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Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings

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  • 2 weeks ago
  • Balvinder Sandhu

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Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings
Our moods can affect our loved ones. And for someone who has bipolar disorder, this impact is stronger, because of the extremes that they experience. Dr Natalie Games, clinical psychologist at Alliance Counselling, defines it as a mood disorder characterised by extreme shifts in mood, energy and activity levels.
These shifts include periods of mania or hypomania (depending on the severity) and periods of depression,
she explains.

"It varies in severity and mild cases may appear ordinary for many years. Symptoms vary; a person may be predominantly depressed or predominantly manic. In between episodes, a person is likely to be quite well and able to function."

Bipolar disorder, with its distinct phases commonly characterised into mania and depression, was formerly referred to as manic depressive illness.
When manic, a person becomes overly elated, more irritable, requires less sleep, makes grand plans and may impulsively engage in potentially dangerous behaviour. When depressed, a person feels persistently sad, hopeless and lethargic, and may feel suicidal, among other symptoms.
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Dr Ang Ren Xuan, associate consultant at Institute of Mental Health (IMH), cites the 2016 Singapore Mental Health Study (SMHS), which found that the lifetime prevalence of bipolar disorder in the Singapore population is 1.6% or nearly 1 in 100 Singaporeans.
The prevalence seems to decrease with age and is most common in the young adult population,
he elaborates.

"According to the SMHS 2016, 62% of those with bipolar disorder were in the 18 to 34 years old category, followed by 25%, 12% and 6% in the 35-49, 50-64 and 65+ age categories respectively."

Living with bipolar disorder
Dr Games offers insights into what living with bipolar disorder is like. For example, many people with bipolar disorder report how their relationships can be dramatically affected by the mood swings.
Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings - Managing stress
One person described how, during a manic phase, they felt like they were 'invincible' and took on too many commitments, overwhelmed their friends and pushed boundaries,
she reveals.

"But when they entered a depressive episode, they isolated themselves, leaving loved ones confused and hurt. This roller coaster can create a sense of distance in relationships, even if the person with bipolar disorder deeply cares for those around them."

Even though the client was so happy when they were in a manic phase, actually it was harder for those around them,
she adds.

"Often people would comment on how much better they thought the client was doing during a depressive phase which was when they were most negatively affected."

Clarice (not her real name) had the experience of being on such an emotional roller coaster due to a friend with bipolar disorder.
Her friend Pauline (not her real name) seemed very friendly and openly shared her problems with all her friends, seemingly to evoke sympathy. At other times, she would be mean and verbally abusive, berating them for not meeting her expectations of being her friend.
Pauline also complained to her friends about each other, leading to conflict among the group.
When we later found out that Pauline was the cause of this unhappiness, we confided to each other the emotional despair she was putting us through,
recalls Clarice.
Pauline was later diagnosed with bipolar disorder.
It was hard on her family because while we only saw her occasionally, they had to live with her,
Clarice muses.

"Eventually her marriage broke down and she was committed to a facility."

They eventually lost touch with each other.

"If only we knew about bipolar disorder, perhaps Pauline could have received help earlier. We just thought she was manipulative and attention-seeking."

This lack of awareness surrounding bipolar disorder can also be a struggle. Dr Games had a client who hid their diagnosis for years because of this.
Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings - Ups and downs
They felt like their ups and downs were misunderstood by others as 'just bad mood swings' or 'attention-seeking behaviour,
she recalls.

"This lack of understanding made it difficult to seek support and it wasn't until they opened up to close friends and family that they felt truly supported in managing their condition."

It's important to remember that everyone's experience is different, and treatment approaches and personal stories vary widely. For those with bipolar disorder, learning how to manage the condition and seeking support can make a significant difference in leading a balanced life,
she adds.
Getting the right diagnosis
Dr Ang reveals that there is no single exact cause of bipolar disorder. Instead, its development is contributed by abnormalities in certain brain structures and functions, as well as psychosocial risk factors.
Studies have shown that bipolar disorder tends to run in families, which suggests that genetics play an important role in the development of the illness,
he says.

"Psychosocial risk factors include adverse life event experiences, difficulties managing stress and poor social support."

According to Dr Ang, bipolar disorder is diagnosed through a thorough history-taking and mental state examination by a psychiatrist. Physical examination and laboratory tests are also performed to rule out medical conditions which could present with mood symptoms commonly found in bipolar disorder. Scales such as the Young Mania Rating Scale (YMRS) can also be used to measure symptom severity in bipolar disorder.
Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings - Dr Natalie Games
Dr Natalie Games, clinical psychologist at Alliance Counselling

Dr Games shares that it’s not uncommon for people with bipolar disorder to have a dual diagnosis, for example, they have a substance use disorder in addition to bipolar disorder. This makes diagnosis for bipolar disorder even trickier.

Unfortunately, being told you have multiple mental health issues can also result from misdiagnosis, since bipolar disorder and related conditions often share symptoms such as changes in mood, energy and activity levels,
she adds.
Treatment for bipolar disorder involves medications which target neurotransmitters in the brain.
While they are generally effective in managing the patient's mood, monitoring is recommended to ensure side effects, if any, are kept to a minimum,
says Dr Ang.
He mentions other treatment options – psychotherapy such as cognitive behavioural therapy (CBT), interpersonal and social rhythm therapy (IPSRT) and family-focused therapy (FFT).
Providing psychoeducation to the patient as well as their caregivers is also important. This empowers the patient and their caregivers to understand more about the illness and steps they can take to keep it under control,
says Dr Ang.

"Managing environmental factors such as having robust stress-coping mechanisms, leading a healthy lifestyle and forming strong supportive relationships with loved ones and friends are all crucial in the management of bipolar disorder."

Bipolar Disorder: Not just bad mood swings
Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings - Not just mood siwngs
To have a better understanding of bipolar disorder, Dr Games bust some myths:
  • Myth #1: Bipolar disorder is just ‘bad mood swings’
It’s much more complex than that. It involves extreme shifts in mood, energy and behaviour that can last for days, weeks or even longer. These mood swings are not just fluctuating emotions as they can significantly impact a person’s life, relationships and ability to function.
  • Myth #2: Bipolar disorder only affects your mood
Bipolar disorder goes beyond just emotions. During manic episodes the person may experience racing thoughts, impaired judgement and impulsivity which could lead to risky behaviours or difficulty making decisions.
In depressive episodes, the person may struggle with feelings of hopelessness, fatigue, difficulty concentrating and even physical symptoms like changes in sleep and appetite. Furthermore, bipolar disorder can also affect relationships, work/school performance and daily functioning.
  • Myth #3: Bipolar disorder cannot be treated
Bipolar disorder is not ‘cured’ in a traditional sense but with proper treatment and support, people with bipolar disorder can lead stable and fulfilling lives. Early intervention and consistent care can significantly improve the quality of life and reduce the frequency and intensity of episodes.
Whether it’s a loved one or someone you encounter on some occasions, we should be more understanding about bipolar disorder.
Most importantly, educate yourself about the condition and recognise that the person's mood swings are not intentional but rather a part of the disorder,
says Dr Games.
Be patient and compassionate during both manic and depressive episodes, offering a non-judgmental space for them to express themselves,
she suggests.

"Try to listen openly without wanting to 'fix' the situation as this is more helpful than offering solutions. Encourage them to stick with their treatment plan, while also respecting their autonomy and boundaries."

Their mood fluctuations are not about you or your relationship so ensure you avoid taking these changes personally – let them know you’re there for them as much as you can be,
she adds.

"Maintaining open communication and being flexible in your expectations can make a significant difference in their life."

Bipolar Disorder: Unmask The Complex Hidden Struggles That Go Beyond Mood Swings - Dr Ang Ren Xuan
Dr Ang Ren Xuan, associate consultant at Institute of Mental Health (IMH)
Some people with bipolar disorder will require long-term treatment for their condition. Encouraging treatment adherence, providing a listening ear and showing emotional support during stressful moments can be of great help in their recovery journey.
Dr Ang offers the following advice:
Ultimately, bipolar disorder is an illness of the brain and is no different from any other disease that afflicts other parts of the body,
he adds.

"Just like how we do not ostracise someone who has fractured an arm, we should all, likewise, strive to be empathetic towards someone who has a mental illness like bipolar disorder."

This article is part of a series on invisible disabilities, an umbrella term that refers to types of disabilities, chronic conditions or medical/neurological conditions that are not immediately apparent to others. We seek to understand more about these invisible disabilities and how we, as loved ones or as general members of society, can better support others going through it.

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Balvinder Sandhu

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A published author who lives in Melbourne but stays in touch with her Singapore roots and way of life.

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