Life naturally has its ups and downs—moments of joy and periods of sadness that ebb and flow with
circumstances. But for people with bipolar disorder, these emotional shifts become something entirely
different. Bipolar disorder is a chronic mental illness that causes dramatic shifts in a person’s mood,
energy, and ability to think clearly.¹ People with bipolar disorder have high and low moods, known as
mania and depression, which differ from the typical ups and downs most people experience.¹
If left untreated, the symptoms usually get worse.¹ The highs climb beyond normal happiness into states
of intense energy, racing thoughts, and impaired judgment. The lows plunge into depths of depression that
make ordinary functioning feel impossible. However, with a strong lifestyle that includes self-
management and a good treatment plan, many people live well with the condition.¹
Although bipolar disorder can occur at any point in life, the average age of onset is 25.¹ Every year, 2.9%
of the U.S. population is diagnosed with bipolar disorder, with nearly 83% of cases classified as severe.¹
Unlike many other mental health conditions, bipolar disorder affects men and women equally.¹
The good news is that bipolar disorder responds well to treatment. At The Horizon Behavioral Health in
Worcester, we help people throughout Central Massachusetts stabilize their moods, prevent episodes, and
build lives that aren’t defined by their diagnosis.
The Two Poles: Mania and Depression
Bipolar disorder gets its name from the two emotional “poles” that characterize the condition. A person
with bipolar disorder may have distinct manic or depressed states.¹ Severe bipolar episodes of mania or
depression may also include psychotic symptoms such as hallucinations or delusions. Usually, these
psychotic symptoms mirror a person’s extreme mood.¹
Understanding Mania and Hypomania
To be diagnosed with bipolar disorder, a person must have experienced mania or hypomania.¹ Hypomania
is a milder form of mania that doesn’t include psychotic episodes.¹ People with hypomania can often
function normally in social situations or at work.¹
Although someone with bipolar may find an elevated mood very appealing—especially if it occurs after
depression—the “high” does not stop at a comfortable or controllable level.¹ During periods of mania:¹ ²
Moods can rapidly become more irritable
Behavior becomes more unpredictableJudgment becomes more impaired
People frequently behave impulsively, make reckless decisions, and take unusual risks
Most of the time, people in manic states are unaware of the negative consequences of their actions
Some people with bipolar disorder will have episodes of mania or hypomania many times; others may
experience them only rarely.¹
The Depressive Pole
Depression produces a combination of physical and emotional symptoms that inhibit a person’s ability to
function nearly every day for a period of at least two weeks.¹ The level of depression can range from
severe to moderate to mild low mood, which is called dysthymia when it is chronic.¹
Bipolar depression shares many features with major depressive disorder but occurs within the context of a
condition that also includes manic or hypomanic episodes. For many people with bipolar disorder,
depressive episodes occur more frequently and last longer than manic episodes, making depression the
dominant experience of the illness.²
At its most severe, bipolar depression can include thoughts of death or suicide. These thoughts require
immediate attention and underscore the critical importance of proper treatment.
Types of Bipolar Disorder
To be diagnosed with bipolar illness, a person has to have had at least one episode of mania or
hypomania.¹ The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines four types of
bipolar illness:¹
Bipolar I Disorder
Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania.¹ Most
people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of
depression is not necessary for a diagnosis.¹ To be diagnosed with bipolar I, a person’s manic or mixed
episodes must last at least seven days or be so severe that hospitalization is required.¹
Bipolar II Disorder
Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting
back and forth with hypomanic episodes, but never a full manic episode.¹ Because hypomania is less
dramatic and disruptive than mania, Bipolar II often goes unrecognized or is misdiagnosed as major
depression. However, Bipolar II is not a “milder” form of the illness—the depressive episodes can be just
as severe and debilitating.²
Cyclothymic Disorder (Cyclothymia)
Cyclothymic Disorder, or Cyclothymia, is a chronically unstable mood state in which people experience
hypomania and mild depression for at least two years.¹ People with cyclothymia may have brief periods
of normal mood, but these periods last less than eight weeks.¹
Bipolar Disorder “Other Specified” and “Unspecified”
Bipolar Disorder “other specified” and “unspecified” is diagnosed when a person does not meet thecriteria for bipolar I, II, or cyclothymia but has had periods of clinically significant abnormal mood
elevation.¹
What Causes Bipolar Disorder?
Scientists have not discovered a single cause of bipolar disorder.¹ Like most mental health conditions, it
results from complex interactions between genetic vulnerability, brain biology, and environmental
influences. They believe several factors may contribute:¹ ² ³
Genetic Factors
The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder.¹
But the role of genetics is not absolute—a child from a family with a history of bipolar disorder may
never develop the disorder.¹ Studies of identical twins have shown that even if one twin develops the
disorder, the other may not.²
Brain Structure and Function
Brain scans cannot diagnose bipolar disorder in an individual.¹ However, researchers have identified
subtle differences in the average size or activation of some brain structures in people with bipolar
disorder.¹ While brain structure alone may not cause it, there are some conditions in which damaged brain
tissue can predispose a person.¹
Environmental Triggers
A stressful event such as a death in the family, an illness, a difficult relationship, or financial problems can
trigger the first bipolar episode.¹ In some cases, drug abuse can trigger bipolar disorder.¹ Once bipolar
disorder emerges, episodes may occur with less obvious triggers or seemingly spontaneously.
The Challenge of Diagnosis
Bipolar disorder is frequently misdiagnosed, often as major depression. This happens because people
typically seek help during depressive episodes—the suffering is obvious and motivates treatment. Manic
or hypomanic episodes, by contrast, may feel good (at least initially) or may not be remembered
accurately afterward.
When depression is treated without recognition of the bipolar pattern, antidepressants alone can actually
trigger manic episodes or accelerate mood cycling.² This is why comprehensive evaluation is so
important.
Accurate diagnosis requires careful history-taking that explores not just current symptoms but past mood
episodes, including periods that might have seemed positive at the time. At The Horizon Behavioral
Health, we take time for thorough evaluation, understanding that correct diagnosis is the foundation of
effective treatment.
Comprehensive Bipolar Disorder Treatment in Worcester, MA
Bipolar disorder is a chronic illness, so treatment must be ongoing.¹ If left untreated, the symptoms of
bipolar disorder may get worse, so diagnosing it and beginning treatment in the early stages is important.¹
There are several well-established types of treatment for bipolar disorder:¹ ² ⁴Medication: The Foundation of Bipolar Treatment
Medications play a central role in bipolar disorder management, helping stabilize mood and prevent
episodes:¹ ⁴
Mood stabilizers form the backbone of bipolar treatment. Lithium remains one of the most effective
options, particularly for preventing manic episodes and reducing suicide risk.⁴
Antipsychotic medications help manage manic episodes and can serve as mood stabilizers for ongoing
treatment.¹
Antidepressants may be carefully used for bipolar depression, typically in combination with mood
stabilizers to prevent triggering mania.¹
Finding the right medication regimen often requires patience. Our psychiatric providers work closely with
patients, monitoring response and adjusting treatment to achieve optimal stability with minimal side
effects.
Psychotherapy
Psychotherapy provides crucial tools for living well with bipolar disorder:¹ ⁴
Cognitive Behavioral Therapy (CBT) helps identify thought patterns that contribute to mood episodes
and develops strategies for managing symptoms. Learning to recognize early warning signs of mania or
depression allows for intervention before episodes fully develop.
Family-focused therapy educates loved ones about bipolar disorder and improves communication and
problem-solving within the family system. Family support significantly improves outcomes.
Brain Stimulation Therapies
Electroconvulsive therapy (ECT) can be highly effective for severe episodes or treatment-resistant
cases.¹ Despite its reputation, modern ECT is safe, carefully controlled, and sometimes produces dramatic
improvement when other treatments haven’t worked.
Self-Management and Lifestyle
Self-management strategies and education are essential components of living well with bipolar disorder.¹
People with bipolar disorder become experts in their own condition over time. Learning personal triggers,
recognizing early warning signs, and developing action plans for emerging episodes all contribute to
long-term stability.²
Sleep is particularly crucial—both sleep deprivation and excessive sleep can trigger mood episodes.²
Maintaining consistent sleep schedules is one of the most important lifestyle factors in bipolar
management.
Complementary Approaches
Complementary health approaches such as meditation, faith, and prayer can support overall wellness and
stress management.¹Frequently Asked Questions About Bipolar Disorder
How is bipolar disorder different from normal mood swings?
Everyone experiences mood variations, but bipolar episodes are far more extreme and persistent. Manic
episodes in Bipolar I must last at least seven days (or require hospitalization), while depressive episodes
persist for at least two weeks.¹ The mood changes significantly impair functioning and are
disproportionate to circumstances.
Can bipolar disorder be cured?
Bipolar disorder is a chronic condition without a cure, but it can be effectively managed.¹ With proper
treatment, many people go years between episodes and maintain stable, fulfilling lives. Treatment is
ongoing because stopping medication typically leads to relapse.²
Why do people with bipolar disorder sometimes stop taking medication?
Medication non-adherence is common for several reasons. Side effects can be bothersome. During stable
periods, people may feel they no longer need medication. Perhaps most challenging, the early stages of
mania can feel good, and people may resist “giving up” that feeling.² Education about the condition and
ongoing support help maintain treatment engagement.
Is bipolar disorder the same as having a “split personality”?
No. This is a common misconception. Bipolar disorder involves mood episodes—periods of depression
and mania—not different personalities.² Dissociative Identity Disorder (formerly called multiple
personality disorder) is an entirely different condition.
Can children have bipolar disorder?
Yes, though diagnosis in children is complex and somewhat controversial.² Childhood bipolar disorder
may look different from adult presentations, and careful evaluation by specialists experienced with
pediatric mood disorders is essential.
Find Your Balance
Living with bipolar disorder means learning to navigate a brain that doesn’t regulate mood the way others’
brains do. It means building systems and supports that help maintain stability. It means accepting that
management is ongoing while refusing to let the condition define your entire identity.
At The Horizon Behavioral Health in Worcester, MA, we partner with people throughout Central
Massachusetts to achieve mood stability and build lives worth living. Our experienced team understands
the complexity of bipolar disorder and provides the comprehensive, compassionate care this condition
requires.
Stability is possible, and we’re here to help you find it.
Contact The Horizon Behavioral Health today to schedule your confidential consultation. Expert
bipolar disorder treatment is available right here in Worcester
Bipolar Disorder
Bipolar disorder causes dramatic shifts between emotional highs and crushing lows that go far beyond
ordinary mood swings, affecting nearly 3% of Americans annually with 83% classified as severe cases.
These episodes affect energy, judgment, sleep, and daily functioning—but effective treatment brings
stability. Our team provides comprehensive medication management, therapy, and support to help you
find balance and reclaim your life.
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References
1. 2. 3. 4. 5. National Alliance on Mental Illness. (2015). Bipolar Disorder Fact Sheet. NAMI.
https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder
National Institute of Mental Health. (2024). Bipolar Disorder. NIMH.
https://www.nimh.nih.gov/health/topics/bipolar-disorder
American Psychiatric Association. (2022). What Are Bipolar Disorders? APA.
https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
Depression and Bipolar Support Alliance. (2024). Bipolar Disorder. DBSA.
Mayo Clinic. (2024). Bipolar Disorder: Diagnosis and Treatment. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
Word Count: ~2,000 words Last Updated: January 2025 Medical Review: Content based on current
clinical guidelines and peer-reviewed sources