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Mood Disorders549The Symptoms of Bipolar DisorderKelly displayed classic symptoms of the mental disorder that used to be called manicdepression and is today called bipolar disorder. In contrast to major depression,bipolar disorder almost always involves abnormal moods at both ends of the emotionalspectrum. In most cases of bipolar disorder, the person experiences extrememood swings. Episodes of incapacitating depression alternate with shorter periodsof extreme euphoria, called manic episodes. For most people with bipolar disorder,a manic episode immediately precedes or follows a bout with major depression.However, a small percentage of people with bipolar disorder experience only manicepisodes (DSM-IV-TR, 2000).Manic episodes typically begin suddenly, and symptoms escalate rapidly. Duringa manic episode, people are uncharacteristically euphoric, expansive, and excited forseveral days or longer. Although they sleep very little, they have boundless energy.The person’s self-esteem is wildly inflated, and he exudes supreme self-confidence.Often, he has grandiose plans for obtaining wealth, power, and fame (Carlson &Meyer, 2006; Miklowitz, 2008). Sometimes the grandiose ideas represent delusional,or false, beliefs. Kelly’s belief that various celebrities were his close personalfriends was delusional.Kelly’s fast-forward speech was loud and virtually impossible to interrupt. Duringa manic episode, words are spoken so rapidly, they’re often slurred as the persontries to keep up with his own thought processes. The manic person feels as if histhoughts are racing along at warp factor 10. Attention is easily distracted by virtuallyanything, triggering a flight of ideas, in which thoughts rapidly and loosely shift fromtopic to topic.Not surprisingly, the ability to function during a manic episode is severely impaired.Hospitalization is usually required, partly to protect people from the potentialconsequences of their inappropriate decisions and behaviors. During manicepisodes, people can also run up a mountain of bills, disappear for weeks at a time,become sexually promiscuous, or commit illegal acts. Very commonly, the personbecomes agitated or verbally abusive when others question his grandiose claims(Miklowitz & Johnson, 2007).Some people experience a milder but chronic form of bipolar disorder called cyclothymicdisorder. In cyclothymic disorder, people experience moderate but frequent moodswings for two years or longer. These mood swings are not severe enough to qualify aseither bipolar disorder or major depression. Often, people with cyclothymic disorderare perceived as being extremely moody, unpredictable, and inconsistent.The Prevalence and Course of Bipolar DisorderAs in Kelly’s case, the onset of bipolar disorder typically occurs in the person’s early20s. The extreme mood swings of bipolar disorder tend to start and stop muchmore abruptly than the mood changes of major depression. And while an episodeof major depression can easily last for six months or longer, the manic and depressiveepisodes of bipolar disorder tend to be much shorter—lasting anywhere from a fewdays to a couple of months (Bowden, 2005).Bipolar disorder is far less common than major depression. Unlike major depression,there are no differences between the sexes in the rate at which bipolar disorderoccurs. For both men and women, the lifetime risk of developing bipolar disorder isabout 1 percent (Miklowitz & Johnson, 2007). Bipolar disorder is rarely diagnosedin childhood. Some evidence suggests that children who display unusually unstablemoods are more likely to be diagnosed with bipolar disorder in adulthood (Blader &Carlson, 2008).In the vast majority of cases, bipolar disorder is a recurring mental disorder(Jones & Tarrier, 2005). A small percentage of people with bipolar disorder displayrapid cycling, experiencing four or more manic or depressive episodes every year(Marneros & Goodwin, 2005). More commonly, bipolar disorder tends to recurevery couple of years. Often, bipolar disorder recurs when the individual stops takinglithium, a medication that helps control the disorder.Carrie Fisher and Bipolar Disorder By age20, Fisher had become a cultural icon inher role as Princess Leia in George Lucas’sStar Wars trilogy. By age 24, Fisher wasgrappling with drug addiction and bipolardisorder. Today, Fisher is a successful actressand writer. Her critically acclaimedone-woman Broadway show, WishfulDrinking, is a funny yet bluntly honestmemoir of her struggles. During her performance,Fisher displays her photo as itappears in an abnormal psychology textbook.Fisher prefers the older term, manicdepression,because, she quips, “It describeswhat it’s like. Bipolar sounds like agay bear from Alaska.” Fisher manages hersymptoms with a combination of medicationand electroconvulsive therapy, whichwe discuss in Chapter 14.bipolar disorderA mood disorder involving periods of incapacitatingdepression alternating with periodsof extreme euphoria and excitement;formerly called manic depression.manic episodeA sudden, rapidly escalating emotional statecharacterized by extreme euphoria, excitement,physical energy, and rapid thoughtsand speech.cyclothymic disorder(si-klo-THY-mick) A mood disorder characterizedby moderate but frequent moodswings that are not severe enough to qualifyas bipolar disorder.