ABSTRACT
As described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, bipolar disorder consists of alternating states of depression and hypomania. Depression is characterized among other symptoms by sadness, lethargy, pessimism, feelings of worthlessness, difficulty concentrating, and insomnia. Bipolar disorder usually presents in young adulthood, but may persist into old age. Community and population-based surveys indicate a marked decline in the prevalence of bipolar disorder in late life. With respect to treatment planning, this disinterest in change is likely to foster resistance to psychotherapy that will have to be addressed before any substantial progress can be made in treatment. Softening such resistance usually requires therapists to expand their patients’ frame of reference by causing them to examine events they had previously been able to ignore, to worry about how they should behave in situations they would previously have managed with aplomb, and to feel anxious and upset in circumstances where they would previously have remained calm and untroubled.
