Tag Archives: Mood Disorders

Mood #WotW

The past few weeks have been rather hectic. I started out last week in a creative, elated and slightly impulsive mood. I spent days and nights finally reading a book I’ve been wanting to read for a while. I hardly slept at all. Needless to say, after four or five days of this mood, I was exhausted and crashed. I spent some days in bed being a bit depressed and not having much energy for anything.

Then on Tuesday I had an utter meltdown and started spiraling down into crisis. I wanted to quit my antipsychotic because, I believed, it made me dull. At that point, however, I was quite irritable. I ended up self-injuring on early Friday morning after a sleepless night. At that point, I realized this pattern of mood lability is very common for me, repeating itself roughly once a month.

I had asked the staff to schedule an appointment with my psych doctor because of my wanting to quit my antipsychotic. However, between me asking to get an appointmnet and the actual appointment, I had this realization I described above. I decided to discuss this with my doctor and she suggested I enlist the help of my named nurse in adapting my crisis prevention plan to acknowledge this longer-lasting pattern. The current version has it look like I melt down out of the blue. She also suggested I may’ve done just a little too much during that four to five days of increased productivity. Many people with mood disorders and borderline personality disorder cope with their affective lability by acting opposite to how they feel. For example, when depressed, they drag themselves out of bed and do something. When they feel elated, on the other hand, it’s time to wind down.

Because I also have a very poor sleep/wake cycle, the doctor suggested I try a sleeping pill for a bit to help me get to sleep at night. Of course, this means I do need to stay up during the day as well. I have now gotten Restoril, a benzodiazepine sleeping pill, as-needed for a week, to be evaluated next week. I tend to develop tolerance to benzos very rapidly. To get me back in sync, I agreed with my named nurse that I’d be taking the medication for three nights and see how I do on Monday. Last night, I got okay but not great sleep.

I hope I will be back to stable soon. I hope this state of stable means I still have some of the creativity I have during my elated moments.

Because I am not too inspired to blog lately, I decided to participate in Word of the Week again. I contemplated for a bit what word to choose for this week, and I’m settling on “mood”. After all, this refers to my affective lability as well as my realization of it.

The Reading Residence
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Things People Don’t Tell You (or Even Know) about Borderline Personality Disorder

Having borderline personality disorder, I have severe and rapid mood swings. Usually, people with BPD experience chronic, low-grade depression, but it can worsen or spiral down into anxiety, paranoia or anger at the drop of a hat. I have experienced that during severe mood episodes, I have similar experiences that are listed as those common in mood or anxiety episodes for people with depression, bipolar or anxiety disorders. The difference is the episodes are usually more severe but last shorter.

Today, I came across a list of things people don’t tell you (or even know) about depression. I can relate to many of these and could add a few that apply to my BPD moods specifically.

1. Most of the things people tell you, are not going to register with you and/or aren’t helpful at the time. “Just accept that you feel like crap”, “just act happier”, or “it will get better”. When I’m in a BPD mood episode, I usually can’t see beyond this episode and am utterly overcome with emotion. Telling me to “just” accept it or “just” act ahppier will seem totally unhelpful, even though it is particularly the “just” bit that is making it unhelpful. It’s not easy, but acting opposite to emotions and acceptance of one’s emotional state do help.

2. It physically hurts. Particularly depression and anxiety can cause physical symptoms. I often experience a heavy weight on my body when in a depressed state. Intense fatigue is another symptom. Anxiety can come with a lot of physical symptoms, such as a racing heartbeat, chest pains, lightheadedness, etc. When you experience these symptoms for the first time, do see your doctor to make sure it’s indeed anxiety and not a physical health condition.

3. Your relationship with food changes to “it’s complicated”. Many people with BPD also experience eating disorders, usually of the not otherwise specified type, where they alternate between anorexic and bulimic or binge eating episodes. Mood episodes can, as the author of the article I linked to says, also cause you to overeat or forget to eat.

4. Some “friends” will let you down, and that’s okay. Being BPD, we often tend to cling to people and have severe fears of abandonment. However, those friends who let us down during a mood episode, probably aren’t worth our frantic efforts to keep them. Friendships are generally hard for borderlines, so especially when not in a severe mood episode, it may be helfpul to invest in interpersonal skills.

5. You feel like you’re absolutely losing your mind. When in a severe mood episode, I can’t see beyond this episode and usually think it is worse than it is. Even if I do recognize that my symptoms are mood symptoms and I’m not going to die of a physical health condition, I often do feel like I’m going crazy. I could’ve been fine hours or even minutes before, but in such a severe emotional state, all there is, is depression, anxiety or paranoia.

6. Everything will start to annoy you. Even you will start to annoy you. My sensory overreactivity gets a lot worse when I’m in a mood episode. So does my general irritabilty. Unfortunately, irritability in BPD is commonly seen as a behavior problem rather than a mood problem./P>

7. Everyday tasks will feel overwhelming. As I said, most people with BPD experience chronic, low-grade depression. For this reason, everyday tasks feeling overwhelming is not just a symptomom of a severe mood episode for me. It could also be related to autism in my case. However, it is true that, when in a severe mood episode, I find everyday tasks even mroe overwhelming than usual. It is important to keep some level of activity even when in an episode.

8. It’s nearly impossible to tell when it’s “just your BPD talking”. With BPD being a chronic mental health condition, we often get used to our irrational beliefs. They however do become worse when in a dysregulated state. At the same time, it is extremely hard to see beyond this mood to our (still distorted) everyday sense of reality.

9. Moods will wreak havoc on your sleep schedule. When depressed, people often experience disrupted sleep. They may sleep more during the day and less at night. On the other hand, borderlines can have periods of hyperactivity similar to bipolar (hypo)mania, when they seem to need less sleep. Sleeping pills may have opposite effects in BPD, causing agitaton and even aggression.

10. Sometimes, you will not feel anything at all. Feeling nothign at all may be a sign of depression, but it is also common in BPD (“chronic feelings of emptiness” is one of the criteria). I personally don’t feel empty or numb that often, but when I do, it’s often the “calm before the storm” and I run an increased risk of falling into a dysregulated mood episode.

11. Your dreams get weird. Both changing moods and the medications many borderlines take can cause you to start having weird, intense or scary dreams. I felt a wave of recognition when I read this in the article I linked to. When I was admitted to the psychiatric hospital in 2007, the psychiatrist asked whether I had scary dreams. I said “No”, but I did say I had these really weird, intense dreams. They quieted for a while and then came back when I went on an anitpsychotic. PTSD is also common among those with BPD, and one of the symptoms of this is recurrent nightmares about the trauma you endured.

12. Your mood will seem totally “logical”. As I said, it is hard when in a severe mood state to look beyond this state. Your mood will also make you feel like it’s the most normal, or even the only state to be in. Some research shows that depressed people lack healthy but unrealistic optimism. Therefore, your thoughts may seem or even be close to reality, but they aren’t helpful.

13. You won’t be able to think clearly about your future. When I was in my worst mood epsiode, even looking a day ahead seemed impossible. I not only had no hope, but no image of even the short-term future whatsoever.

14. Mood episodes distort your view of the past, too. When I am in a severe mood episode, I can not only not see that it will ever get better, but I exaggerate how long I’ve been in this state. This doesn’t happen consciously or with a purpose, but it’s impossible to look not only beyond this state, but also to the past before this state started.

15. BPD makes you feel like you’re alone. You’re not. I often feel like no-one has similar experiences to mine. Of course, it is true that no-one is in my head so no-one has the same expeirneces, but many people do have similar experiences. You are not alone with BPD.

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.

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.