"I have been told I have bipolar disorder and I just can't accept it."

What is bipolar disorder?
Symptoms of bipolar disorder, also called manic-depressive disorder, include both symptoms of depression, and symptoms of mania.

• Unpleasant emotions like sadness, lack of enjoyment, guilt, loss of interest in others, and hopelessness;
• Behaviors like withdrawal from others, inactivity, suicidal behaviors, self-criticism, crying;
• Cognitions (thoughts) like, "I'm worthless," "No one cares about me," "The future is hopeless," and cognitive problems like difficulty making decisions;
• Physical symptoms like fatigue, insomnia or oversleeping, loss of appetite or increased appetite

• Pleasant emotions like euphoria, elation, and enthusiasm, and occasionally unpleasant emotions like anger and irritability;
• Behaviors like impulsively spending a lot of money, initiating multiple sexual liaisons, driving recklessly, making risky business investments; talking excessively, staying up all night working or playing;
• Cognitions (thoughts) like, "I can do anything I want," "I'm going to make a huge fortune," "Everyone loves me," and cognitive problems like racing thoughts or distractibility;
• Physical symptoms like reduced need for sleep, increased libido, high energy levels.

Often individuals with bipolar disorder experience multiple episodes of depression and only one or an occasional manic episode. Sometimes they experience depressed and manic symptoms simultaneously (for example, feeling simultaneously depressed and œrevved up”).

Bipolar disorder can ruin relationships and destroy careers; nearly 20% of patients with bipolar disorder commit suicide. Effective treatment is essential, because people who manage their illness well can live productive, happy lives.

Cognitive-behavioral model of bipolar disorder
Aaron T. Beck's cognitive theory proposes that individuals who have a biological vulnerability to bipolar disorder and who hold problematic beliefs about themselves (e.g., the belief that they are worthless) can, when those vulnerabilities and beliefs are activated by life stressors, experience symptoms of bipolar disorder. Symptoms, in the cognitive-behavioral model, are made up of emotions (e.g., depression or elation), thoughts (e.g, "I'm worthless," or "I'm amazingly talented") and behaviors (e.g., passivity or excessive activity).

Recent work by Sheri Johnson suggests that people who are vulnerable to manic episodes are driven by excessive striving for unusually ambitious goals.

Other psychologists view bipolar disorder as due to a malfunction of the biological and psychological systems that control goal-directed appetitive behavior; the person with bipolar disorder can bounce back and forth between states of over- and under-activation of those systems. When the appetitive system is over-active, the person is too energetic in pursuing goals; when the system is underactive, the person is lethargic and does not carry out activities needed to pursue important goals.

Cognitive-behavior therapy for bipolar disorder
Cognitive-behavioral interventions typically include helping the person with bipolar disorder to:

• identify and change the thinking (cognitions) and behaviors that accompany depressed and elated emotions, with the notion that if the cognitions and behaviors change, the emotions will also change;
• establish a regular routine of daily activities, especially a regular sleep-wake cycle, as this regularity can help stabilize mood and behavior;
• identify early signs of depression or mania so that early action can be taken to head off large mood swings;
• identify reasonable goals and reasonable levels of activity to accomplish them;
• rely on family members to help provide feedback and moderated activity and thinking;
• understand the need for medication and overcome obstacles to taking it regularly.

Additional resources

Web links:
The Association for Behavioral and Cognitive Therapies

Books:
For links to purchase these books and others, please go to Self-Help Books for Adults

Burns, D. D. (1999). Feeling good: The new mood therapy. New York, NY: William Morrow and Company.

Ellis, T. E., & Newman, C. F. (1996). Choosing to live: How to defeat suicide through cognitive therapy. Oakland, CA: New Harbinger Press.

Greenberger, D. & Padesky, C. A.(1995). Mind over mood: A cognitive therapy treatment manual for clients. New York, NY: Guilford Press.

Miklowitz, D. J. (2002). The bipolar disorder survival guide: What you and your family need to know. New York, NY: Guilford Press.

Scott, J. (2001). Overcoming mood swings. New York, NY: New York University Press.