Today we have a vocabulary lesson – the bipolar disorder edition. I’m including some mentions of clinical definitions here, but the vernacular use of the terms is what I’m really trying to clarify.
Pretty much anyone who is familiar with this condition has already heard the terms “bipolar disorder”, the current terminology of choice, and the older descriptors “manic depression” or “manic depressive illness”. So I’m not going to go into those. Likewise, I’m not going to define depression, mania, or hypomania. Those are easy to look up. Do it yourself.
There’s even quite a bit of information on dysphoria and mixed states, the uglier side of hypo/mania and the concurrent combination of manic and depressive symptoms. Dysphoric mania and mixed states are synonymous terms; apparently they are extremely unpleasant, although I don’t really speak from first-hand experience. These mood episodes are considered the biggest risk factors for suicide in bipolar individuals.
Did you catch the vague word in that last sentence? This is the vocabulary that I’m talking about: episodes, cycles, and swings. All these terms are usually modified with the specifier of “mood” and are employed in varying ways across individuals. I once posed the question on a bipolar forum as to what the differences were, and got some pretty consistent answers to these otherwise relatively unspecific terms.
Everyone has mood swings. I suspect that the reason no one discussed that particular term is because normal emotional shifts are often referred to as mood swings, but bipolar cycles are much more severe. As one person eloquently described it:
My normal mood changes are noticeable to me, but I can let go of them, or distract myself from them. Moods from my bipolar cycling consume me.
This much is clear: there is a marked difference between bipolar mood states and normal emotional shifts. When you’re in the mood state, it’s usually obvious. But prodromal symptoms or phases can be much harder to distinguish from normal emotions, at least for the person experiencing them. So I still use the term “mood swing” as my way of denoting a lack of certainty as to whether a shift in mood is normal or a step on the way to crazy-land.
The consensus definitions for the terms mentioned above are:
- Cycle: (noun) the current mood state
- Cycling: (verb) dramatic shifts in mood states from one mood to another, regardless of speed or frequency at which this occurs
- Episode: (noun) cycles when mood states are severe enough to be disruptive
This definition of cycling fits with the usages I’ve typically seen, as does episode. I don’t necessarily agree that this definition of “cycle” is useful because the word suggests motion rather than a stasis – however temporary – in a particular mood state. One person noted that it’s not a cycle or episode unless it’s persistent. I think the degree of persistence is subjective, and depends on the individual’s typical mood lability patterns. Rapid cycling is another detail often discussed around cycling, so that’s a factor in the perceived degree of persistence. That’s a topic that I’m going to go into another day in a bit more detail, but to quote a well-informed respondent, there are also guidelines about how episode length affects diagnosis:
By the DSM’s standards, a hypomanic ‘episode’ must last for a minimum of 4 days, a manic ‘episode’ for at least a week, and a depressive ‘episode’ for at least 2. These time requirements are completely arbitrary. A lot of research, actually, has discovered that the mean duration for hypomanic experiences is only 1-2 days.
Cycling is clearly a fairly complex notion. Another person discussed the difference between “normal” cycling and “straight” cycling. These aren’t necessarily terms that are frequently used or have any clinical equivalent, but I think it was an interesting distinction because it’s a notable quality of the experience. The description she offered is that “normal cycling” means shifting from one mood state to another, but spending some time at a baseline/normal/equilibrium state in between. “Straight cycling” meant going straight from depression to mania, or vice versa. In my experience, both are equally possible. In fact, a typical mood cycle pattern that I’ve had often, and that I’ve heard is fairly common, is to go from hypo/mania straight down to depression – maybe with a few days of transition between moods, but with no pause at the baseline, and quite often no time at baseline at all. I made up a little graphic to show what this difference might look like on a mood chart:
So these definitions, clarifications, and nuances were how a few people summarized their understanding of the vague terminology used to described the emotional motion of bipolar disorder. How about you? Have a clearer, better, more accepted definition? Any more specific delineations of variations on these themes besides rapid cycling?