Bipolar Spectrum

ABOUT DEPRESSION

Depression typically manifests as low mood or anhedonia (experiencing diminished pleasure in activities) accompanied by other symptoms such as fatigue, inappropriate guilt, and over-sleeping. When you're depressed, you might not necessarily feel sad, but rather you may notice that it is difficult to engage with things and you find yourself withdrawing from life.

Depression can be conceptualized as a multi-dimensional construct with two subtypes. Anaclitic depression is associated with interpersonal concerns, whereas introjective depression is associated with achievement concerns. Individuals with anaclitic depression tend to become dependent on others due to feeling weak and powerless. You may attempt to cater to others in order to gain approval and as a way of attempting to avoid rejection and abandonment. Individuals with introjective depression impose high standards on themselves and feel guilt and shame if they fail to meet these standards. You may be harshly self-critical, self-doubting, and self-loathing at times. 

ABOUT MANIA + HYPOMANIA 

Mania typically manifests as elevated mood (agitation, feeling upbeat or euphoric, feeling jumpy or "wired") plus an unusual increase in energy accompanied by other symptoms such as racing thoughts, distractibility, inflated self-esteem and/or feeling of invincibility, talking more than usual, and an increase in goal-directed activity. "Manic" thinking may manifest as having lots of convoluted ideas as well as having the experience of being unable to keep up with one's thoughts. In a true manic state, you will feel very much unlike yourself. 

Hypomania includes the same symptoms of mania, but the symptoms are less intense. Individuals experiencing a true manic episode are inclined to behave in ways that are reckless to the point of endangering themselves, whereas individuals experiencing hypomania do not necessarily notice an impairment in functioning. Hypomania can be brief; symptoms must last at least four successive days to be considered a true hypomanic episode, but these symptoms can also occur over a shorter or longer duration of time. 

A SPECTRUM APPROACH TO MOOD DISORDERS

Mood symptoms exist on a spectrum from pure unipolar depression to pure mania. There are numerous ways in which mood symptoms can present. You can experience discrete mood episodes with periods of remission in between. You can experience episodes of intensified mood symptoms with periods of subclinical mood symptoms in between. You can experience many subclinical mood episodes over time or chronic low-level mood symptoms that at times recede "into the background," but never fully remit. You can also have enduring hypomanic and/or depressive personality traits.

Discrete mood episodes can include both depressive and manic or hypomanic symptoms. Mood episodes can also include psychotic symptoms, such as delusions and hallucinations. Individuals who experience psychotic symptoms strictly in the context of a mood episode do not meet criteria for a schizophrenia spectrum disorder. Individuals with cyclothymia, a bipolar-related disorder, can experience short duration (i.e. less than four consecutive days) mood episodes. If you experience intense mood shifts that last hours at a time, that tendency is more indicative of Borderline Personality Disorder than a bipolar-related disorder. 

HYPOMANIA IN THE CONTEXT OF THE MANIC-DEPRESSIVE PERSONALITY 

Hypomanic personality traits include extraversion or gregariousness, emotionality, confidence,  impulsivity, ambitiousness, aggressiveness, liveliness, and irritability. Some individuals display enduring hypomanic traits that manifest at a baseline level. When functioning at a high level, individuals with a hypomanic character structure may be very successful and generally feel upbeat. When under stress, they can experience a variety of mood symptoms and associated features that do not exist within the bounds of discrete episodes. While experiencing hypomania, you may be prone to abrupt shifts in mood. You can experience scattered, racing thoughts that are difficult to sort through. You may also struggle to complete projects when enthusiasm gives way to apathy. Oftentimes, hypomania does not register to the individual as being problematic unless it becomes a part of a self-defeating cycle. You may enter a mode of operating wherein you push yourself until you become exhausted. Sometimes individuals with hypomania push themselves under the guise that they are "being productive," but then once you push past your limits you must recuperate for extended periods of time, thus interfering with overall productivity and leading to feelings of guilt about being "lazy." However, you can only operate continuously at a high level if you're giving yourself the proper fuel. Therapy does not have to be about completely changing who you are and losing parts of yourself that you value, but rather about learning to work with yourself and live in a more sustainable way.