Understanding Bipolar Disorder

Are you plagued by significant mood swings that surprise even you? Do you feel as if your emotions have a life of their own, meaning that simple anger can escalate into rage in minutes?  Is it common for you to feel either boundless bursts of energy or debilitating fatigue?  Among my clients, one of the most widely misunderstood and feared diagnoses is Bipolar Disorder.  Let’s understand what it is, its’ symptoms and treatment options. 

Simply put, the definitive feature of Bipolar Disorder is the cycling of polar opposite emotions (think ecstasy/despair or rage/meekness).  Humans experience a broad spectrum of emotions, although individuals with Bipolar Disorder report experiencing cycles of emotional extremes.  Many individuals report feeling “crazy” because, despite their best attempts to balance their thoughts and feelings, their emotions frequently overpower their thoughts and drive unwanted behaviors.  A diagnosis of Bipolar Disorder is not based upon a single snapshot in time but rather, observation of patterns of behaviors characteristic of both depression and mania.  To receive this diagnosis a myriad of diagnostic criteria must be met.  Let’s briefly examine the symptoms of depression and mania.

Depression

I doubt that anyone who has experienced life is unfamiliar with feeling depressed. Today the term depression will be limited to the experience of an overwhelming sadness and even despair regarding the past and present as well as a profound sense of hopelessness regarding the future.  Behaviors associated with depression can include sleep disruption, appetite impairment (too much or too little) and inability to focus and/or concentrate.  Often an individual may question whether life is worth living and possibly become 
actively suicidal.  Emotions may range from irritation to rage, 
increased tearfulness to feeling  “numb.”  Social isolation frequently occurs, as does a noticeable disengagement from  once pleasurable activities.  For example, the avid runner may stop all physical activity.  Physical symptoms like unexplained pain, gastrointestinal distress and migraines may appear without obvious triggers. 

Mania

The polar opposite of depression is mania.  Some hallmarks of mania include: scattered thoughts (so many wonderful ideas that you cannot focus on just one) and heightened creativity (many projects are begun but not completed).  Speech may be pressured (you interrupt others while they are speaking because you have too much to say and no time to waste) and emotions run high (bouts of uncontrollable laughing or crying).  Sleep and appetite may become erratic based upon elevated energy levels.  There is also frequently an increased motivation to engage in reckless behaviors like speeding, daring sports and/or illegal activity without
considering the possible consequences. Physical symptoms may include a sense of restlessness (feels like an engine is running inside of you), irritability (shorter than normal fuse), agitation and increased anxiety (nervousness, racing heart, sweaty palms & pacing).

Cycles

A qualification of Bipolar Disorder is an observed history of both mania and depression. An individual’s transition from depression to mania and vice versa is known as cycling.

While some individuals may experience both mood states at the same time, that is not common. Cycles are directly related to brain chemistry and therefore are specific to each person.  A cycle may occur several times a day to once per year.  Again, this is highly dependent on the individual.  Often my clients will report feeling restless or agitated and/or significantly fatigued prior to the onset of a cycle. An increased vulnerability to self-medicate through alcohol, food, illegal drugs, promiscuity or gambling may occur in an attempt to mask these uncomfortable feelings during a transition.

Origins

Bipolar Disorder is a physiological imbalance within the brain.  Some research suggests that there may also be structural abnormalities within the brain. Research findings also predict a genetic contribution among blood relatives.  There is an equal likelihood of occurrence among males and females.  Stress, significant life events and a history of significant childhood trauma may also contribute to the development of Bipolar Disorder. 

Treatment Options

Clearly Bipolar Disorder is a dis-equilibrium in the naturally occurring neurochemicals within the brain.  Therefore a primary treatment consideration is effective medication management.  Psychiatrists specialize in highly specific medication protocols that are tailored to an individual’s symptom profile.  It is not uncommon to be prescribed a mood stabilizer as well as an antidepressant and perhaps an anti-anxiety medication.  As a patient, it is vital to develop an open and collaborative relationship with your psychiatrist in order to effectively manage your symptoms.
   

Therapy is the second component of treatment. Mood swings can be exhausting not only for the client, but also for those that they love.  Ongoing therapeutic support that combines identifying and then understanding the cycles and the accompanying risky behavioral responses is the first step in mood management.  The next step is learning and then implementing less risky behaviors as alternative coping strategies.  Research indicates exponentially greater success when a team approach to treatment is utilized.

An obstacle to treatment is often a client’s reluctance to forgo the manic cycle.  Although maladaptive, it had often served as motivation for task accomplishment as well as increased feelings of well being. Similar to the patient-psychiatrist relationship, the client-therapist relationship must also feel comfortable and collaborative.  A client’s treatment team often becomes an enduring relationship.

Conclusion

The stigma attached to Bipolar Disorder needs to be eradicated! The fears attached to being labeled “crazy” prevent far too many individuals who would benefit from treatment to seek it out.  Stereotypes of “crazy” within the entertainment industry have reinforced the stigma. Why?  Mania has been sensationalized!

The Oscar award winning film, Silver Linings Playbook has begun to challenge this stigma.  Bradley Cooper, Jennifer Lawrence and Robert DeNiro brought to life the real struggle of Bipolar Disorder within families.  Catherine Zeta-Jones, Robin Williams, Jean-Claude Van Damme and Jane Pauley are celebrities who have publicized their personal challenges in managing their cycles.  Their goal has been to “break down the stigma.” 

The diagnosis itself does not necessarily limit personal growth and success.  Once an individual understands and takes responsibility for their symptoms, effective management begins.  Refusing or halfheartedly following a treatment regime will ultimately impact relationship, professional and personal success. 

If this post has raised questions about yourself or someone you love, don’t delay – schedule an appointment with your physician and/or a licensed psychologist.  NOW is the perfect time!

Great Changes Are Happening In My Life...So Where's My Mojo?

One of the most frequently asked questions in my practice centers around the notion that a positive life transition must be continually met with happiness and enthusiasm. This is an interesting phenomenon that deserves some clarification.

The media often portrays only the positive emotions related to major life transitions such as pursuing a degree, leaving our parent’s home as a young adult, receiving that much anticipated promotion or corner office, marriage and even retirement. There is often the inference that if you are not feeling similarly then you must lack self-confidence, charisma or even worse, must be suffering from depression. Why? because dichotomous thoughts and feelings don’t sell the new wardrobe, the prestigious vehicle, or the sexy vacation that a major life transition promises to afford.

What is seldom discussed is that all change requires not only our bodies but our psyches time to recalibrate. The equilibrium of what was “normal” is temporarily thrown off course. The stress attached to recalibration may cause our immune systems to weaken and despite proper self care target us for minor colds and flus precisely when we often feel motivated to “go the distance.”

Our psyches (thoughts and feelings) must also find a new set point. Regardless of the positive nature of the change, there is loss. Why? Our sense of the predictability of our world is temporarily thrown into a spin cycle. One change in our routines often brings a cascade effect of other unimagined changes. We need to redefine, sometimes in a major way, sometimes in a minor way, our new “normal.” We require time to grieve the losses that accompany this marvelous change. It is okay and even necessary to reconsider our choice, feel less confident and possibly more anxious for a reasonable amount of time. If there are many changes that result from a career change for instance, the longer it may take to regain a true sense of confidence and excitement.

In this instance grief does not equal depression. If a person denies this temporary internal conflict between thoughts, feelings, and motivation it may possibly manifest down the road as depression. That is why it is important to recognize and label these feelings as grief and this transition as a recalibration. Unfortunately, high achievers often just push themselves harder, longer and faster when this is an appropriate time to conserve your resources and allow yourself some time to grieve the chapters that have closed in anticipation of new beginnings.

If those around you are merely focused on the positive potential of your change, it may be a wise investment of your time and resources to seek some professional guidance to effectively work through the recalibration phase. This is one instance when proactive intervention can make the difference between grief as a reaction to life versus grief that left unattended morphs into depression.

Adolescent Suicide

As a parent of adolescents, nothing sends chills up my spine more than the thought of my own child taking his life. As parents, it is important to note that suicide is the second leading cause of death among teens after accidents. These figures are misleading because many accidents can also be successfully hidden suicides. Among teens, the most popular method of committing suicide is through the use of handguns. If personal firearms are present in your home environment, always remember to keep them locked and the ammunition stored in another secure location.

Some teens are more likely to commit suicide than others. What factors put your adolescent at risk? The most significant risk factor is some form of substance use such as alcohol and/or drugs. Excessive dieting or binge eating (consuming large quantities of food and then vomiting the stomach's contents) also increases your teens odds of suicide risk. More easily identifiable behaviors include: isolating - a desire to stay in their room coupled with decreased social contact with friends or relatives, and a decreased interest in hobbies or activities they once found enjoyable. Other behaviors include an increased sense of hopelessness and great despair about tomorrow. This may be acted out as school truancy, increased sleep, or poor personal hygiene. This may also include reckless driving and/or neglecting to fasten their seat belt. Another good indicator of your teen's emotional state can be the lyrics to their favorite songs - what message are they conveying to the listener? Finally, teens that have a family history of suicide are at a twofold greater risk of committing suicide than teens that have no family history of suicide.

As parents, what types of behaviors do we need to look out for that may indicate that our adolescent may be contemplating taking their own life? Statements like, "Why bother, I want to die, I wish I were dead, or there will never be a tomorrow" are very strong clues that your child may be extremely depressed and may be considering suicide. If your teen gives away their prized possessions for no apparent reason or talks about "When I'm gone" is another red flag that requires immediate intervention.

Is there anything besides becoming a watchdog that a parent can do to decrease the likelihood of suicide? Most certainly! Remember to love your child and let them know by your words and most importantly your actions, that you love them despite their changing bodies, their mood swings, and their growing independence. Don't make your love conditional, meaning, "I'll love you if you...(fill in the blank - do the dishes, mow the yard, take out the nose ring, remove the green dye from your hair)." Teens need to know that you will love them despite their apparent flaws. They need to feel worthwhile, that what they do matters to you. Remember rejoicing when they took their first steps or made potty in the potty chair? This same enthusiasm needs to be transferred to trying out for drill team or band, not necessarily making the cut. In other words, reward the effort not the end result. As your teen's parent, you are their most loyal fan and able advocate. If any of the risk factors or behavioral indicators sound familiar, seek out a licensed psychologist and request a consultation. Your child may express reluctance or outright refusal, but once they feel better, they will thank you for your concern.