Bipolar Disorder Simplified: Light, Sleep and Perfectionism
Bipolar disorder affects more than 13 million Americans and over 170 million people around the world. New research confirms this disorder may be a lot simpler than one might think.
A diagnosed case of bipolar disease is typically symptomized by alternating manic and depressive states. The more frequent the alternation and the more elevated the highs and lows are, the more severe the case. And a manic or depressive state that lasts more than seven days is considered diagnosable as Bipolar Disorder I according to the National Institute of Mental Health.
Research two years ago found that the U.S. had the world’s highest rates of bipolar disease, at 4.4% of the population, while the 2.4% of the world’s population had bipolar disease. That’s a lot of folks.
Meanwhile, India has the lowest rates with 0.1% of the population. Not so much.
Many might say it is an issue of diagnosis – as doctors in the U.S. may be looking out for the symptoms, and the access to healthcare may be better.
These may be true, but two new studies reveal there may well be other, more simpler reasons.
Bipolar disorder and circadian rhythms
The first study comes from France’s INSERM (French Institute of Health and Medical Research), where researchers studied 25 people with bipolar disorder and 28 healthy people. The subjects underwent sleep studies and actigraphy – the monitoring of sleep and activity cycles.
The researchers also analyzed the patients for the existence of a particular genetic sequence called the ASMT variant, which appears linked with a lack of melatonin production.
The researchers found that those with bipolar disorder tended to have dramatically different circadian cycles with respect to waking and sleeping patterns.
This confirms previous research that has found bipolar disorder related to a disorganized circadian cycle as it relates to the body’s normal response to light.
The acetylserotonin O-methyltransferase (or ASMT) gene is involved in this process, as it oversees to production of two enzymes need to produce melatonin in the body.
Because this gene is related to light exposure, it is apparent that bipolar disorder may be a byproduct of a lack of regulated sun exposure, either on the part of the subject or their parents.
This reality is backed up by numerous studies linking bipolar disorder with dysfunctional sleep cycles. This was confirmed in another INSERM review of research. When the circadian rhythms are off, melatonin production is altered. And significant alteration over time has an epigenetic effect upon certain alleles.
This also ties in with part of the reason Americans have such dramatically high rates of bipolar disorder. Americans spend much of their lives indoors, as opposed to other countries that work out of doors and spend more time out of doors.
Bipolar disorder and perfectionism
Another finding that has been been gaining acceptance among researchers is the fact that bipolar disorder is related to anxiety and stress regarding expectations of perfectionism.
A notable recent study on this aspect of bipolar disease and perfectionism comes from researchers from the University of New South Wales’ School of Psychiatry, who studied 142 patients diagnosed with bipolar disorder.
The researchers conducted extensive questionnaires and interviews with patients, in order to determine if there was any relationship between their bipolar disorder and a tendency to be self-critical and perfectionistic.
The idea is not new. Several years of research has accumulated evidence that bipolar disorder is related to a person’s levels of stress – in conjunction with an expectation of perfection by the subject.
This notion of the stress of having to be perfect pervades our materialistic society, as so many of us feel the pressure to succeed, and this pressure translates to significant stress and anxiety leading to highs and lows.
And this is precisely what the researchers found in their study. The researchers stated in their results:
“Stress and anxiety both significantly mediated the relationship between both self-critical perfectionism and goal attainment values and bipolar depressive symptoms.”
This is not the first study that has found this among bipolar patients. In a study from the University of Massachusetts, 337 college students were followed. The study found that those with over-bearing parents had a tendency of feeling anxious regarding an expectation of perfectionism. The researchers stated:
“In general, harsh and authoritarian parenting styles were related to maladaptive, but not adaptive, components of perfectionism in Caucasian-American men and women and Asian-American women.”
Currently most bipolar disorder patients are treated with psychoactive medications. These include lithium, Valproic acid, Lamotrigine, gabapentin, oxcarbazepine and others. These come with a host of side effects, including dizziness, nausea, headaches, heartburn and other. Some of these drugs also produce, believe it or not, mood swings.
Looking at these basic environmental issues as they relate to bipolar disease indicate simple solutions that relate to light entrainment and behavior therapy and better parenting may provide greater changes of improvement. As stated by the University of New South Wales researchers:
“Targeting self-critical perfectionism in the psychological treatment of bipolar disorder when there is anxiety comorbidity may result in more parsimonious treatments.”
So we have two potential reasons why the U.S. ranks so high for bipolar disorder while India ranks so low. The pressure to succeed combined with a lack of outdoor light exposure.
These can be summed up with one word that many of us have forgotten how to do: Play.
Geoffroy PA, Boudebesse C, Henrion A, Jamain S, Henry C, Leboyer M, Bellivier F, Etain B. An ASMT variant associated with bipolar disorder influences sleep and circadian rhythms: a pilot study(1.). Genes Brain Behav. 2013 Nov 11. doi: 10.1111/gbb.12103.
Boudebesse C, Henry C. [Emotional hyper-reactivity and sleep disturbances in remitted patients with bipolar disorders]. Encephale. 2012 Dec;38 Suppl 4:S173-8. doi: 10.1016/S0013-7006(12)70096-9.
Corry J, Green M, Roberts G, Frankland A, Wright A, Lau P, Loo C, Breakspear M, Mitchell PB. Anxiety, stress and perfectionism in bipolar disorder. J Affect Disord. 2013 Dec;151(3):1016-24. doi: 10.1016/j.jad.2013.08.029.
Hewitt PL, Flett GL. Perfectionism and stress processes in psychopathology. (Perfectionism: Theory, Research and Treatment) American Psychological Association, Wash., 2002.
Kawamura KY, Frost RO, Harmatz MG. The relationship to perceived parenting styles to perfectionism. Personality and Individual Differences. 2002;32:317–327.
Gardner A. U.S. has highest bipolar rate in 11-nation study. CNN Health. http://www.cnn.com/2011/HEALTH/03/07/US.highest.bipolar.rates. Acc. Dec. 10, 2013.