Bipolar disease can run in families

Dear Dr. Roach: My husband’s brother and paternal uncle were both diagnosed with bipolar disorder. His uncle struggled miserably for decades before his death; his brother has been in and out of institutions and outpatient programs for years. Because of the pain this has caused to our family, my husband and I have both tried to learn as much about bipolar disorder as possible. One thing I’ve read repeatedly is that a person is born with bipolar tendencies, and that it can be treated but never cured.

All of this reading, as well as our family’s experience, makes me terrified that my husband will also someday become bipolar, and I watch maybe too closely for signs. Are there absolute alarm-bell signs that warrant a frank conversation?

W.S.

Answer: Bipolar disease is not uncommon, but is frequently missed as a diagnosis and occasionally diagnosed incorrectly in people who have a different condition. The necessary symptom to diagnose bipolar I disorder is mania. Mania, by definition, is an abnormally and persistently elevated, expansive or irritable mood, along with increased energy or goal-directed activity. The symptoms that go along with this include inflated self-esteem, decreased need for sleep, being more talkative than usual, racing thoughts, distractibility and excessive involvement in activities that can lead to painful consequences (overspending, sexual indiscretions, etc.).

That last symptom is certainly an absolute alarm-bell sign. Most of us have had some of those symptoms, but it’s the abnormal and persistent nature of them that alerts a clinician (or family member) to the possibility of bipolar disorder.

Bipolar II disorder is similar, but it is less intense and of less duration. In bipolar I, symptoms need to last at least a week, while four days are necessary with bipolar II.

Bipolar disease of any kind does run in families to some extent. A person who has a first-degree relative (sibling, parent or child) with bipolar, is estimated to have a 5% to 10% lifetime risk of being diagnosed with bipolar disorder.