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Bipolar Disorder

Bipolar disorder, previously known as manic depression, is a serious mental health condition characterised by extreme mood swings ranging from low mood (depression) to emotional highs (mania or hypomania). Such periods of depression or mania can last several weeks or longer, and dramatically impact relationships, work performance and daily functioning. It’s estimated that 1.5 to 3.5% of the UK population are diagnosed with bipolar disorder (NHS UK, 2017), with the World Health Organisation identifying bipolar disorder as the largest cause of loss of life and health amongst 15 to 44 year olds. Bipolar disorder is a life-long condition, affecting almost every aspect of one’s life and impacting the lives of family and friends.

Due to the nature of its symptoms, bipolar disorder is often misunderstood or misdiagnosed, particularly since the symptoms can also occur in other mental illnesses. It’s not so surprising, therefore, that the condition is also misunderstood by the general public. I’ve very often heard the term bipolar used very casually, as if anyone who’s slightly moody or having an ‘off’ week is branded bipolar. This is quite misleading since the illness is far more than the presence of mood swings and much more severe and debilitating. Several years ago, when I was still studying to become a psychotherapist, someone shared with me a personal story which gave me a deeper understanding of bipolar disorder and how it can impact anyone close to the individual suffering from it. This person shared with me how, throughout her childhood, her father would suddenly disappear for weeks on end. During this time he’d barely sleep or eat, gamble away the family’s savings and on one occasion even gave away the family car. As soon as she completed her O-Levels, Michelle (name changed for anonymity) went out to work to try to support her mother, who finally had to re-mortgage the house so she could support her husband’s reckless gambling and spending. Michelle’s father was eventually diagnosed with bipolar disorder and received the required treatment, but it was too late to reverse the damage caused to his wife and children.

In bipolar disorder, moods can swing from one extreme to another and are often so intense that they interfere with everyday life. Such patterns of mood swings vary widely between one person and another, with some people having only a couple of bipolar episodes in their lifetime, with others experiencing them frequently throughout their entire life. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania (similar to mania but less severe and without psychotic episodes).

Warning signs of bipolar disorder:


  • Reckless behaviour – increased spending, alcohol and drug consumption, risky sex
  • Not sleeping for extended periods
  • Rapid thoughts and speech
  • Increased use of phone – making contact with many people
  • Increased working hours
  • Grandiose, unrealistic plans
  • Full of energy
  • Not eating
  • Emotional intensity
  • Increased interest in religious/spiritual themes
  • Increased sex drive and sexual behaviour
  • Paranoid thoughts
  • Inability to concentrate


  • Change in sleep patterns
  • Increased irritability
  • Fatigue
  • Withdrawal
  • Decreased motivation
  • Loss of interest in usual activities
  • Suicidal thoughts
  • Change in eating habits
  • Decreased libido
  • Feelings of worthlessness and hopelessness
  • Paranoia

During periods of mania or depression, persons with bipolar disorder may experience psychosis, where they’re unable to differentiate between fantasy and reality. Such episodes may include hallucinations, wherein the person may see, hear, touch or smell things which are not real. They may also experience delusions, where they believe something which is not real. During a depressive phase, psychosis may cause the sufferer to believe they’ve committed a crime, are bankrupt, have lost family and friends, have a partner who is being unfaithful, have a terminal illness, have been abducted, and so on. During a ‘high’, the hallucinations and delusions take a different course, where someone suffering from bipolar disorder may believe they’re famous, have special powers, believe someone important is in love with them, have unique talents and other such grandiose beliefs. Some people may even enjoy the high of a manic episode, excited by how creative and productive they are during these periods. Sadly, however, a high is usually followed by a crashing low which counteracts any productiveness or creativity the person may have enjoyed.

So, what causes bipolar disorder?

A combination of different factors contribute to the onset of bipolar disorder, including:

  • Genetic factors
  • Brain chemistry
  • Childhood trauma
  • Stressful life events

Someone with a genetic predisposition for bipolar disorder may experience life events which trigger the illness. Such events may include sudden and drastic changes such as loss of a job, moving home, losing a loved one and so on. It may also be triggered in someone who experiences abuse and trauma at a young age. In some cases, substance abuse may bring on a depressive or manic episode. Cocaine, ecstacy and amphetamines can trigger mania, whilst tranquilisers and alcohol can trigger a depressive episode. Sleep deprivation can also trigger an episode, as can seasonal changes.

Diagnosis and Treatment

Bipolar disorder is often difficult to diagnose since its symptoms resemble those of other mental illnesses, such as schizophrenia or borderline personality disorder. Nevertheless, it’s important that anyone suspecting that they or a family member/friend has bipolar disorder, visit a doctor or mental health practitioner to be formally diagnosed and begin treatment. The aims of treatment would be to minimise the frequency of manic and depressive episodes and decrease the severity of symptoms. If left untreated, a manic or depressive episode could last up to a year, having a huge impact on one’s ability to maintain a job, live a healthy lifestyle and maintain stable relationships.

Treatment could include a combination of:

  • Medication
  • Psychotherapy
  • Cognitive Behaviour Therapy
  • Hospitalisation

Special care would also need to be taken to maintain a healthy lifestyle (i.e. eating healthily, maintaining a regular sleep pattern and exercising). Even when stable and not experiencing symptoms of bipolar disorder, treatment should be continued to reduce the chances of relapse. This includes taking prescribed medication and seeking support in the form of psychotherapy or counselling.  This would keep symptoms in check and reduce the chances of stressful life events triggering episodes. It would also help maintain stable, nourishing relationships which would go a long way towards providing the support needed to manage the illness.

Danjela Falzon - Malta therapy clinic

About Danjela Falzon

Danjela has been practising as a Psychotherapist since 2011, having read for a BSc in Psychology at Birkbeck, University of London, followed by a Masters in Gestalt Psychotherapy at GPTIM. She works therapeutically with individuals, adopting an approach which is warm and empathic, yet direct and challenging when necessary. She also works with groups, teaching mindfulness and providing support and guidance to reduce stress and anxiety.

TherapyPacks Terms and Conditions

1. TherapyPacks come in bundles of 5 or 10 sessions. Prices of bundles:

  • 5 sessions – €270 – must be utilised within 3 months from date of purchase
  • 10 sessions – €520 – must be utilised within 6 months from date of purchase

2. Bundles are not transferable. This means they cannot be used by, or gifted to, anyone else but the person whose name is listed as the TherapyPacks bundle holder.

3. Bundles which are purchased for Couples Therapy and Family Therapy can only be used by members of the couple or family with one therapist. If members of a couple or family decide to take up individual therapy with another therapist, the bundle will only apply to sessions with the therapist originally referred and cannot be also used for the individual sessions with another therapist. Exceptions will be made if the original therapist is unable to see the client or family and the couple or family are referred to another therapist. After referral, the same conditions will apply.

4. Bundles are valid for a limited time period, as listed above. This means that the bundles will expire once the respective time period has elapsed. Any sessions not utilised within this period will be lost. This means that a refund will not be given for unused sessions. Start date commences on date of purchase of bundles.

5. Bundles are only valid for full price sessions (charged at €60) and not for sessions with trainee psychotherapists, reports or assessments.

6. Full payment needs to be made on purchase, via bank transfer, cash or credit card.

7. Management reserves the right to terminate or suspend the use of the bundles. Reasons for such are at the discretion of the clinic.

8. Refunds or extensions of time period within which bundles may be used is at the discretion of management and will only be granted in exceptional circumstances.

9. Management reserves the right to modify or replace the terms and conditions. In such circumstances, clients will be given adequate notice and time to adhere to such.

10. The clinic’s cancellation policy is applicable also to bundles. Late cancellations or no shows will result in the forfeit of a session within the bundle allocation.

11. Responsibility for ensuring timely use of session bundles remains that of the TherapyPacks bundle holder or, in the case of a minor, their carer/legal guardian.