Understanding the experience of mood change and early intervention for people diagnosed with bipolar disorder

Bipolar Disorder (BD) is a chronic, severe mental illness characterised by recurring mood episodes of depression, mania or hypomania, interspersed with periods of euthymia (stability). Episode change is a core aspect of living with BD yet qualitative findings in this area derive from a cross-sectional approach that highlights the impact of living with BD episodes rather than the experience and process of mood change itself. No study has examined what it is like to experience successive mood states over time. Nor has any work explored the experience of first BD mood episode and early intervention services, despite their recognised potential to improve outcomes. This thesis explores the experience of mood change and early intervention for people diagnosed with BD. Two empirical studies are presented, using Interpretative Phenomenological Analysis. The first study uses a longitudinal approach to explore the experience of three women during BD moods and euthymia. Idiographic trajectories reveal the participants' changing sense of disconnection with self, other people and their environment, along with an ongoing struggle for self-coherency. BD moods are shown to create significant changes in agency, felt connection, temporality and relational balance, leading to confusion and shame. In the second study, eleven young people are interviewed about their experience of first-episode psychotic BD and NHS early intervention services. Dramatic changes in their sense of interpersonal control during first episode are illustrated and the benefit of existing early intervention provision is highlighted. However, findings also illustrate a complex tension between self-renewal, compromise and risk of relapse during their journey. Mood change for people with BD is suggested to be all-encompassing and cumulative, creating identity loss and ongoing incoherency during both early and late stages of the illness. The value of existing early intervention provision is illustrated and possibilities for tailoring services to people in this group are proposed.