head around the concept of mixed episodes isn’t easy. A mixed episode refers to a simultaneous mix of the lows and highs associated with bipolar disorder. Imagine feeling depressed but at the same time experiencing racing thoughts, a decreased need for sleep and a sense of restlessness. Perhaps now the symptoms don’t seem so implausible? People with mixed states appear to be more vulnerable to psychotic symptoms and for a diagnosis of a mixed episode you need to have had symptoms of mania and depression for at least a week, resulting in severe disruption to your daily life.