Mental illness is a subject widely discussed yet never fully understood. We are all too familiar with the phrases “Be kind” and “It’s okay to talk” after the unfortunate suicides of celebrities as a symptom of what is usually a hidden long-term battle with a mental disorder.
However, people soon forget and are quick to assume and judge when a family member, close friend or colleague begins to display symptoms in which their behaviour changes.
There are currently over 200 recognised mental illnesses and some of these can co-exist. Two of the most common yet misunderstood disorders aside from depression and generalised anxiety are bipolar and borderline personality disorder (BPD).
Both of these disorders can have devastating effects on daily life, relationships with others and overall well being. They can be difficult illnesses to manage but with the correct balance and care, many do go on to live a full and happy life.
Sources suggest that bipolar affects around 45 million people worldwide while BPD is estimated to affect between 0.7 and 2% of the general population with it being present in 20% of all in-patients at psychiatric facilities.
Both of these disorders may require medical help at a facility due to the severity of symptoms that are present, although this isn’t the case for every individual.
Bipolar is categorised into two main types, I or II, type one focuses on major depression and manic episodes whereas type II focuses on major depression and hypomania.
According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), the global handbook that sets out criteria for diagnosis and is updated in accordance to new research (seven times since its publication in 1952) to be diagnosed with bipolar disorder I you need to meet the following:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day.
Three (or more) of the following symptoms: inflated self-esteem, decreased need for sleep, more talkative, flight of ideas or racing thoughts, distractibility, increase in goal-directed activity, excessive involvement in activities that have a high potential for painful consequences.
The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features.
The episode is not attributable to the physiological effects of a substance.
To be diagnosed, you have to have suffered at least one manic episode during your lifetime or a hypomanic episode which will be later explained in the diagnostic criteria for bipolar II
Alongside mania also comes major depression in both types, which can last for a prolonged length of time and is as follows:
Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day
- Diminished interest or pleasure in all, or almost all, activities.
- Significant weight loss when not dieting or weight gain.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Diminished ability to think or concentrate, or indecisiveness.
- Recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
These symptoms must cause significant distress and impairment to everyday life and must not be due to the effects of substance abuse.
Richard Smith, who had his first manic episode at the age of 17 and has a type I diagnosis said this: “What led to the speculation that I may have bipolar was in my behaviours preceding me being sectioned. The early stages of mania feels like everything is amplified in terms of happiness. But for those around the manic person, it is very draining and sometimes even scary.”
When asked about his feelings toward his initial diagnosis he said he felt a huge sense of clarity and validation, but it also was a very real wake-up call that this would be something he would have to face for the rest of his life.
“I never really felt listened to by psychiatry. I often felt judged by the people who were supposed to be offering help…This isn’t true for everyone in the profession. I have had good treatment from certain people but there is a very ‘us and them’ mentality,” he continued.
Smith exclaimed how stigmatisations surrounding bipolar such as not being able to fully contribute to society due to the condition have affected him and how he has at times regretted being open about his diagnosis.
“I always say that I have bipolar, not that I am bipolar. The condition is part of me; it does not define me…I shouldn’t have to be judged simply because I am in possession of this diagnosis.”
Those with type II bipolar also suffer from major depression, however, the episodes of mania are not usually severe enough to require medical attention or affect day to day life. This is therefore described as hypomania as opposed to mania.
Although, it is important to note that although there are noticeable differences between the severity and duration of both types of bipolar, type II is not a milder form.
Those with a bipolar diagnosis — be it I or II — can and do have a lifelong battle with their illness and finding a suitable balance but this does not restrict their quality of life. A large majority of people with the disorder go on to live a fulfilled and happy life and are not bound to their condition.
There is usually a need for a combination of different treatments to ease or prevent the effects of mania and depression. Mood stabilisers such as anticonvulsants and antipsychotic medications like Olanzapine and Epilim Chrono are frequently used for those with bipolar, especially if they are at risk of having psychotic episodes.
Some experience psychosis as a symptom of a severe mania or depression episode and usually result in the need for hospitalisation to keep themselves and others safe as psychosis can result in hallucinations and delusions that can prove fatal if not treated, however, this is not the case for everyone.
Talking therapies are also used as a treatment to combat depressive episodes and give people the skills to be able to deal with these as antidepressant medication carries the risk of inducing mania in some patients.
Recognising triggers and signs of manic or depressive episodes are a vital aspect of recovery, this knowledge can allow individuals to seek out help and prevent a potentially dangerous episode. Support from family members and close friends is unequivocally as important also.
Educating oneself by reading books or online publications and how to better support the people in your life who suffer from the illness shows not only your care but also your knowledge that this is a serious and sensitive topic and those with bipolar should be validated without judgement.
Popular celebrities such as Stephen Fry, Kanye West and Carrie Fisher were all diagnosed with bipolar. Fry openly discusses his diagnosis in his 2006 documentary Stephen Fry: The Secret Life of the Manic Depressive.
He has suffered from mental illness most of his life but didn’t receive his initial diagnosis of bipolar disorder until he was 37. To him, it is imperative that there is a greater public understanding of mental illnesses to end stigmatisations and allow people to be heard.
The exact cause of the disorder is currently unknown but research into this leads experts to believe that there is a complex mix of social, physical and environmental factors. Many believe that bipolar is down to a chemical imbalance in the brain.
It is also thought that there is a higher risk of an individual developing bipolar if someone else in the family suffers, but no single gene is believed to be responsible for this.
Another misunderstood mental illness is borderline personality disorder (BPD) or emotionally unstable personality disorder (EUPD).
This is not to be confused with dissociative identity disorder (DID) or commonly described as ‘multiple personality disorder’.
While BPD is classified as a personality disorder, it is mainly about emotional regulation and attachment issues.
There are no multiple personalities or anything ‘wrong’ with the personality for that matter.
Symptoms of BPD usually become present during adolescence and persist into adulthood. The cause is not yet known as there is little scientific research into the disorder however, it is thought that a mixture of genetic and environmental factors play a part.
In one study it was found that 71% of people with BPD had experienced at least one traumatic event during childhood and around 75% of all diagnoses are female.
The DSM-5 diagnostic criteria for BPD is as follows:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealization and devaluation (one minute you love them and the next you hate them.)
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating.)
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
- Affective instability due to a marked reactivity of mood.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger.
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
These symptoms can make day to day life increasingly difficult, especially due to the inability to regulate mood and the effects it has on the people surrounding a person with BPD.
Those with the disorder are often described as having ‘black and white’ patterns of thinking. In psychiatry, this is often referred to as ‘splitting’. It is considered a defence mechanism and those who ‘split’ see things in all or nothing situations. This can mean adoring one person or a thing for some time, and the slightest ‘off’ behaviour or feeling could result in them, therefore, thinking about the person or hobby negatively and discarding them from their life or going back and forth between love and hate.
Tom Barker, who was diagnosed with BPD in 2007 after having troubles in his work and personal life said at first it was quite difficult to get a formal diagnosis and get the help he needed.
“Once I finally found out what it was that I actually had, it was like a door opening and I was able to get more of an understanding of the illness and the impact it has,” he said.
“I looked it up on the internet and bought some books to try and help me understand it further but I haven’t found getting help very easy at all.”
Barker previously had issues with medical professionals who didn’t take his concerns as seriously as he would have liked or found that certain therapies weren’t as beneficial.
“I was told by a mental health nurse that some of the services I’d accessed in the past now wouldn’t be open to me because I wasn’t sick enough… I think if someone with a history of serious mental illness is asking for help before it gets serious, they should be listened to,” he claimed.
“Just because you’ve met one person with BPD, doesn’t mean you’ve met them all. We are all different and won’t all present with the exact same five symptoms.”
There is often no middle ground or rationality when it comes to this which can make personal relationships extremely difficult and sometimes frustrating for the other person. Borderline Personality Disorder often makes individuals seem like they are exaggerating or in some cases attention-seeking, however, this is not the case.
People with the disorder genuinely do feel like the smallest thing will tear their world apart, and it is a constant battle with one’s mind.
It is a complex mental illness, and it can be exhausting for all parties, although care must be taken not to invalidate feelings that may seem like an overreaction, it is simply best to try and get the individual into a calm space to ride out their feelings and then discuss rational thoughts.
A common trend amongst patients with BPD is the presence of a ‘favourite person’. This person could be a romantic partner or even just a friend and can change from person to person over time, however, this person usually determines the mood and self-worth of someone with the disorder.
It is an intense single attachment to one person and is clinically described as an idealisation or unstable relationship. Those with BPD will go to great lengths to make their person happy but more often than not become codependent and rely on that person for their happiness.
This is often seen as an unhealthy relationship but is believed to be out of conscious control.
There are currently no medications set to treat BPD, but antidepressants can be used to aid symptoms of depression and suicidal thoughts.
Dialectical Behavioural Therapy or DBT is a talking therapy based around Cognitive Behavioural Therapy but has been adapted to suit those with more intense emotions.
The therapy allows those with the diagnosis to better understand and accept themselves whilst also making positive changes to their behaviour and lifestyle through learning to manage symptoms.
If there is one thing we should take from all this, is that we need to be educated and informed of mental illnesses not just as a whole but individually. There are so many misconceptions and very little knowledge when it comes to the general public that it can be harmful.
Many refuse to speak up about their condition and struggles out of fear they won’t be understood or treated equally. A mental illness does not make anyone any less of a person and most people with mental health struggles live a relatively ‘normal’ life.
Everybody’s brain and emotions work differently and we need to be open about that.
Too many people are suffering in silence and succumbing to the feelings of despair and loneliness and we are the reason why.
*All names have been changed to comply with anonymity requests*
**Quotes have been edited for clarity**