What's Normal Anyway? Celebrities' Own Stories of Mental Illness (28 page)

Are there different types of bipolar disorder?

B
IPOLAR
I
DISORDER
:
BP I is defined by manic episodes that last at least a week, or by severe manic symptoms that need hospital treatment. Usually, but not always, the sufferer also has depressive episodes, which last at least two weeks.

B
IPOLAR
II
DISORDER
:
BP II is defined by a pattern of depressive periods interspersed with ‘hypomanic' episodes, which involve mild or moderate (rather than full-blown) mania. Some people describe this hypomania as pleasant and it can be associated with productivity and creativity.

C
YCLOTHYMIC DISORDER
:
People suffering from cyclothymia have recurrent episodes of hypomania and mild depression for at least two years. Although considered a less severe form of bipolar disorder, cyclothymia may still affect people's daily functioning.

R
APID-CYCLING BIPOLAR DISORDER
:
Those with rapid cycling experience four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. Some people may have more than one episode in a week, or even a day.

B
IPOLAR DISORDER NOT OTHERWISE SPECIFIED
:
BP-NOS is diagnosed when a person has symptoms of the illness (which are outside their normal behaviour) that do not meet the criteria for either bipolar I or II.

How common is bipolar disorder?

It is thought that 1–2 per cent of the general population suffer from bipolar disorder, although up to 4–5 per cent may be on the bipolar spectrum.

Are certain types of people more likely to develop bipolar disorder?

Women may be slightly more likely to be affected by bipolar disorder than men. The condition usually develops in the late teens or early adulthood, with around half of all cases starting before the age of 25. However, the disorder is commonly not correctly diagnosed for around ten years, with an average of 3.5 misdiagnoses before this.

Why do people get bipolar disorder?

There are thought to be several factors involved in the development of bipolar disorder:

G
ENES
:
Although no one particular gene is responsible for causing bipolar disorder, it does seem to run in families, with close relatives of people with the condition being at greater risk of developing bipolar disorder than other people.

E
NVIRONMENT AND LIFE EXPERIENCES
:
Factors such as childhood abuse and trauma, bereavement, relationship or work stress may also act as triggers in a person already predisposed to developing bipolar disorder, or bring on episodes in an existing disorder.

B
ODY CHEMISTRY
:
People who have bipolar disorder often have higher levels of the stress hormone cortisol than other people, while those in manic states have higher levels of the neurotransmitters norepinephrine and dopamine. Abnormal thyroid hormones and elevated insulin levels have also been linked to bipolar disorder.

What is the treatment for bipolar disorder?

The aim of treatment is to reduce the frequency and severity of symptoms. Most people can be treated at home but, in severe cases, hospitalisation may be needed.

M
EDICATION
:
Mood stabilising drugs are the primary treatment for bipolar disorder and are usually taken on an ongoing basis. Lithium, which has been used for over sixty years, is the most commonly prescribed medication, but anticonvulsants, antipsychotics, antidepressants, and benzodiazepines (‘tranquillisers') may also be used.

T
ALKING THERAPY
:
Talking therapy may also be helpful, with cognitive behavioural therapy (CBT) being recommended for the depressive states and also to help people recognise symptoms early on and so prevent relapse. Family therapy may help sufferers and their relatives to deal with the distress that the disorder can cause.

S
ELF-EDUCATION, SELF-HELP MEASURES, AND SELF-MANAGEMENT
:
Such treatments may include mood monitoring, coping skills, exercise, nutrition, regular sleeping patterns, and avoiding stress, as well as learning about the illness, its treatment, and signs of relapse.

What are the risks associated with bipolar disorder?

Bipolar disorder may be associated with other mental health problems, self-harm, alcohol and drug abuse. Some studies have found that people suffering from bipolar disorder have a 15–20 times greater risk of suicide than the general population.

What is the prognosis for people with bipolar disorder?

On average, people with bipolar disorder have five or six episodes over the course of twenty years. However, with early diagnosis and proper treatment, people are often able to significantly stabilise their moods, improve their symptoms, and live relatively normal lives, despite the recurrent nature of the illness.

Who can I contact for help if I think I have bipolar disorder?

Your first point of contact should be your GP, who may refer you to a psychiatrist on the NHS for assessment and treatment. They may also put you in touch with a community mental health team (CMHT), early intervention service (EIS), crisis service, and/or assertive outreach team, who can help with assessment and treatment, usually in the home. There are also day hospitals that can be visited every day or as needed. In addition, the below organisations may be able to offer help, support, and advice:

Bipolar UK
Tel: 020 7931 6480
Email:
[email protected]
Web:
www.bipolaruk.org.uk

Equilibrium – The Bipolar Foundation
Web:
www.bipolar-foundation.org

Please see the ‘Useful contacts and links' pages for more resources and organisations which may be able to help, including national mental health charities such as Mind, Sane, and Rethink.

Anxiety disorders

What is anxiety?

Everybody feels anxious sometimes and it is usually a perfectly normal and, indeed, helpful response. For example, some anxiety can enhance energy and performance when doing exams, in job interviews, or speaking in public. People also experience anxiety in situations where there is a threat, such as being attacked by an animal or person. This anxiety triggers the body's natural ‘fight or flight' response – where adrenaline is released into the bloodstream, triggering physical changes such as an increased heart rate and breathing – which helps the person to put up a fight or run away. The anxiety then naturally subsides once the situation is resolved. However, anxiety can become a problem if a person feels excessively anxious on a regular basis for no obvious reason, or in relation to situations, objects, or events that do not cause most other people anxiety. In extreme cases, anxiety symptoms can take over a person's life.

What are the symptoms of anxiety?

M
ENTAL SYMPTOMS
:
These may include feeling nervous, apprehensive, panicky, on edge, or worried most or all of the time. People may also feel irritable, suffer from insomnia, be unable to concentrate, and have an exaggerated startle reflex (for example, jumping at loud noises).

P
HYSICAL SYMPTOMS
:
These may include palpitations (a racing heart or irregular heartbeat), hyperventilation (over-breathing), feeling very hot or very cold, muscle tension, shaking or trembling, dizziness, faintness, dry mouth, problems swallowing, indigestion, and diarrhoea.

Are there different types of anxiety?

When anxiety becomes a problem that affects people's daily functioning, they may be suffering from an anxiety disorder. Some of the most common anxiety disorders are listed below (see separate factsheet for obsessive compulsive disorder):

G
ENERALISED ANXIETY DISORDER
:
GAD is the most common type of anxiety disorder, characterised by wide-ranging and excessive anxiety and worry that is difficult or impossible to control and causes significant distress and disruption in everyday life. This anxiety may apply to specific areas of life – including work, finances, relationships, and health – or be felt as more of a ‘free-floating' dread, not attached to any one thing. People with GAD often have very negative thinking patterns and always believe that the worst will happen (‘catastrophising').

P
ANIC DISORDER
:
Panic
attacks
are sudden episodes of intense anxiety, fear, and distress, usually lasting 5–20 minutes. Physical symptoms include palpitations, sweating, shaking, nausea, chest pain, dizziness, feeling hot or cold, shortness of breath, and feeling detached from the situation or oneself. During a panic attack people often fear that they are going to lose control, ‘go crazy', or drop dead. (This is not the case: although panic attacks can be terrifying, they are not physically dangerous.) Panic
disorder
is diagnosed when a person has unexpected and repeated panic attacks where at least four of the above symptoms are present, followed by intense fear of having another attack, worry about what might happen as a result of an attack (such as dying), and/or avoidance of situations where panic attacks have happened before.

A
GORAPHOBIA
:
Recurrent panic attacks, along with the fear of having another attack, and avoidance of situations in which attacks have previously occurred, may result in agoraphobia. Agoraphobia is not, as commonly thought, a fear of open spaces or an inability to leave the house
per se
(although it may involve both these things), but anxiety about being in situations or places where escape is difficult or embarrassing, or where help is unavailable. Such situations may include being in crowds, going to cinemas, restaurants or theatres, travelling on public transport, going across bridges or under tunnels, and being away from home. People with agoraphobia frequently avoid these situations or need to be accompanied by another person.

S
OCIAL ANXIETY DISORDER
:
Also known as social phobia, sufferers become extremely anxious about what other people – particularly strangers – might think of them and worry that they are being judged. They fear being the centre of attention, worrying that others will notice them behaving oddly or in an anxious way, and often think that they are weak, stupid, or crazy. Social anxiety may sometimes be dismissed as extreme shyness, but for sufferers it may lead to drastic restrictions on, and distress in, their lives. They may, for example, avoid – or experience extreme anxiety during – social activities such as eating in front of other people, going to parties, having guests in the home, and work-related activities.

P
OST-TRAUMATIC STRESS DISORDER
:
PTSD may develop after exposure to a traumatic event, such as when a person has experienced or witnessed a situation involving actual or threatened death, serious injury, or sexual violence. Learning about events that involve such trauma (for example, the death of a loved one) may also trigger the condition. PTSD may manifest, for example, in soldiers who have been in combat, victims of violent crime such as rape, families of murder victims, and those caught up in natural disasters. Symptoms may include feelings of fear, horror, helplessness, flashbacks, panic attacks, nightmares, increased emotional arousal, and avoidance of feelings or situations that trigger memories of the event.

S
PECIFIC PHOBIAS
:
People may also develop what are also known as ‘simple phobias', relating to a particular object, event or situation, exposure to which may trigger excessive fear, anxiety, and panic. Some of the most common specific phobias include those relating to animals (such as dogs, spiders, or snakes), enclosed spaces, heights, blood, flying, or going to the dentist. These situations are usually avoided.

How common is anxiety?

It is thought that around 10 per cent of the general population suffer from anxiety of some description and the same amount will experience the occasional panic attack. Research suggests that 3–5 per cent suffer from GAD, 3 per cent from a specific phobia, and 1–2 per cent from panic disorder. Up to 30 per cent of people who experience a traumatic event go on to develop PTSD.

Are certain types of people more prone to developing anxiety?

Anxiety disorders are more common in women than men and are highest in people aged twenty-five to thirty-four, usually declining with age.

Why do people suffer from anxiety?

It is thought that a combination of factors causes anxiety disorders:

G
ENES
:
Research shows a strong genetic factor in some anxiety disorders. For example, nearly one in five people with panic disorder has close relatives with the condition.

E
NVIRONMENT AND LIFE EXPERIENCES
:
Anxiety disorders may be triggered by learned behaviours (such as observing parents with anxiety problems), traumatic experiences in childhood (such as sexual or physical abuse, or poor parenting), and/ or may come about from stressful events later in life (such as divorce or bereavement).

B
ODY CHEMISTRY
:
An imbalance of neurotransmitters in the brain – including serotonin, noradrenaline and gamma-aminobutyric acid – may also be involved in the development of anxiety disorders.

L
IFESTYLE
:
Poor diet, too much caffeine, recreational drugs (such as cocaine, cannabis, and amphetamines), and stress can also cause, mirror, or exacerbate anxiety.

M
EDICAL CONDITIONS AND MEDICATIONS
:
Some physical diseases (such as thyroid or heart problems) can cause anxiety, as well as hormone imbalances (which may occur premenstrually or in menopause). Commonly used drugs such as tobacco, and withdrawal from alcohol, narcotics, and prescription medications (such as antidepressants), may also trigger anxiety symptoms.