Running head: BIPOLAR DISORDER 1

Bipolar Disorder

Nathan G. Hurst Claunch

California State University Bakersfield

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Abstract

Bipolar Disorder (BD) is a psychological disorder that is present in roughly 2% of the

population. It affects those with it through depression, sadness, fits of anger, moments of rage,

and alienation of those close to them and those diagnosed with BD can even forget and not

remember the episodes after they happen. Treatments include both pharmaceutical and natural

interventions determined by the severity of the disorder and whether or not the subject is

experiencing a level 1 (severe) or level 2 (less severe) episode. Within a classroom environment,

accommodations can be made through section 504 or an IEP that will help students with the

interventions required to have success.

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Bipolar Disorder

In society today the label “bipolar” is generally given to individuals who have a history

of severe depression that cause them to act severely un-natural. Per Burton (2017), two terms

“melancholy” (depression is the clinical term for melancholy) and “mania” are derived from

ancient Greek root words. Melancholy is made up of ‘melas’ or black, and ‘chole’ or bile,

because Greeks thought depression came from too much black bile. Mania comes from the word

‘mainesthai’, or to rage and go mad. Today’s modern terms “manic depression” and “bipolar

disorder” originated in the 1950’s and 1980’s respectively with “bipolar disorder” being

considered less stigmatizing. Bipolar disorder carries two distinct level that it can be categorized

in, level 1 and level 2. BD (Bipolar Disorder) level 1 consists of more severe mood episodes like

mania and depression and BD level 2 consists of less severe mood episodes such as a depressive

mood, low energy, loss of pleasure, and feelings of guilt.

Etiology

The consensus among psychologists on the etiology, or causes, of bipolar disorder

revolve around two main sources, genetics and biological changes in the brain. Like many

illnesses and disorders bipolar disorder can be handed down from generation to generation.

Craddock and Sklar (2013) state, “In patients with established disease, a family history of mood

or psychotic illness is common”. Similar to hair color, height, and freckles bipolar disorder is

something that can be shared within multiple generations of a family. Also, Craddock and Sklar

(2013) state, “… a family history of bipolar disorder is an important clinical predictor of a likely

bipolar course in a patient who presents with one or more episodes of depression even before

their first personal episode of mood elevation”. When someone with a history of bipolar disorder
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in their family displays depression the genetics involved can help predict a path towards a

diagnosis of bipolar disorder even before any manic episodes take place.

In addition to the genetic causes of bipolar disorder, certain biological changes in the

brain can also be sourced as a cause to the disorder. For example, traumatic and stressful life

events can lead to changes within the brain where bipolar disorder can develop and begin to

overtake the emotions and actions of the subject to these events. Per Koenders et al. (2014),

“Stressful life events play an important role in the course of BD. The occurrence of major events

in the life of BD patients has been associated with an increased risk of relapse into mood

episodes and increased time until recovery Especially negative life events seem to be more

common in the months prior to both depressive and manic episodes”. Serious events like divorce

and death can place a traumatic strain on the brain of and individual and either biologically affect

change or enhance some bipolar traits that already exist within and individual with and existing

bipolar disorder either from other past events or genetic traits.

Prevalence

While the term “bipolar disorder” is widely used in today’s society as a way to generalize

behaviors that include depression, anti-socialization, and anger or rage, actual prevalence of

bipolar disorder is much less in society than would be assumed. A rather comprehensive study

completed by Clemente et al. (2015), included 25 population- or community-based studies and

276,221participants. This vast experiment conducted over a number of years concluded that

bipolar disorder within the pooled lifetime prevalence of Bipolar Disorder type 1 was 1.06%

with a 95% confidence interval, and that of Bipolar Disorder type 2 was 1.57%. This rather small

portion of the population that has Bipolar Disorder contradicts the generalized idea that anyone

with anger or depression suffers from BD.

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Psychological characteristics including cognitive

impairment and academic performance

Bipolar Disorder affects those individuals who are diagnosed with it in a variety of ways

beyond the social implications of being ostracized from those close to them. Per Montagna et al.

(2017), “… cognitive impairment is a disabling feature of the bipolar disorder (BD), present in

all the phases of the disease. Obesity and metabolic disorders represent another risk factor for

cognitive dysfunctions in BD, since the excess of weight could adversely influence several

cognitive domains”. This study is linking the cognitive impairment of Bipolar Disorder with

obesity and determining that a large number of people diagnosed with BD are also considered

obese, which in turns affects their cognitive abilities along with the disorder.

Academic performance in those with BD can vary, however, in those with Pediatric

Bipolar Disorder (PBD) there are some alarming results. Pavuluri, O’Connor, Harral, Moss, and

Sweeney (2006), found that academic functioning in those diagnosed with PBD can be

compromised and there is an increase in the need for special education services. Additionally,

math and reading deficiency in children with PBD is in the 30-40% range and children with PBD

have a lower scale IQ than those who do not.

Physiological and behavioral characteristics

The physiological and behavioral characteristics of people diagnosed with Bipolar

Disorder is rather specific and comprehensive across the board. In the article Characteristics of

the Child Behavior Checklist in Adolescents with Depression Associated with Bipolar Disorder,

the authors conducted a study in which thirty-two adolescents, ages 12–18 years, with a

depressive episode associated with bipolar disorder were recruited, and their primary caregivers

completed a CBCL (child behavior check-list). The findings showed that adolescents diagnosed
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with BD were withdrawn 69.2% of the time, anxious or depressed 68.2% of the time, and had

rule breaking behavior 68.1% of the time per their primary caregivers. Per Southammakosane et

al. (2013), “Adolescents with bipolar depression showed significantly elevated scores above the

accepted norms in most of the CBCL subscales”.

Treatment, intervention, evidence-based strategies for students with the disability

Treatment of BD varies from which symptom of the disorder the individual is feeling and

with what level of BD they are experiencing. Geddes and Miklowitz (2014) state, “Lithium,

introduced by John Cade in 1949, remains the best established long-term treatment for bipolar

disorder. Although the metal has been in clinical use for more than 50 years, the most convincing

evidence of long-term efficacy comes from randomized clinical trials in which lithium was

included as an active comparator”.

In regards to non-pharmaceutical treatment and strategies, Granek, Danan, Bersudsky,

and Osher (2018) state, “the available literature on coping with BD indicates that people with

this condition … use a variety of coping strategies in their day-to-day lives”. For example,

professional help, social support, and emotional, coping strategies can help with students who are

dealing with BP on a daily basis. These strategies, in order to be effective, need to be a part of

the students Individual Educational Plan and implemented by the staff with the help and support

of both administration and the students legal guardians.

Educational implications for teachers

The implications in a classroom for the teachers of students diagnosed with Bipolar

Disorder determine that like all students those with BP require the patience and attention that the

majority of students need. Per McCabe and Shaw (2015), teachers should know that each student

with BD is different and different levels of support. Additionally, teachers should foster
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communication and collaboration among the other educators and mental health professionals on

staff in order to ensure the educational success of the student. Through either section 504 or the

students IEP, the staff should administer effective learning to students with BD and help to

understand what keys and triggers are harmful to them within the academic environment.

Conclusion

Bipolar Disorder, both level 1 and 2, is something that is not new to society and has

impacted individuals and those around them longer than history has been written. Recent

findings have shown that BD can be caused by a few different reasons and while it does not

affect a large percentage of people in society it can be more prevalent in certain cultures,

geographical areas, and in people from different soci-economic backgrounds. Treatments are

available, both pharmaceutical and naturally, however, intervention in students is vital to ensure

their success in academic environments.

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References

Clemente, A. S., Diniz, B. S., Nicolato, R., Kapczinski, F. P., Soares, J. C., Firmo, J. O., &

Castro-Costa, E. (2015). Bipolar disorder prevalence: a systematic review and meta-

analysis of the literature. doi: 10.1590/1516-4446-2012-1693

Burton, N. (2017, September 7). A Short History of Bipolar Disorder. Retrieved April 15, 2020,

from https://www.psychologytoday.com/us/blog/hide-and-seek/201206/short-history-

bipolar-disorder

Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381(9878), 1654–

1662. doi: 10.1016/s0140-6736(13)60855-7

Geddes, J. R., & Miklowitz, D. J. (2014). Treatment of Bipolar Disorder. Focus, 12(2), 205–216.

doi: 10.1176/appi.focus.12.2.205

Granek, L., Danan, D., Bersudsky, Y., & Osher, Y. (2018). Hold on Tight: Coping Strategies of

Persons with Bipolar Disorder and Their Partners. Family Relations, 67(5), 589–599.

doi: 10.1111/fare.12328

Koenders, M., Giltay, E., Spijker, A., Hoencamp, E., Spinhoven, P., & Elzinga, B. (2014). EPA-

1204 – Stressful life events in bipolar i and ii disorder: cause or consequence of mood s

ymptoms? European Psychiatry, 29, 1. doi: 10.1016/s0924-9338(14)78450-0

McCabe, P. C., & Shaw, S. R. (2015). Pediatric disorders: current topics and interventions for

educators. New York, NY: Skyhorse Publishing.

Montagna, M. L., Stella, E., Ricci, F., Borraccino, L., Triggiani, A., Panza, F., … Lozupone, M.

(2017). Bipolar disorder, obesity and cognitive impairment. European Psychiatry, 41.

doi: 10.1016/j.eurpsy.2017.01.2167
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Pavuluri, M. N., O’Connor, M. M., Harral, E. M., Moss, M., & Sweeney, J. A. (2006). Impact of

Neurocognitive Function on Academic Difficulties in Pediatric Bipolar Disorder: A

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10.1016/j.biopsych.2006.03.027

Southammakosane, C., Danielyan, A., Welge, J., Blom, T., Adler, C., Chang, K., … Delbello, M.

(2013). Characteristics of the child behavior checklist in adolescents with depression

associated with bipolar disorder. Journal of Affective Disorders, 145(3), 405–408. doi:

10.1016/j.jad.2012.06.017