The ultimate guide to bipolar disorder

The ultimate guide to bipolar disorder
Bipolar disorder is a lifelong psychiatric disorder characterized by extreme changes in mood, energy level, and activity ranging from emotional highs (manic episode) to emotional lows (depressive episode). Here is what you need to know.
Written by Orchid Team
Medically reviewed by Dr. Vanessa Cutler
  • Dr. Vanessa Cutler, MD MPH, is a board-certified adult and child psychiatrist. She is an assistant clinical professor of psychiatry at NYU Langone and Medical Director of Behavioral Health at Four Winds Hospital in Saratoga Springs in addition to holding privileges at numerous hospitals across New York State.

What is bipolar disorder?

Bipolar disorder is a lifelong psychiatric disorder characterized by extreme changes in mood, energy level, and activity ranging from emotional highs (manic episode) to emotional lows (depressive episode). These episodes can happen rarely or multiple times in a year. Most people with bipolar disorder spend the majority of their lives in a depressive episode as opposed to a manic one. 

There are two major types of bipolar disorder

  • Bipolar I Disorder: This is defined by having manic periods that last at least 7 days or severe enough symptoms to require hospitalization. Depressive periods usually happen as well. 
  • Bipolar II Disorder: This is defined by a pattern of depressive and less severe manic periods called hypomanic periods. 

There are some cases of bipolar disorder that do not fit either category. Examples include those caused by certain drugs or medical conditions. These are referred to as other specified and unspecified bipolar and related disorders. In addition, there are some conditions, like cyclothymic disorder, that are similar to bipolar disorder but do not meet official criteria. 

What causes bipolar disorder?

At this point the cause of bipolar disorder is unknown. Some studies have shown physical differences in the brains of people with bipolar disorder and genetics is known to play a strong role. Scientists are studying each of these to learn more about what causes bipolar disorder. 

What are the risk factors for bipolar disorder?

  • genetics
  • environment

How does genetics influence risk of bipolar disorder?

Bipolar disorder is one of the most heritable psychiatric illnesses. For example, there is a substantial familial component to bipolar disorder: if someone has one first degree relative like a parent with bipolar disorder, their risk of developing bipolar disorder is somewhere between 10% and 25%.  Multiple studies give an estimated range of heritability of bipolar disorder of between 79 and 93%. One of these studies conducted on 19,124 pairs of twins from Finland estimated bipolar I disorder to be 93% heritable

How does the environment influence the risk of bipolar disorder?

A variety of environmental factors have been linked to increasing the risk of developing or triggering bipolar disorder. These include traumatic events such as child abuse or the death of a loved one, and drug or alcohol abuse, particularly cannabis abuse

How common is bipolar disorder?

Around 4.4% of U.S. adults will experience bipolar disorder in their lifetime. Bipolar disorder is typically diagnosed in the teen years through the early 20s but a significant number of patients do not have onset until after the age of 50. While men and women have similar levels of diagnosis for bipolar I, women develop bipolar II disorder more often than men and are at greater risk for alcohol use problems, thyroid disease, medication-induced obesity, and migraine headaches.   

How is bipolar disorder diagnosed? 

The first step is to rule out other possible medical causes, like endocrine disturbances, brain tumors, and blood pressure problems. Next, a mental health or psychiatric evaluation is done to determine if the criteria for bipolar disorder are met. To be diagnosed with bipolar disorder, a person must have experienced at least one lifetime episode of mania or hypomania. A full list of the diagnostic criteria for the different forms of bipolar disorder can be found here.

What are some complications of bipolar disorder?

People with bipolar disorder have a lifespan that is 8-15 years shorter than people without this disorder. They are also more likely to have other mental health issues like anxiety, attention-deficit /hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and substance use disorders. If left untreated, there can be problems related to drug and alcohol use, suicide or suicide attempts, legal or financial problems, damaged relationships, and poor school performance.  

Is there anything I can do to reduce my child’s genetic risk?

As explained in the bipolar disorder whitepaper, genetics plays an important role in determining the risk of bipolar disorder. Using Orchid’s embryo scoring, you can prioritize the embryo with the lowest genetic risk for bipolar disorder and reduce their risk. 

Is there anything I can do to reduce my risk of bipolar disorder?

There is currently no way to prevent bipolar disorder as the cause is not clearly understood. However, you can reduce the effects of bipolar disorder by taking medications exactly as directed and avoiding drugs and alcohol as they can make symptoms worse or make them more likely to return.  

How is bipolar disorder treated?

An effective treatment plan for bipolar disorder usually involves medication and psychotherapy. Medication usually includes mood stabilizers, antipsychotics and sometimes other classes of medication, as well. Psychotherapy is also recommended and may include bipolar specific therapies such as interpersonal and social rhythm therapy (IPSRT) or family-focused therapy.


  1. People with bipolar disorder experience extreme swings in emotions between manic and depressive periods.
  2. Bipolar disorder is a lifelong disease that can be successfully treated with medication and psychotherapy.
  3. There are no proven ways to prevent bipolar disorder but there are strategies to decrease the likelihood and intensity of episodes.

Where can I learn more?

  1. Additional resources can be found here.
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