Bipolar disorder

Symptoms of Bipolar Disorder

Bipolar disorder manifests mainly through episodes of mania, hypomania, and depression.

• Manic phase: characterized by euphoria, excessive energy, reduced need for sleep, increased talkativeness, accelerated thoughts, impulsive behavior and sometimes grandiosity. In some cases, psychotic symptoms such as delusions and hallucinations may occur.
• Hypomanic phase: similar to mania but of less intensity, with no obvious psychotic symptoms and less functional impact.
• Depressive phase: characterized by sad or irritable mood, loss of interest in daily activities, fatigue, changes in sleep and appetite, feelings of guilt and worthlessness, difficulty concentrating, and, in severe cases, suicidal thoughts.

The alternation between these emotional states can be cyclical and varies from person to person, with episodes of different duration and intensity.

Psychoanalytic origins of bipolar disorder

Classical psychoanalysis, with Freud, emphasized the conflict between the pleasure principle and the reality principle, while later authors such as Melanie Klein and Otto Kernberg explored the role of early object relations experiences in the genesis of affective oscillations. In particular, Klein identified the schizoparanoid position and the depressive position as key moments in psychic development, hypothesizing that in bipolar disorder there is an inability to stabilize in the depressive position, resulting in oscillations between idealization and devaluation.

Mania and depression: two sides of the same coin

From a psychoanalytic perspective, the manic phase can be seen as a defense against the psychic pain and sense of loss characteristic of depression. The grandiosity and hyperactivity typical of mania represent an attempt to deny feelings of helplessness and despair. Freud, in his paper on “Mourning and Melancholy” (1917), suggests that mania may be a reaction to depression, a kind of escape from suffering related to a lost love object.

Similarly, the depressive phase can be interpreted as a return of the psychic reality removed during mania. The individual, no longer able to sustain the denial of loss and internal fragility, falls into a state of self-denial and passivity. According to the Kernberg school, bipolar disorder could result from a failed integration of representations of self and others, with a split between idealized and persecutory images.

Defense mechanisms and personality organization

In patients with bipolar disorder, the predominant defense mechanisms include splitting, denial and omnipotence. Splitting prevents the integration of conflicting affects, causing the patient to oscillate between extreme emotional states. Denial allows the patient to avoid confronting feelings of loss and vulnerability, while omnipotence is a strategy for maintaining a sense of control and security.

Psychoanalytic treatment of bipolar disorder

Bipolar disorder is usually treated through a combination of mood stabilizer use and psychotherapy. Psychoanalysis can make a significant contribution. Conflict and defense analysis can help patients understand the meaning of their affective oscillations and develop a greater ability to tolerate emotional ambivalence.

A targeted psychoanalytic approach can facilitate the processing of early traumatic experiences and improve the integration of split parts of the personality. The goal is not only symptom reduction, but a deeper transformation of the psychic structure, allowing for greater affective stability and better emotion regulation.