bipolar dual diagnosisBipolar disorder is far more than the mild mood swings that accompany life’s circumstances for most people. It is a serious, chronic brain disorder. It consists of extreme moods that go from high energy mania to deep depression. Some people experience more mania, others more depression, others a milder form of bipolar disorder called Cyclothymic Disorder, while still others may experience a severe form of bipolar disorder, rapid-cycling bipolar disorder, with frequent shifts (four or more per year) between manic episodes and depression. When bipolar disorder spirals out of control, destructive and dangerous behaviors can ensue and the person may engage in high risk activities like sexual indiscretions, unbridled spending, foolish business investments and even self-harm behaviors and suicide. The person can also become psychotic, experiencing hallucinations; seeing or hearing things that aren’t there. Hospitalization is often necessary to stabilize the person and insure their safety.

Bipolar disorder was previously known as manic depression and was often misunderstood and misdiagnosed. Today the DSM-5 defines three main types of bipolar disorder; Bipolar I: manic or mixed episodes that last at least seven days that may be preceded by or followed by major depressive episodes lasting at least two weeks or hypomanic (a less extreme form of mania) episodes; Bipolar II: a pattern of major depressive episodes and hypomanic episodes; and Cyclothymic Disorder: a milder form of bipolar disorder that persists for at least 2 years with numerous periods of hypomanic symptoms, as well as depressive symptoms, neither of which meet criteria for manic, hypomanic or major depressive episodes. There is also Substance/Medication Induced Bipolar and Related Disorder and Unspecified Bipolar and Related Disorder. Within all of these categories there are many specifiers that further define the condition in symptoms and severity.

The symptoms of mania are feeling very up or energized, irritability, goal driven or pleasure seeking behaviors, risky behaviors, distractibility, decreased need for sleep, restlessness, fast and excessive talking, grandiosity and racing thoughts. Depression symptoms include long periods of sadness, loss of interest in activities, feeling tired and lethargic, difficulty concentrating, indecisiveness, feelings of worthlessness or guilt, restlessness or irritability, changes in eating, sleeping and hygiene habits, thoughts of death or suicide, or suicide attempts.

Co-occurring substance use disorders are common and can also complicate the diagnosis of bipolar disorder. Many people who suffer from bipolar disorder use alcohol or drugs to try to manage their moods and cope, but that only makes it worse. Addictions can develop and compound the problem. Conversely, substance abuse can trigger or prolong bipolar disorder or mimic the symptoms. Other co-occurring disorders can include anxiety disorders like PTSD and social phobia or other disorders like ADHD. Physical disorders like thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses also are common in people with bipolar disorder. It is uncertain if the physical ailment triggers bipolar disorder or if they are a result of the treatments for it, or both.


If you or someone you know is suffering from bipolar disorder and substance abuse, don’t delay in getting evaluated. It is critical to identify and diagnose the disorder and begin treatment as soon as possible. Often persons suffering from bipolar disorder do not realize the extremes of their moods and behaviors. They also may enjoy the feeling of mania, which is a high, sometimes euphoric feeling. This however usually doesn’t last and, as the mania escalates, irritability and erratic behavior sets in. Depression may follow. It is imperative to get help before these symptoms increase and worsen. There are many resources available like NAMI and NIMH (The National Institute of Mental Health) that can provide more information, support and education. So don’t delay in the getting the crucial help needed to manage bipolar disorder. Call today to schedule an evaluation with a qualified professional.

This post was written by: Elizabeth Ossip, LCSW, CAP, IADC