The History Behind Bipolar Disorder

The medical community has been talking about differences in mood since ancient times using different terms. As science’s understanding of bipolar disorder has evolved, so have the criteria for diagnosing and classifying bipolar disorders.

Ancient Greece and Rome

Greek philosopher and physician Hippocrates (460–337 BCE) was the first to describe differences in extreme moods. These were “melancholia” and “mania.”

Roman physician Caelius Aurelianus discussed two kinds of “mania,” which he attributed to the philosopher Plato.

From these early writings until the 1800s, “mania” and “melancholia” were discussed separately and not as part of a single condition.

Jean-Pierre Falret and Jules Baillarger (1800s)

In 1851, French psychiatrist Jean-Pierre Falret described “folie circulaire,” a condition that was a cycle of depression, mania, and time in between these two states.

At about the same time, neurologist Jules Baillarger described “folie à double forme,” shifting from mania to depression without an interval in between.

Although different from each other, these descriptions led to a widespread acceptance by the end of the 1800s of a cycling mood condition.

Karl Kahlbaum and Emil Kraepelin (1800s)

Psychiatrist Karl Kahlbaum was among the first to link symptoms and outcomes of people who had mood disorders. This was an early stage classification system.

Another psychiatrist, Emil Kraepelin, was the first to more definitively put a diagnostic name to differences in mood states like mania and depression.

Kraepelin called the conditions “dementia praecox” and “manic-depressive insanity,” now known as schizophrenia and bipolar disorder.

DSM-I (1952): Manic-depression

In the DSM-I, the now-called “manic depression” was under psychotic disorder. This first edition of the DSM identified three types:

• manic
• depressed
• other

The definition includes severe mood swings that tend to come back. The definition of “manic” in the DSM-I is similar to that in the DSM-5.

The “depressed” category is what the DSM-5 now calls major depressive disorder. The “other” category is the only one to mention mixed or cycling states.

DSM-II (1968): Manic-depressive illness

In the DSM-II, “manic depression” became “manic-depressive illness.” It was now categorized as an affective disorder, also known as a disorder of mood.

“Manic depression” in the DSM-II was of three types:

• manic
• depressed
• circular

It was characterized by mood swings that tended to recur.

In 1980, the third version of the DSM was released. In the DSM-III, the phrase “bipolar disorder” was introduced.

The DSM-III made several changes from the previous DSM versions, offering distinct criteria for manic and depressive episodes.

The DSM-III also distinguished between unipolar and bipolar depression for the first time, noting they are distinct conditions.

While earlier DSM versions had emphasized the recurring nature of episodes as a defining characteristic of manic-depressive illness, the DSM-III focused on the polarity of mood. In this classification, any mania indicates bipolar disorder.

According to recent research, bipolar disorder has a yearly prevalence of about 2.8%. The National Institutes of Health reports that about 4.4% of U.S. adults have bipolar disorder at some time in their lives.

Bipolar disorder is thought to affect all genders in equal numbers, but a 2021 meta-analysis found possible evidence of an increasing diagnosis of bipolar disorder in females.

The causes of bipolar disorder are unknown. Still, several factors might be linked to the condition, including:

• differences in brain structure
• family history
• genes

You may be more likely to have bipolar disorder if a close relative, such as a parent or sibling, is diagnosed with the condition.

But every person’s experience is different. Just because a parent has bipolar disorder does not mean their child will develop the condition.

Types of bipolar disorder

The current criteria for diagnosing bipolar disorders are in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

There are three diagnoses in the DSM-5:

• bipolar I disorder: diagnosed after one manic episode
• bipolar II disorder: diagnosed after one depressive episode and one hypomanic episode
• cyclothymic disorder: diagnosed after shifting between hypomania and depressive symptoms more frequently, and with less intensity, than in bipolar I or II disorders

To better understand the differences, it helps to know how the DSM-5 defines episodes.

• manic episode: period of at least 1 week of extreme highs or irritability, in addition to other behavioral changes
• hypomanic episode: less severe mania that need last at least 4 days
• major depressive episode: period of at least 2 weeks with a set number of specific depression symptoms

Bipolar disorders are treatable and can be managed with medication and talk therapy. Consider speaking with your doctor or a mental health professional to discover what best fits your needs.

As early as the ancient Greeks and Romans, scientists were beginning to identify mood states that are now part of the definition of bipolar disorders. Those included “melancholia” and “mania.”

As researchers learned more about these mood states, they further refined their definitions. It was not until the mid-1800s that a clinical picture that resembled present understanding was developed.

During the 20th century, the psychiatric community further refined its terminology and diagnostic criteria through editions of the DSM. It was not until the DSM-III in 1980 that the phrase “bipolar disorder” became official.

About 2% of people live with bipolar at any given time. More than 4% of people will experience bipolar disorder during their lifetime.

Bipolar disorders are treatable conditions managed with medication and talk therapy. To find support, you can visit Psych Central’s find help page.

You can also consider free online therapy if that better suits your needs.