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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人们产生很多成见的疾病。
We think of mood swings.
我们想到情绪波动。
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.
想象一段深度抑郁和狂躁的时期，一个疯狂的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如何界定双相情感障碍，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. It might even help treat more people.
但他们对此不确定可能也没什么，这样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中分为几种亚型。
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.
有双相情感障碍一型，当我们想到双相情感障碍时，最可能想到的就是这种。
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高涨或恼怒，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,
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，
not need to sleep as much, or experience what's known as a "flight of ideas," which is basically a racing mind.
有一种宏伟的目标感，不需要睡很多觉，或者是体验到所谓的“思维奔逸”，这基本上是一种快速的思维。
The most notable feature of bipolar II, on the other hand, are the periods of major depression.
另一方面，双相情感障碍二型最显著的特征是重度忧郁。
Patients also experience periods of hypomania, which is a less extreme version of a manic episode.
病人也会经历轻躁期，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.
这种亚型被称为循环性情感疾病，一个人至少经历两年的抑郁和躁狂症状，但没有严重的抑郁或躁狂发作。
For kids, it's one year.
对于儿童来说，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”，这听起来相当模糊。
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.
但就是这样设定的，患有躁郁症患者，如果不符合其他三种症状的全部标准，就可以被归为此类。
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的方法，但可以通过治疗和服用稳定情绪药物来进行控制。
It's also not totally clear what causes it, but there may be genetic factors involved.
目前也不完全清楚其起因，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%的人口患有一型双相情感障碍，1%患有二型双相情感障碍，且估计还有约5%的患者为比较温和的亚型。
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,
根据2013年的一项研究，仅有20%的双相情感障碍患者在寻求治疗的第一年被诊断为患有双相情感障碍，
and the average delay between onset and diagnosis is five to ten years!
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.
双相情感障碍一型比较容易识别，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，双相情感障碍二型却很难与重度抑郁症区分开。
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，轻躁症可能只是感觉良好或正常的一天。
Researchers say that it's definitely possible that depressive patients who don't respond to antidepressants could actually have bipolar II.
研究人员表示，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二型。
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变为躁狂症。
And things only get more complicated from there.
情况只会变得更复杂。
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会有混合性情绪发作，即轻躁、抑郁和/或躁狂混合在一起。
And that's weird and confusing, for patients and researchers alike,
这对病人和研究人员来说都很奇怪，并会让他们感到混乱，
because it basically flies in the face of the idea of bipolar as a disorder characterized by discrete episodes.
因为它基本上违背了双相情感障碍是一种以离散型发作为特征的疾病的观点。
There are also people who just experience hypomania, without any of the depression.
也有人只是经历了轻躁狂，却没有任何抑郁表现。
And they often kinda like it! They say it makes them super productive.
他们经常喜欢这样！他们说这会让他们超有效率。
A large clinical study published in 2011 has also suggested that hypomanic and manic episodes
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
can be shorter than the widely-accepted four and seven days that are now used as cut-offs in the DSM-5.
可能比广泛接受的4天和7天短，这个时间目前用作DSM-5的临界值。
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，这些较短的发作时间仍然有效。
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渐进性的，尽管没有足够的证据可以肯定。
All of this has led researchers to talk about bipolar disorder as a spectrum.
所有这些都使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.
该观点认为，人们可以表现出各种各样的轻度亚变异，因此许多人的病情可能未被辨识出来。
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，甚至在过去的十年里，一些研究人员已经推翻了这个想法。
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”类别是哪些呢？
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种患者。
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“持续时间短的轻躁狂抑郁发作”是一种需要进一步研究的疾病。
Researchers have also called for additional research to pinpoint genetic or biomarkers
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。
that can help identify those with disorders on the bipolar spectrum with something more concrete than just the usual behavioral criteria.
这些标记物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而对他们分类的。
They're about helping people to get the best treatment,
他们的目的是帮助人们得到最好的治疗，
and about making sure diagnoses are as accurate as possible to make future studies and future treatments more reliable.
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DSM-5就是为了适应这种情况而设计出来的。
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相情感谱系。
Thanks for watching this episode of SciShow Psych, which was brought to you with the help of our Patreon supporters.
感谢收看本集《心理科学秀》，我们是在Patreon支持者的帮助下把它制作出来的。
Patrons get access to some pretty cool perks, including the satisfaction of helping to bring awesome science videos to the whole Internet.
用户在Patrons上能享受到一些超酷的优惠，包括帮助将令人惊叹的科学视频带到整个互联网上而获得的满足感。
If that sounds like your jam, head over to patreon.com/scishow.
如果这听起来让你感兴趣的话，那就去patreon.com/scishow看看吧。
