Depression. Eating disorders. Anxiety. It’s hard to escape the ugly truth that mental illness is a major health concern on college campuses across the nation. In a survey conducted by Her Campus of 92 undergraduates from various universities, 71% reported knowing someone who has been diagnosed with a mental illness while in college. In addition, 70% believe that mental health issues are prevalent among their student body. Despite heightened awareness of the most commonly diagnosed disorders, like depression or anorexia, a significant but lesser known illness escapes the mental health education of many collegiettes: bipolar disorder.
The National Institute of Mental Health asserts that bipolar disorder is most often diagnosed in college-age individuals. Only 2.3 million Americans are diagnosed bipolar patients, but the peak age of onset of the disorder is 18-22. Moreover, the number of college students being diagnosed with bipolar disorder has increased in recent years, says Nilda Hernandez, Ph.D., former Associate Professor of the Social Work Department at the College of New Rochelle. Bipolar disorder may seem complicated or scary, but it’s more relevant to college students now than ever before.
What is Bipolar Disorder?
Bipolar disorder is “a psychiatric illness in which a person has abnormal moods reflecting two opposite poles: depression on the one hand, and mania, a state of abnormally elevated energy, on the other,” says Dr. Richard Kadison, Chief of Mental Health Services at Harvard University, in his book, College of the Overwhelmed. Bipolar disorder is a type of depression, but unlike in major “unipolar” depression, bipolar individuals alternate between extreme emotional highs and lows. They sometimes have “episodes,” heightened periods of depression or mania lasting more than a week but behave normally in between episodes.
"You could say that a bipolar person cycles through emotional highs and lows faster than the mood swings of an average person,” says Roy Stefanik, DO, assistant professor in the Department of Psychiatry at the Georgetown University School of Medicine. “In addition, the amplitude of their highs and lows is much greater than that of a normal individual.”
You’ve probably heard about the severe feelings of hopelessness, fatigue, and anxiety that characterize depression, but many people are unfamiliar with mania, the other component of bipolar disorder. Dr. Hernandez explains that a manic episode can consist of any of the following symptoms:
- Racing thoughts
- Rapid speech
- Impulsive behavior
- Inflated self-esteem
- Trouble focusing
- Difficulty Functioning
“For college students, mania can translate to staying out all night partying, shopping sprees, gambling, promiscuity, or lawbreaking,” says Dr. Stefanik. Of course, impulsive behavior takes on a different meaning from person to person, and risky behavior is all too common at wild college parties, but when a person’s judgment is clearly impaired or they are doing something they wouldn’t normally, it could be considered a manic episode.
An early sign of bipolar disorder is a drastic change in sleep schedule, which indicates that a person is having their first, mild manic episode. The episode usually consists of getting very little sleep, from two to three hours a night, over the course of several days. Unlike the all-nighters you may be forced to pull because of a big exam or project every once in a while, these sleepless episodes occur without motivation and do not leave the person feeling especially impaired during the day.
In the majority of patients, however, bipolar first becomes evident through an episode of depression. “The typical patient comes to the counseling center because their initial symptoms look like major depression,” says Dr. Stefanik. In fact, the National Institute of Mental Health indicates that bipolar women are more likely to experience an initial depressive episode than a manic episode.
Once triggered, bipolar disorder is a lifelong illness. Genetics largely influence the development of bipolar disorder, so if members of your family are bipolar, you are much more likely to develop the mental illness, Dr. Stefanik says. He adds that roughly half of all people diagnosed with bipolar disorder are female; collegiettes and their male counterparts are equally likely to be bipolar.
After the disorder develops, it can take on a diverse range of episodic patterns. Due to the unpredictable nature of the illness, it can be can be difficult to distinguish between major depression and bipolar disorder. For this reason, Dr. Stefanik notes that it takes an average of five years after an initial psychiatric consultation to diagnose someone as bipolar. However, once diagnosed, bipolar disorder can be treated and managed effectively.
Why Bipolar Disorder is Linked with College
Only two percent of HC survey respondents perceived that bipolar disorder was likely to be diagnosed in college students, yet in actuality, half of all cases develop in young adults before age 25, and most bipolar individuals experience their first episode in their late teens or early twenties, according to research by the National Institute of Mental Health.
The early age of onset may be linked to the high rate of depression diagnosis among college students. In College of the Overwhelmed, Dr. Kadison asserts that students who display depression symptoms are treated with antidepressants, but antidepressant medication can trigger an initial manic episode in those who are genetically predisposed to bipolar disorder. Because college mental health services provide people in their late teens and early twenties with access to treatment they might not have had otherwise, bipolar disorder may be triggered in certain college students who seem to have major depression.
For students whose bipolar disorder has already developed, but has been misdiagnosed as depression, “depression medication makes bipolar disorder worse,” Dr. Stefanik says. He adds that antidepressants can contribute to the Kindling Effect, in which the mood swing cycle of bipolar disorder accelerates to a severe degree.
Finally, the high stress associated with the college years contributes to the onset of bipolar disorder, as it does for most other mental illnesses. “Many college students feel stress and anxiety about adjusting to newfound independence,” says Dr. Hernandez, with stressors including “lack of sleep, poor eating habits, increased pressure to excel academically, financial worries, and their relationships with significant others, roommates, peers, and faculty.” She notes that college life does not necessarily trigger disorders like bipolar, but the anxiety associated with college may lead to symptoms which could, in turn, develop into serious mental illness.
Treatment: What to Expect
Students who are experiencing depressive and/or manic symptoms should visit their university’s mental health counseling center or see a private psychiatrist, says Dr. Hernandez.
Most treatments for bipolar disorder target its symptoms. One highly prescribed treatment for bipolar disorder is lithium medication, which, when taken long-term, can reduce both manic and depressive episodes. Therapy is ineffective during manic episodes, but long-term treatment has overall positive effects. “The lifelong outcome is highly valuable,” Dr. Stefanik says. Once treated, some individuals are able to limit their mania to a single episode during their lifetime, although others may experience chronic depressive and manic symptoms.
In addition to medication, bipolar treatment involves educating the patient and developing their ability to cope with the symptoms. When it comes to dealing with the lingering stigma that your family or college community may have about serious mental illness, “one factor is how well the student understands her disorder, treatment and prognosis, as well as how well the student copes with the reactions of others,” Dr. Hernandez says. The more educated you are about your illness or that of a friend, the less scary it becomes, allowing you to focus on positive aspects like the benefits of treatment.
Finally, loved ones are an important component of the treatment process. “When a college student is diagnosed as bipolar, it’s helpful to bring in their family or other close people as part of the treatment,” says Dr. Stefanik. “It could be helpful to bring them in for meeting with counselor, talk about what happened leading up to when the disorder was triggered, and provide them with resources to educate them.”
The vast majority of bipolar college students are able to continue with classes and extracurricular commitments after being diagnosed. “I think they can have a very good college life,” Dr. Stefanik says, “If they do the things that they need to take care of themselves, and identify early on that they’re having problems.” For bipolar students who are seeking treatment and supported by friends or family on campus and at home, a normal college experience is definitely attainable.
College of the Overwhelmed, by Dr. Richard Kadison, Chief of Mental Health Services at Harvard University
National Institute of Mental Health
Nilda Hernandez, Ph.D., former Associate Professor of the Social Work Department at the College of New Rochelle
Roy Stefanik, DO, assistant professor in the Department of Psychiatry at the Georgetown University School of Medicine