After a controversial speech and a series of social media messages, many are worried about the mental health of rapper Kanye West, who has spoken in the past about being diagnosed with bipolar disorder.
Bipolar disorder is broadly defined as a cycle of manic and depressive episodes, but there are actually three different types of bipolar disorder.
According to Dr. Ken Duckworth, the chief medical officer of the National Alliance on Mental Illness, bipolar I disorder is characterized by manic episodes lasting at least a week, or manic symptoms that often require immediate hospital care. The episodes of mania are typically followed by a period of depression.
Bipolar II disorder is defined by a pattern of depressive episodes, followed by brief, hypomanic episodes. Hypomanic episodes are not as extreme as true manic episodes experienced in bipolar I disorder, according to Duckworth, but have similar trademarks, such as impulsivity.
The third type, cyclothymia, is defined by periods of hypomanic symptoms and depressive symptoms lasting for at least two years (but lasting for at least one year in children).
What are the symptoms of bipolar disorder?
Symptoms of bipolar disorder vary depending on which type of the disorder someone has, and whether they are in a depressive or manic episode. It is possible to experience both types of episodes at once, which will lead to a combination of behaviors.
During manic or hypomanic episodes, people may show symptoms like:
- Unusually intense emotions
- Loss of appetite
- Decreased need for sleep
- Fast talking
- Racing thoughts
They may also report feeling up, high, jumpy or wired, or describe being more irritable or elated. People experiencing a manic episode may also believe they can do many things at once or feel that they are "unusually talented, important or powerful," according to the National Institute of Mental Health (NIMH). There may also be more risky behavior, such as excessive eating and drinking, reckless sexual activity and uncharacteristic spending.
Depressive episodes have near-opposite symptoms, with people often experiencing:
- Increased appetite
- Changed sleeping patterns
- Slowed down or restless
- Feeling sad, empty or helpless
- May speak very slowly in conversation
The NIMH also says people experiencing a depressive episode may have trouble concentrating and making decisions, take little interest in "almost all activities" and can have thoughts of death or suicide.
Duckworth said that since bipolar disorder is relatively cyclical, episodes may be triggered by similar things, such as time changes or changes in the seasons (due to changing amounts of sunlight).
"(Bipolar disorder) is a recurring wave that keeps coming at you," he said. "It might come 20 times in a lifetime, it might come 10 times or three times ... There's no simple answers."
Who is typically diagnosed with bipolar disorder?
According to the NIMH, the condition is usually diagnosed during late adolescence or young adulthood. An estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives. Occasionally, symptoms can appear in children. For women, bipolar disorder may appear during pregnancy or postpartum.
Research is ongoing to understand why some people have this disorder. According to the NIMH, most agree there is not a single cause, but some studies point to brain structure differences and genetics.
Bias in bipolar diagnosis, treatment
Research indicates that there may be racial bias in the diagnosis and treatment of bipolar disorder. According to Mental Health America (MHA), the rate of bipolar disorder among Black Americans is the same as it is among other Americans, yet Black Americans are less likely to receive a diagnosis and treatment.
A 2018 paper published in the journal Bipolar Disorders: An International Journal of Psychiatry and Neurosciences suggested that Black Americans are more likely to be misdiagnosed, something Duckworth supported.
"(Doctors may) overcall schizophrenia and undercall bipolar disorder," said Duckworth, adding that there is a "long history" of white psychiatrists under-diagnosing mood disorders in people of color.
The paper also suggests that there are "disparities in recruiting patients of African ancestry to participate in important genomic studies." That gap in research may lead to "a missed opportunity to address potential racial differences in the risk and course of bipolar illness."
MHA also suggests that disparities may be caused by economic or insurance-related factors. Duckworth said that another factor in the conversation could be cultural differences between experts and their patients.
"We need to do better, as a field, in terms of getting the diagnosis right and in terms of cultural humility," he said. "The question is, how do I show humility in terms of learning about people’s experience, and the first idea is you have to listen and be open to the conversation about how privilege has intersected with diagnoses or culture."
How is bipolar disorder treated?
Treatment for bipolar disorder will vary significantly depending on the type of bipolar disorder someone is diagnosed with, a person's other conditions and their general presentation of the disorder.
Duckworth said that for the most part, the best way to treat bipolar disorder is through a combination of a mood stabilizer, psychotherapy and community support connections. He also recommends having a reliable therapist or psychiatrist available for contact in case of emergency.
"There is no cure, but people can live successful lives with bipolar disorder," he said.