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experience episodes of depression. In fact, most people who receive the diagnosis of bipolar disorder spend significantly more time depressed as opposed to manic (Post, 2003). The criteria for identifying an episode of depression in bipolar disorder are no different from identifying episodes of depression in ‘unipolar depression’ (‘unipolar’ referring to cases when people experience episodes of depression but without the ‘highs’). Most people experiencing depression do not have the highs associated with bipolar disorder. What that means is that if a person experiences their first episode of mania, they will be given a diagnosis of bipolar disorder, but if they experience a first episode of depression, they will be diagnosed with ‘major depressive episode’ or ‘unipolar depression’. If, at a later time, they then have an episode of mania or hypomania, then a diagnosis of bipolar disorder will be used. ‘My experience of depression tends to follow the same pattern each time. It comes on quite quickly, the first sign is that my sleep gets interrupted, I wake early in the morning and can’t get back to sleep, then my appetite goes, I no longer feel hungry. Alongside these things are a worsening of my mood, I feel bleak and lonely, even when I am around people who I love and am loved by. I feel an intense ache deep inside my chest and a sense that I am a horrible person that no-one can possibly like. I feel useless and guilty and as though I have done something dreadful and it is only a matter of time before I am found out. As time goes by I start to feel suicidal, that the world and especially those close to me would be better off without me.’ Debbie Mayes – service user 1.3 Continuum The use of medical terms such as ‘diagnosis’, ‘episode’, etc., tends to give the impression that bipolar disorder is a discrete disorder that is clearly distinguishable from ‘normal’ aspects of human life and from other kinds of psychological problem. It also tends to imply, in the case of bipolar disorder, that the different episodes (manic, hypomanic, depressed, mixed) can all be distinguished from each other and from so-called ‘normal’ mood. We now know that this picture is too simplistic, however. There is now a huge body of evidence which would suggest that these experiences are both very complex and overlapping and also range on a spectrum or continuum with normal experiences (Jones & Bentall, 2006). There is also a great deal of overlap between the different types of episode – manic episodes are characterised by many conventional aspects of depression (irritability and even low mood) and of course there are explicitly ‘mixed’ episodes. On the other hand, people experiencing conventional (i.e. not ‘bipolar’) episodes of unipolar depression report aspects of hypomania during those episodes. The idea of episodes itself tends also to become problematic. Cyclothymia is a diagnostic term referring to recurrent episodes of mild (but clearly problematic) mood disturbances between hypomania and a mild form of depression referred to as ‘dysthymic mood’. The existence of this term indicates how the experiences of bipolar disorder overlap considerably with less severe problems.

Part 1: Understanding the bipolar disorders

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Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...