Sunday, April 24, 2011

You are (probably) not bipolar!

The word "bipolar" has now entered the vocabulary of the average 17 year old American. On the street, the word is used to describe someone who has intense, unpredictable mood swings, as in "Ever since my boyfriend broke up with me, I have been so bipolar. I am fine one moment and then I just feel like crying." 

When a word becomes slang its original meaning gets watered down (see, "awesome," "pimp," and "rock star"). This is well and good. The problem here is that the loose definition of this word on the street mirrors the loose definition of the word in the psychiatric world. And that is a problem.

Here is the full DSM-IV criteria for bipolar disorder. For the record, in this post, I am talking about bipolar 1 disorder which involves full-blown manic episodes, not bipolar II disorder which involves hypo-manic (meaning smaller manic), episodes.

As the name implies, bi-polar disorder, which used to be called manic-depression, involves two poles - mania and depression. Technically, you don't actually have to have depression to be bi-polar but most people with bi-polar have both. 

Most people know more or less what depression looks like, but most people have not seen full-on mania. Therefore I will try to describe it:

A manic episode is essentially a huge increase of energy in the person's system. It is not subtle. It differs from a normal mood swing because a. it is much more intense and b. It lasts at least a week and without meds can go on for weeks before it peters out.

Because of all this energy the person experiencing the episode may:

  1. 1. need much less sleep than normal. (While this is not a requirement for a manic episode, I have not seen a case where this was not true.) This is different from insomnia. With insomnia a person wants to sleep, and feels crappy because they cannot. With a manic episode, the person doesn't need to sleep as much as normal and still has plenty of energy.
  2. talk a mile a minute, as if their words cannot catch up to the speed of their thoughts and this is exactly what is happening. Sometimes their speech is not pressured but their thoughts are still moving too fast for the person to follow them.
  3.  be super distracted, again due to the speed of their thoughts. 
  4. experience a massive increase in their sense of self-importance. At one end of the spectrum this looks as if the person suddenly becomes as confident as the Situation on Jersey Shore and at the other end, the person truly believes they are like Jesus or Neo, blessed with special powers and here to save other people.
  5. loose inhibition and do things they normally wouldn't such as go on gambling, sex, or shopping sprees.
  6. work single-mindedly and with great intensity on a project. Sometimes the person can make progress (it is likely that some great works of art have been created during manic episodes). Other times, the person is just too disorganized to make anything other than a mess.
  7. feel either GREAT or very irritable
  8. become psychotic (losing touch with reality) and think all number of crazy things such as they are the savior, people are out to get them, they have special powers, ect.
Some of these symptoms can be caused by problems other than bi-polar disorder. For a psychiatrist or a therapist, it can be hard when taking someone's history to sus out whether the person truly has bi-polar disorder. What sounds like bi-polar disorder can actually be a history of drug abuse, particularly cocaine or meth abuse. The drama that surrounds the life of someone with borderline personality disorder can also look like bi-polar disorder.

Another way people get misdiagnosed with bipolar disorder is that they are helped by mood stabilizers, the class of medication used to treat bi-polar disorder, even though they are not bi-polar. Here is what I have seen happen: A client gives a murky history to their overworked psychiatrist and in the history it sounds like their could be symptoms of bi-polar disorder. The psychiatrist wants to treat with a mood stabilizer and so diagnoses the patient with bi-polar disorder.

Diagnoses in general, including misdiagnoses, tend to follow the client. Other clinicians will see the diagnosis and unless they are really on the ball, they will just keep the diagnosis already in place. 

The primary treatment for bipolar disorder is medicine. The person will be told to take their meds or risk having another episode. They will be told to watch for red flags that they are getting manic, and if they notice red flags, to call their psychiatrist to up their meds. This is not a bad thing, and mood stabilizers have helped a number of people with bipolar disorder to lead normal lives.

The problem is, if you are misdiagnosed as bipolar, you will be told you have a biological illness for life and the treatment is to take your meds. These meds may help but they may also zonk you out, so you don't feel fully awake. Some cause pretty severe weight gain. Psychosocial treatments (therapy, group therapy) that focus on your life circumstances will likely be de-emphasized in your treatment plan. This takes away your autonomy - the sense that with help you can grow and change your life for the better. Instead, you have an illness and you need meds.

This is natural in a health care system that wants to minimize costs - drugs are cheaper than therapy.

My advice: if you receive a diagnosis of bipolar disorder, do your research and really talk it over with the person who diagnosed you. Do not be a passive recipient of psychiatric care. Mood stabilizers have saved the lives of some people with bipolar disorder and others that do not have bipolar, but no matter what diagnosis you actually have, do not underestimate the role of your relationships, work, health habits, thoughts, feelings, and your own will in creating a life that works.

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