Tag Archives: Bipolar Disorder

B – #AtoZChallenge on Mental Health

Welcome to my letter B post in the #AtoZChallenge on mental health. This is a much harder letter than A was, but I still found some interesting terms in mental health starting with the letter B.

Behavior

Behavior is defined on Wikipedia as “the range of actions or mannerisms by individuals in conjunciton with themselves or their enviornment”. Well, it does not include just individuals, but also animals, artificial entities, etc., but the full definition is way too complex to go into here. The bottom line is that behavior includes all actions a person (or animal, artificial entity, etc.) conducts in interaction with themselves or their environment. Everyone exhibits behavior, sometimes not even consciously.

In mental health care, however, “behavior” has a different meaning. It refers not to everything a person does, but to specific actions that are supposed to say something about their mental health. “Behavior” then becomes a sign of mental illness. Worse yet, when a mental nurse says something is “behavioral”, they usually mean it’s willful. “That’s behavior”, is a mental nurse-ism for “you are willfully acting inappropriately”.

Biomedical Model

This is the model which sees illness as a direct result of dysfunction in the body. The biomedical model, when applied to mental illness, sees mental illness as purely a chemical imbalance or a brain disease. Proponents of the biomedical model use only medications or other biological interventions (eg. brain surgery) to treat mental illness. There are hardly any doctors who subscribe exclusively to the biomedical model, especially in mental illness.

Bipolar Disorder

Also known as manic-depressive disorder, this disorder is characterized by alternating episodes of major depression and mania. Mania is a state of elation where a person is overly active, reckless and impulsive and/or irritable. Some people in a manic phase spend thousnads of dollars they don’t have on things they don’t need. Bipolar disorder is not about mood swings. Rather, the depressive or manic phases last for at least a week for mania and two weeks for depression, often longer. Some people in manic states experience psychosis too. Then we get the well-known delusion of gandeur. Please note that being convinced you are Napoleon does not make you bipolar per se. Bipolar mania, as I said, also includes increased activity, impulsivity and irritability.

Borderline Personality Disorder

I have this diagnosis and it’s really one of the most misunderstood mental illnesses by mental health professionals. The lay perception (and perception by some professionals) of BPD is one of a woman who threatens suicide when a friend doesn’t answer the phone within five seconds. She has one boyfriend after another, with whom she picks fights then five minutes later makes love. She doesn’t show up for therapy appointments, but demands her therapist make time for her whenever she does show up, then when they refuse she runs in front of a slow-moving car saying she’s going to kill herself. That last one was a true example from my psychology textbook, seirously.

Surprise: this is not what BPD is like in most cases. Firstly, BPD occurs almost as often in men as in women but is underdiagnosed in men and overdiagnosed in women. Secondly, BPD is characterized by emotion regulation difficulties, which means a person’s emotions can shift rapidly. People with BPD often do engage in self-injurious or suicidal behavior. They also have an intense fear of abandonment, which leads some to fall in and out of love very rapidly. Borderlines do outwardly look like they are manipulative bitches sometimes, but inwardly, they suffer tremendously from their rapidly shifting emotions. They do not demand excessive attention per se (like people with histrionic personality disorder do) Learn more about what it’s like to suffer from BPD.

On long-term mental units, you don’t see many people with BPD, because standards of care dictate they can only be admitted very briefly for crisis intervention. Us borderlines are supposed to get dependent otherwise. Well, I can tell you, I know people with other diagnoses who are much more dependent than I am.

(Not So) Busy: Looking at the Roots of My Fatigue

This week at the spin cycle, the writing prompt is “busy”. I am not technically very busy. I do not work, after all, and am not in full-time school. I still have enough time to sleep, although I sleep often at the wrong moments. During the day, that is.

That being said, you might believe it would be easy to incorporate new requirements into my schedule. Exercise three times a week. Go to the educational department at my institution to study for 90 minutes twice a week and study for an extra hour on Sundays. Write a blog post everyday Monday through Friday. Yet why don’t I accomplish this?

It’s probably that I feel too overwhelmed. It’s not necessarily that there’s not enough hours in the day, but that there are too many requirements on my mind at the same time.

I also, of course, do have limited energy. I don’t know why, but it’s probably one of those symptoms of the aches and pains of daily living. What I mean is, I don’t have a physiological explanation for it, but it’s there nonetheless.

I am not busy as a bee most of the time. Sometimes, I have more energy and tend to put my day full of activities. It seems I’m almost normal then. Right now, I feel far from normal. I feel exhausted while I’ve hardly even done much of anything.

When I once read part of a book about medically unexplained chronic health symptoms, the author presumed there were two causes of these types of symptoms (other than of course an unknown physiological ailment). Some people tended to push through and do too much, while others tended to give up and do too little. On the surface, I appear to be fiercely in the second category. After all, even on days when I feel as though I push through, I don’t do nearly as much as a healthy person my age. I still don’t work or go to school full-time and I don’t care for a family.

However, it seems to me like I do have issues with dividing my limited energy correctly, pushing through on days when I feel lots of energy and giving up on days when I feel little. Psychological treatments of mental illnesses like bipolar disorder, which include fluctuations in energy levels, teach the exact opposite. Dialectical behavior therapy for borderline personality disorder also teaches acting opposite to one’s state of mind. Could it be that I, too, need to rest when I feel energetic and push through when I feel fatigued?

I know that conventional treatment of chronic fatigue syndrome follows this line of thought. Now I don’t claim to have CFS, and I don’t mean to say that this line of treatment is correct for those who do have CFS. What I mean is that it could be helpful for me.

Everyday Gyaan

Borderline Personality Disorder Awareness: BPD Explained

May is mental health month in the United States. It is also borderline personality disorder awareness mnth. BPD is my current diagnosis. I have written a few posts on this condition already, but most required some previous knowledge of BPD or mental illness in general. In honor of mental health month and BPD awareness month, I am going to write about my experiences with mental illness in this post and will share facts along the way.

I have always struggled with rapidly shifting emotions and mood swings. If it had been popular at the time and my parents had sought help for me, I might’ve been diagnosed with a childhood-onset mood disorder. I do not have bipolar disorder or major depression now, but these conditions are thought to affect children differently. In the current edition of the psychiatrist’s manual, the DSM-5, there is a diagnosis for children with severe mood swings, dysphoric (sad or angry) moods and extreme temper tantrums. This disorder is called disruptive mood dysregulation disorder. It is thought not to be lifelong, as it can only be diagnosed in children under age eleven.

I remember as a child of about nine already experiencing suicidal thoughts and making suicidal threats, particularly during meltdowns or tantrums. This is not necessairly a sign that the child is going to attemtp suicide – I never did -, but this is also not just “attention-seeking”. It is, in fact, a sign that a child is in serious distress.

Making repeated suicidal threats or attempting suicide is one of the core symptoms of borderline personality disorder. It is commonly thought that most people with BPD only threaten suicide and “aren’t serious about it”. In fact, however, about ten percent of people with this diagnosis die of suicide.

As a teen, I started self-injuring. Self-injury is also a core feature of BPD. This may have many functions other than “attention-seeking”. Of course, some people with BPD do not know how to ask for attention and instead use self-harm as a way to get it. Even then, attention is a human need and withholding it altogether will not usually solve the problem. Other functions of self-injury may include to express pain, to numb out feelings or conversely to feel something when one is feeling empty or numb.

Chronic feelings of emptiness are another symptom of BPD. Generally, a person with BPD is somewhat depressed or numb. This feeling of numbness is also common with major depression, post-traumatic stress disorder and dissociative disorders, all of which commonly co-occur with BPD.

Dissociation is the feeling of being disconnected from oneself, one’s thoughts or feelings or one’s surroudnings. Symptoms of dissociation, particularly depersonalization (feeling “unreal”), are common in many mental illnesses. The most well-known specific dissociative disorder is dissociative identity disorder, also known as multiple personality disorder. My former therapist, who diagnosed me with BPD, believed that BPD and DID/MPD are on the same spectrum.

Paranoia is also common in people with BPD. However, as opposed to people with schizophrenia or related disorders, people with borderline personality disorder experience paranoia only briefly when under stress. For example, when I am overwhelmed with eotions, I tend to mistrust people and situations, while I am not usually paranoid.

Lastly, people with BPD have difficulties in relationships. Firstly, they often have an intense fear of abandonment and go to great lengths to prevent people from leaving them. Some may push people away (“I abandon you before you can abandon me”). Others, like me, are excessively clingy. People with BPD may also alternate between idolizing and devaluing the people who are important to them.

No two people with BPD or any other mental illness are alike. For a diagnosis of borderline personality disorder, you only need to meet five out of nine criteria. I meet between six and eight depending on how you look at it.

Borderline personality disorder bears similarities to post-traumatic stress disorder, dissociatve disorders and mood disorders, particularly bipolar. However, the difference between bipolar and borderline personality disorder is that people with bipolar disorder experience long-lasting mood episodes, whereas people with BPD have rapidly-shifting moods. BPD cannot be diagnosed in children, although of course they can have mood swings. They may then be diagnosed with disruptive mood dysregulation disorder. Psychiatrists are beginning to diagnose BPD in adolescents starting at arund age fifteen. This is good, because, the earlier someone gets treated, the more likely they are to reach recovery.

Mood Disorders in Children

Mood disorders in children, especially bipolar disorder and explosive mood disorders (also known as severe mood dysregulation and called disruptive mood dysregulation disorder in DSM-5), are controversial. Many children after all have temper tantrums, hyperactivity, sleep problems, etc., yet do not need a diagnosis. I found a list of fifteen symptoms of childhood bipolar disorder, of which I easily met the required four as a child. However, I never had the classic symptoms of bipolar disorder and do not have bipolar disorder now that I’m an adult. I did have mood disturbances as a child, but these could also be due to my autism and emotion regulation disorder.

Dsiruptive mood dysregulation disorder (DMDD) has much stricter criteria than those proposed in the above article for childhood bipolar disorder. In order to be diagnosed with DMDD, a child needs to meet many criteria, including temper outbursts on average at least three times a week over a twelve-month period, persistent irritability most of the day, nearly every day, symptoms occurring in at least two contexts and being severe in at least one (home, school, or with peers), etc. The diagnosis cannot be made in a child under six and should not be made for the first time in adulthood.

The diagnosis of disruptive mood dysregulation disorder cannot co-occur with oppositional defiant disorder (ODD), intermittent explosive disorder or bipolar disorder. If a child meets both criteria for DMDD and ODD, only the mood disorder needs to be diagnosed. If a child has ever had a manic or hypomanic episode, only the diagnosis of bipolar disorder must be made. For childhood bipolar disorder, the same criteria for a manic or hypomanic episode apply as for adults, except that the duration may be shorter. According to the accompanying text in DSM-5, rates of conversioon from DMDD to adult bipolar disorder are low. Adults with a history of DMDD are more likley to suffer frm depression or anxiety.

Mood disorders, including DMDD, can however co-occur with other disorders, such as ADHD or autism. ADHD and autism can also mimic a mood disorder. For example, if a child with autism or ADHD won’t stop talking, this shouldn’t be confused with the talkativeness seen in a (hypo)manic episode. However, mood symptoms can also be missed if a child has ADHD or autism, because irritability, temper outbursts, etc. are seen as a normal part of the ADHD or autism.

If a child’s mood disturbances are interfering with their daily functioning, take them to their doctor or psychologist for assessment. It isn’t always necessary to give them additional labels or prescribe them medication. Sometimes, just a change in handling strategy may help. You could’ve noticed this already, but, with a problem child, it’s often helpful to have a professional be your second pair of eyes.

Love Survives Mental Illness

Over at Bipolar Mom Life, there’s a great post for Valentine’s day on love surviving mental illness. This is a very powerful story. Unlike in my case, the author had not become mentally ill yet when she got married. Then again, with mental illness being unpredictable, it isn’t like my husband knew what to exppect when we started dating or even when we got married in 2011. IN fact, I didn’t know what to expect. Until roughly a year ago, we were expecting to go live together within the foreseeable future. We still hope to one day live together, of course.

Love does not always survive mental illness. In fact, love does not always survive the test of time, with around 40 percent of marriages failing in general. Then again, according to an article in BP magazine, 90 percent of marriages in which one partner has bipolar disorder, end in divorce. I bet that with borderline personality disorder, this percentage is at least as high.

There are several obstacles to a successful marriage for someone with BPD. There are of course those characteristics that are inherent in the disorder – higher risk of infidelity, aggression, idealizing and devaluing, etc. There are also problems that are not necessarily inherent in the condition, but which are more likely to occur due to the dynamics of partners not only being partners, but also having the patient or carer role. I cannot go into detail about this, but I want to warn mentally ill people who are in a relationship that their partner is their partner first, may be their carer second, and is not their therapist.

Emotion Regulation Skills for BPD Sufferers

In the Netherlands, borderline persoanlity disorder is sometimes also called emotion regulation disorder. There were in fact psychiatrists advocating for this name change in DSM-5, but it didn’t happen. Indeed, I myself notice that emotioon regulation problems are, besides having little sense of self, the most prominent symptom of my BPD. Tonight, I noticed how being told that I had to ask a fellow patient to help me with something minor rather than a staff member, set into motion a train of emotions and behaviors that I now realize, at least to some extent, was uncalled for.

Learning to regulate emotions does not mean stuffing them. Rather, it means observing and describing your emotions, decreasing your vulnerability to negative emotions and increasing positive emotions. Identifying what emotion you are feeling is usually the first step, and it can be especially hard. Many people, even those without mental illness, learn that certain emotions are not allowed, so they convert them into others. I for one often act angry when I’m sad or overwhelmed. However, all emotions have value.

Changing emotions requires first observing them without judgment, then letting go of them through for example mindfulness. Mindfulness allows you to experience the coming and going of emotions like a wave. In mindfulness, you shouldn’t try to block or suppress an emotion or try to keep it around. Rather, let emotion run its natural course.

This does not mean acting on emotions the moment they come up. We are not our emotions. Therefore, another step in emotion regulation is choosing whether to act upon your emotion. This seems impossible at first – at least, it does for me -, which is why mindfulness is important. When you have chosen to challenge an emotion, some therapies, like dialectical behavior therapy (DBT), explicitly teach acting opposite from the emotion. The most useful example of this I’ve heard is from a woman who suffered from bipolar disorder. When she was sliding into depression, she was encouraged to become active, while she was encouraged to take it slow when she was climbing towards mania. Other therapies, like rational emotive therapy, emphasize the fact that an emotion doesn’t come out of the blue, and encourage sufferers to challenge the thoughts that lead to their emotions. I believe that challenging cognitions may be best done when emotions are not overflowing you.

The Childhood Bipolar Controversy Reviewed

Bipolar disorder in children is controversial. It didn’t use to be diagnosed as often as it is now, especially in the U.S., and more atypical symptosm are suggested to be bipolar. In the journal Child and Adolescent Mental Health, Boris Birmaher reviewed the literature surrounding this controversy. It’s an interesting article, viewing the controversy from all sides.

Birmaher starts by describing the diffiuclties diagnosing manic, hypomanic and depressive episodes in children and adolescents. Particularly, it is hard to distinguish symptoms of (hypo)mania from normal episodes of increased activity or from ADHD. Depressed symptoms are also hard to diagnose because children do not always feel or look depressed all the time. Adolescents experiece more atypical symptoms (increased sleep and appetite and weight gain) than adults do. Birmaher discusses whether onepisodic mania can be seen as bipolar.

He fortunately also shreds the idea that irritability only is bipolar. It isn’t. In fact, it is not severe mood dysregulation (also known as disruptive mood dysregulation disorder) eitehr, which surprised me. Irritability only is more indicative of ADHD or disruptive behavior disorders than of bipolar or SMD. Elation only, also, is not common in childhood or adolescent bipolar. More likely, patients experience both irritability and mood elation.

Birmaher is quite clear that pediatric bipolar disorder exists. The prevalence is around 2%, with just over 1% of children and adolescents presenting with bipolar I. For some perspective, Levorich et al. (2007) show that as many as half of adult bipolar patients in their study reported onset in childhood (14%) or adolescence (36%).

Birmaher is not a bipolar proponent, in the sense that he thinks atypical symptoms warrant a diagnosis of BP. He makes it quite clear that more research is needed into the risk factors for converting from atypical or subsyndromal bipolar-like symptoms into full-blown bipolar in children and adolescents. It looks like family history of bipolar is one such factor. Levorich et al (2007) found that, the earlier the onset of bipolar disorder, the more likely the patients were to have a parental history of bipolar or depressive disorders.

Levorich et al. (2007) particularly studied prognosis in adults with bipolar disorder, comparing those with (retrospectively reported) childhood or adolescent onset bipolar to those with onset in adulthood. They found that, the earlier the onset of the disorder, the more likely patients were to suffer from dysphoric (irritable) rather than euphoric mania and the more likely they were to have comorbid anxiety and drug abuse. In addition, the researchers tracked all participants’ mood over a year’s period. This showed that those with early onset bipolar had more depressed episodes, more severe manic and depressive symptoms and fewer good days in a year than those whose bipolar started in adulthood. For these and other reasons, Levorich et al. advocate an active ruling in or outo f bipolar d isorder in children and adolescents, rather than it being considered a last resort diagnosis.

References

Birmaher B (2013), Bipolar Disorder in Children and Adolescents. Child and Adolescent Mental Health, 18: 140-148. DOI: 10.1111/camh.12021.

Levorich GS, Post RM, Keck PE, Altshuler LL, Frye MA, Kupka RW, Nolen WA, Suppes T, McElroy SL, Grunze H, Denicoff K, Moravec MKM, & Luckenbaugh D (2007), The Poor Prognosis of Childhood-Onset Bipolar Disorder. Journal of Pediatrics, the, 150(5):485-490. DOI: 10.1016/j.jpeds.2006.10.070.