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Like many psychological disorders, bipolar disorder is one for which we have a lot of stereotypes.
像许多心理障碍一样，双相情感障碍是一种让我们存在很多成见的疾病。
We think of mood swings.
我们会想到情绪波动。
We imagine periods of deep depression and episodes of mania where a frenzied person thinks they're invincible or is all-consumed by their desire to achieve a goal.
我们想象一段深度抑郁和狂躁的时期，一个狂暴之人认为他们是不可战胜的，或者被他们实现目标的欲望所吞噬。
Popular media only reinforces these stereotypes, to the point where a lot of us probably don't have a very clear idea of what bipolar disorder is actually like.
大众媒体只会强化这些刻板印象，以至于我们很多人可能对双相情感障碍的实际情况并没有很清楚的认识。
And like a lot of psychological disorders, bipolar disorder is much more complicated than we give it credit for.
和许多心理障碍一样，双相情感障碍比我们认为的要复杂得多。
Even psychologists continue to argue about how to define bipolar disorder—and whether it might be more of a spectrum than we used to think it was.
就连心理学家也在继续争论，该如何定义双相情感障碍，以及它是否比我们过去认为的更为复杂。
But it might be ok that they're not sure.
但他们可能不确定。
It might even help treat more people.
它甚至可以帮助治疗更多的人。
Bipolar disorder is divided into several subtypes in the DSM-5.
双相情感障碍在DSM-5中分为几个亚型。
That's the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which sets out the criteria used in the US for diagnosing people with psychological disorders.
这是《精神障碍诊断与统计手册》的第五版，该手册规定了美国用于诊断精神障碍患者的标准。
There's bipolar I, which is the type we're most likely to think of when we think of bipolar disorder.
其中包括双相情感障碍I，当我们想到双相情感障碍时，很可能会想到这种类型。
A person has to have at least one manic episode—in which they experience at least a week of their mood being abnormally elevated or irritated—to be diagnosed with bipolar one.
一个人至少要经历一次躁狂发作，其中他们至少要经历一周的情绪异常升高或恼怒，才能被诊断为躁郁症。
During a manic episode, they might be obsessed with working towards a particular goal, have a grandiose sense of purpose, not need to sleep as much, or experience what's known as a "flight of ideas," which is basically a racing mind.
在狂躁的一段时间里，他们可能会沉迷于朝着某个特定的目标努力，有一种宏伟的目标感，不需要花很多时间睡觉，或者体验所谓的“思维奔逸”，基本上来说，就是一种快速的思维。
The most notable feature of bipolar II, on the other hand, are the periods of major depression.
另一方面，双相情感障碍II最显著的特征是重度抑郁症。
Patients also experience periods of hypomania, which is a less extreme version of a manic episode.
病人也会经历轻度躁狂，这是一个不太极端的躁狂发作。
With the subtype known as cyclothymic disorder, a person experiences at least two years of depressive and hypomanic symptoms, but no major depressive or manic episodes.
这种亚型被称为胸腺疾病，一个人至少经历了两年的抑郁和躁狂症状，但没有严重抑郁或躁狂发作。
For kids, it's one year.
对孩子来说，是一年。
And the last subtype in the DSM-5 is "other unspecified bipolar and related disorders," which sounds… pretty vague.
DSM-5中的最后一个亚型是“其他未指明的躁郁症和相关疾病”，听起来相当模糊。
But that's by design. This is where people with bipolar-ish symptoms that don't meet the full criteria of any of the other three can be categorized.
但这是设计出来的，患有躁郁症的人，如果不符合其他三种症状的全部标准，就可以被归为这一类。
There's no cure for bipolar disorder, but it can be manageable with therapy and mood-stabilizing medication.
双相情感障碍没有治愈方法，但可以通过治疗和情绪稳定药物来控制。
It's also not totally clear what causes it, but there may be genetic factors involved.
目前也不完全清楚，它的病因，但可能与遗传因素有关。
About 1% of the population has bipolar I, another 1% has bipolar II, and approximately 5% are estimated to have a milder subtype.
大约1%的人群患有双相情感障碍I，另外1%患有双相情感障碍II，估计约5%的人患有症状较轻微的亚型。
All that said, bipolar disorder is actually really tricky to diagnose.
尽管如此，双相情感障碍实际上很难诊断。
According to a 2013 study, only 20% of bipolar patients are diagnosed with a form of bipolar in the first year of seeking treatment, and the average delay between onset and diagnosis is five to ten years!
根据2013年的一项研究，只有20%的双相情感障碍患者在寻求治疗的第一年就被诊断为双相情感障碍，而且从发病到确诊的平均延迟时间是5到10年！
Bipolar I is easier to recognize, because the patient is usually experiencing a manic episode when they seek diagnosis.
双相情感障碍I比较容易识别，因为患者在寻求诊断时通常会经历躁狂发作。
But bipolar II can be really difficult to tell apart from major depressive disorder.
但是，双相情感障碍II很难与重度忧郁症区分开来。
The difference usually comes down to whether or not the patient has a history of hypomania… but for someone who's often depressed, hypomania just might feel like a good or normal day.
区别通常在于患者是否有轻躁症病史，但对于经常抑郁的人来说，轻躁狂可能只是感觉良好或感觉正常的一天。
Researchers say that it's definitely possible that depressive patients who don't respond to antidepressants could actually have bipolar II.
研究人员说，毫无疑问，那些对抗抑郁药没有反应的抑郁症患者可能患有双相情感障碍II。
And that could be really bad, because taking antidepressants without mood stabilizers can cause someone with bipolar disorder to switch to mania.
这可能真的很糟糕，因为服用不含情绪稳定剂的抗抑郁药会导致双相情感障碍患者转化为躁狂症。
And things only get more complicated from there.
事情只会变得更复杂。
Some people with bipolar disorder have mixed mood episodes, which are when hypomania, depression, and/or mania get all smushed together.
一些患有双相情感障碍的人出现混合性情绪发作，即轻躁、抑郁和/或躁狂混杂在一起。
And that's weird and confusing, for patients and researchers alike, because it basically flies in the face of the idea of bipolar as a disorder characterized by discrete episodes.
病人和研究人员对此感到奇怪又混乱，因为它基本上违背了这样一种观点，即双相情感障碍是一种以离散事件为特征的疾病。
There are also people who just experience hypomania, without any of the depression.
也有人只是出现了轻躁，却没有任何抑郁表现。
And they often kinda like it! They say it makes them super productive.
他们经常是这样！他们说，这让他们超有效率。
A large clinical study published in 2011 has also suggested that hypomanic and manic episodes can be shorter than the widely-accepted four and seven days that are now used as cut-offs in the DSM-5.
2011年发表的一项大型临床研究也表明，轻度躁狂和躁狂发作的时间可能比DSM-5中所写的人们广泛接受的4天和7天要短。
These shorter episodes, the researchers argued, should still count when trying to decide if someone has bipolar disorder.
研究人员认为，在试图判断一个人是否患有双相情感障碍时，这些较短的发作仍应计算在内。
And some researchers even believe that bipolar disorder can be progressive, although there's definitely not enough evidence to say for sure.
一些研究者甚至相信，双相情感障碍是可以渐进发展的，尽管没有足够的证据可以加以肯定。
All of this has led researchers to talk about bipolar disorder as a spectrum.
所有这些都让研究人员把双相情感障碍作为一个谱系来讨论。
The idea is that people can present with a wide variety of mild subvariants—and that many people's conditions might therefore have gone unrecognized.
这个想法是，人们可以呈现出各种各样的轻度亚变异，因此许多人的病情无法被辨识。
And there's a lot of support for that way of thinking!
很多人支持这种想法！
But… even within the last decade, some researchers have pushed back on this idea.
但是，甚至在过去的十年间，一些研究人员已经将这种想法推倒了。
Some psychologists still advise a more conservative approach, to prevent overdiagnosis in the future.
一些心理学家仍然建议采取更为保守的方法，以防止将来出现过度诊断。
The good news is that the DSM-5 leaves room for us to keep figuring this stuff out.
好消息是DSM-5给我们留下了继续解决这个问题的空间。
That "other unspecified bipolar and related disorders" category we mentioned?
我们提到的“其他未指明的双相情感障碍和相关疾病”的类别？
It allows clinicians to continue to identify and diagnose patients who have subvariants that don't meet traditional thresholds.
它允许临床医生继续识别和诊断那些不符合传统阈值的亚变异患者。
And the DSM-5 specifically calls out "depressive episodes with short-duration hypomania" as a condition that should be studied further.
DSM-5特别指出，“持续时间短的低躁狂抑郁发作”是一个需要进一步研究的病症。
Researchers have also called for additional research to pinpoint genetic or biomarkers that can help identify those with disorders on the bipolar spectrum with something more concrete than just the usual behavioral criteria.
研究人员还呼吁开展更多的研究，以确定基因或生物标记物，这些可以帮助人们用比通常的行为标准更具体的东西来识别双相情感障碍患者。
Ultimately, formal psychiatric diagnoses aren't about categorizing people for the sake of categorizing them.
最终，正式的精神病诊断并不是为了对患者进行分类才分类的。
They're about helping people to get the best treatment, and about making sure diagnoses are as accurate as possible to make future studies and future treatments more reliable.
其目的是帮助人们获得最好的治疗，确保诊断尽可能准确，使未来的研究和治疗更加可靠。
So while the definitions of bipolar disorder are still slippery... the DSM-5 is designed to accommodate that.
所以，虽然双相情感障碍的定义仍然很模糊，但是，DSM-5就是为了适应这种情况而设计的。
And hopefully, as a result, we'll someday understand bipolar disorders and the bipolar spectrum better than we do today.
希望有一天，我们能比今天更好地理解双相情感障碍和双极症谱系。
Thanks for watching this episode of SciShow Psych, which was brought to you with the help of our Patreon supporters.
感谢收看这一集的《心理科学秀》，它是在Patreon支持者的帮助下呈现给你们的。
Patrons get access to some pretty cool perks, including the satisfaction of helping to bring awesome science videos to the whole Internet.
Patreon可以提供一些超酷的好物给你们，包括帮助将令人惊叹的科学视频传遍整个互联网。
If that sounds like your jam, head over to patreon.com/scishow.
如果这听上去对你的胃口，那就快去patreon.com/scishow看看吧。
