Tag Archives: bipolar disorder defenition

“Bipolar Disorder” or Typical Human Behavior?

I’ve been seeing a recurring theme lately.

I told someone I’ve known for a while (but who has somehow escaped the knowledge of what has really gone down the last year or two) that I have bipolar disorder.

She asked me, “ok, so what does that mean?”

“Mood swings,” I said, “overreactions to things, stuff like that.”

I may have been much too general because her response made me pause for a moment,

“Isn’t that everyone?”

Rather than go on a long rant trying to explain further, I laughed.

Likewise, I was recently at my third visit with my new therapist and she was analyzing one of the horrible days I had last week with an abrupt mixed manic episode at work where I had to leave early.

“You were in a bad mood because you were still sick, which anyone can do,” she started, “you were frustrated with your boss about how you were being treated, you were anxious about coming back to work after having been sick for the last few days,” she grinned wildly, “are any of these things that anyone else (bipolar diagnosis aside) might experience?”

Frankly, this long speech pissed me off because, though I hope to have a therapist who can tell it like it is, I’d rather them do it in a nurturing, enlightening way rather than a smarmy, shit-eating-grin sort of way. After taking so long to come to terms with the notion of having bipolar disorder, having your “support person” question it really drives me bananas. 

“Which part,” I asked, “of the following is also typical of ‘normal’ human behavior? You forget, I do not presume to know what is typical and what isn’t, as the only experience I have to base my conclusions on is my own. But having paranoia that leaves one simply terrified of their co-workers, is that typical? How about having the overwhelming urge to attack and/or destroy the people around me? Maybe overwhelming feelings of suicidally that crop up in that situation -surely that is ‘normal’ as well?”

I’ve been thinking about this the last few days and it makes me think about what a few people have said to me, regarding jumping to the conclusion after receiving a diagnosis that any subsequent activity is linked to that diagnosis.

For example, someone with bipolar disorder grieving over a loss assuming they are having a depressive episode associated with bipolar disorder.

Or, (and I expect this is what that therapist meant to say, though she did so in a terrible way) becoming legitimately angry about something but calling it a manic episode.

At first, part of me got concerned that this is something I might be doing too. Am I attributing the regular moods of life with bipolar disorder? Do I lump all of my emotions into one category?

The conclusion I came to is no.

The whole concept behind bipolar disorder (as I see it anyway) is that people experience a wide range of emotions. Up to a point, these emotions are totally normal, everyday occurrences for people. Becoming furious is not singularly a bipolar experience.

But, there is a point where these emotions can do a number of different things that are what relate them to the notion of bipolar disorder.

1. The emotion could be a response to something that has happened (like a normal reaction) but is not a proportional response -either in magnitude or duration. 

i.e, wanting to kill the co-worker who borrowed your pen without asking, or being depressed for a week because you know you bought stamps but can’t find them in your house.

2. The emotion could be occurring independently of outside events. 

i.e, walking down the street and then bursting into tears for no apparent reason.

3. The emotional response could include abnormal sorts of elements.

i.e, delusions, hallucinations, suicidally, homicidality, etc.

When sitting down and looking at it, these were the things that stood out to me as defining factors of what makes my emotional responses different than those of (what I’ve heard) is the typical human response.

The fact that I have these sorts of responses doesn’t mean I am somehow being controlled by something called bipolar disorder. In fact, the reality is the opposite. Bipolar disorder is merely a description of what I have already been experiencing.

And, unfortunately for me, these incidences happen fairly frequently.

I feel pretty confident that I am able to discern an “episode” (meaning, an occurrence of one or more of those elements -I don’t usually require a specific duration of my symptoms to personally identify these elements, even though I recognize that most doctors do) after the amount of mood charting I’ve been doing, and I find it pretty straightforward when there is a big difference between feeling bummed out about something and feeling depressed and suicidal.

I think it can be common, though, for people with bipolar disorder to either begin tagging all negative emotion as bipolar disorder and expecting that to be something that can be simply eradicated. It can be easy for me, sometimes, to forget that it is normal to feel a bit of misery every once in a while, or loneliness, or anger. As long as it isn’t the killer sort, I consider it a welcome change.

DSM-5 Draft Criteria Open for Final Public Comment

I don’t know about everyone else but I have a hunch this is typical: when first receiving a psychiatric diagnosis I inevitably wanted to know where the names and criteria of these disorders came from. I was led directly to the Diagnostic and Statistical Manual; version 4 (also referred to the DSM-4). This is the book that holds the categorization and criteria for diagnosing an inexplicable range of mental illnesses.

Well, the DSM has been under revision lately, and the latest draft of the new version (DSM-5) can be found at the American Psychiatric Association’s DSM-5 Development page. May 2nd through June 15th is the last opportunity for the public to submit comments on the draft (posted on the website), and after that we will be able to watch the final proposals posted to the website (without the ability to comment) until it is published.

Many things have been changed (though some only minutely), but bipolar disorder (as well as borderline personality disorder, and major depressive disorder, to name a few) is something that has had some tweaking done.

Have you checked out the website yet, or the changes made to the criteria for bipolar disorder? Most notably, increased energy/activity has been added to the symptoms of mania/hypomania, which I think is a big step in the right direction. Had this been considered an indicator ten years ago, I am certain my diagnosis would have happened much more quickly.

Bipolar NOS (not otherwise specified) is now NEC (not elsewhere classified) which seems a bit silly to me to keep changing the name when people already have a hard time understanding these sorts of disorders. However, there are a few subcategories of NEC and a couple of “pace-holder” sorts of subcategories which may prove useful to some.

Mixed episodes are now proposed to be categorized by a manic or depressive episode (whichever is the dominant episode) with the label ” with mixed features” tagged onto it. The criteria is much more specific, and I’m not sure if this change is really for better or worse. Personally, I find mixed episodes to be some of the most confusing states I’ve ever experienced, so I don’t know if I believe the new criteria will make them easier to spot or will just exclude mixed sorts of episodes that don’t meet the full criteria for being “mixed features”.

Anyway, this is just a taste of the revision, and since we are approaching the end of the commenting period I’d definitely urge you to take a look at the website, you can find Bipolar and related disorders here, and consider shooting a few comments their way if you feel so inclined!

The Afflicted Brain vs. An Individual Brain

Let me start by saying my first hospitalization was after a major depressive episode at the age of 16. Even before that, I remember symptoms of depression in my life at the age of 12 or 13, if not before. Overwhelming anxiety since at least 7 or 8 years old. And symptoms of hypomania even before that. Bizarre periods as a small child in the grocery store where I literally could not stop laughing, so much so that at best, all I could do was roll around on the linoleum floor in the freezer aisle. And even earlier, a wicked temper so fierce I periodically looked like the victim of child abuse from the bruises I’d pick up from throwing tantrums.

To me, the way my brain works now (at 26) is the way it has always worked. I have mood swings. I get snippy. My mind races and then screeches to a halt. I feel things deeply, music and art moves me. I get caught up in words. I think too much. Fear or excitement makes me physically ill. I can explode.

It is the way it has always been.

So when people tell me that bipolar disorder is completely separate from them, that it is an illness they seem to have acquired, or that they have bipolar disorder but are not bipolar, I have to admit… my heckles raise a little bit.

It seems common for doctors to encourage their patients to distance themselves from this “disorder”, and on one hand I could see how encouraging someone to think of themselves as having a disorder as opposed to just being different might make people feel better about themselves. It harps back to school to some degree, people just want to fit in, they don’t want to be different.

Personally, I think this attributes to stigma to some degree though. It is hard to embrace people that are different, that is true. But it seems more detrimental to tell people they aren’t different, they’re actually the same as everyone else but afflicted with something that forces them into being different. People become angry at this affliction for making them different, and subsequently others become angry at the affliction as well. The goal then becomes to banish the affliction, instead of just embracing and helping those that are different.

I think it is important to make the distinction that we’re all human, and just because someone has bipolar disorder doesn’t make them something other than human (which is the message I get to some degree from “I have bipolar disorder but I am not bipolar”). At the same time though, I think this particular phrase can be misconstrued very easily to be read as someone who can embrace the idea of the affliction, but can’t embrace their own thoughts and brain processes as their own.

This relates to yesterday’s post on accountability a little bit, because I don’t think people can really take responsibility for their actions until they embrace the fact that their actions are a direct result of them, for better or worse. It becomes easy to shrug off something when it is the result of the affliction, but actually taking responsibility for something ugly that happens is much more difficult with that mindset. For someone who is familiar with their own actions and the way their thought processes work and embraces the fact that they are simply different, that acceptance paves a direct path to taking responsibility for one’s own actions. There is no longer a distinction between the inner self and the scapegoat.

What is bipolar disorder anyway? A series of symptoms that may or may not be produced as the result of a brain that functions differently than the norm?

My brain does not function the way the majority of brains today function. Does that make it an inferior brain? No. It holds me back from time to time, but it has also launched me forward into places I never expected to be. It is sporadic, it can display alternate versions of reality from time to time (delusions, hallucinations, and the like), and it can rob me of my energy or give it to me in spades. But each brain is unique, which is why we’re all unique, and that is part of the reason this affliction is not easy to eradicate. The genetic marker is on different places on the chromosome, symptoms vary wildly, reaction to medications vary wildly, and even the rule of thumb about what this disorder is is skewed from one place to the next.

Treating the affliction here, when the affliction may just be something created to explain something we don’t understand, (which is a difference in behavior based on how the brain functions) seems illogical.

Can’t we all just say, “to heck with it!” and treat whatever symptoms each singular person has which are unbearable for that individual?

Oh wait. That’s how treatment does work. That’s why it is different for everyone. But for some reason, the mental health model does not reflect that.

We aren’t dealing with a specific number of afflicted brains, we’re just dealing with a number of different brains as large as the population of the earth.

So my brain is irregular? Big whoop. I bet there are eons more irregular brains than one would guess. The only difference is that some irregularities are easy for some to live with and difficult for others. The people with difficulty seek help, where instead of being welcomed openly as one of the billions of individual brains on the earth, they’re simply told they’re regular and have an affliction causing all of their ailments.

So it perpetuates.

This is why I don’t quite agree with the model of “mental illness”. Not to mention most people are terrified at the word “illness” on its own anyway.

I just think that instead of being encouraged to distance oneself from the so-called affliction, we should be encouraged to embrace it. If even the patient is being encouraged to distance themselves from “mental illness” -how can we expect to remove stigma and encourage anyone else to want to embrace it?

The Diagnostic Discrepancy

If you’re an American who has been diagnosed with a mental disorder, chances are you are familiar with something called the DSM-IV-TR. The Diagnostic and Statistical Manual of Mental Disorders, currently in revision with the release of version 5 expected to take place in May of 2013, contains the standard diagnostic guidelines for all current mental disorders in the USA.

What you may not be aware of is that the majority of the rest of western civilization uses another set of guidelines. The International Statistical Classification of Diseases and Related Health Problems or ICD for short, contains a chapter (V) which is used primarily for diagnosing mental disorders. This information is apparently also currently being revised by the World Health Organization with a scheduled release of 2015.

The information in these two manuals is not identical.

This is just one of a few facts I learned at the Bipolar Disorder in Focus conference last week.

So, clearly there is a problem here. There isn’t a clear understanding of what bipolar disorder is across the board, and the criteria for having the diagnosis is different depending on where you live.

There has been such a large discrepancy in the information between the two manuals that, from what I’ve been told, up until 1980 if you were diagnosed in the USA with bipolar disorder, the same criteria would mean a diagnosis of schizophrenia in Europe.

That is obviously an extreme example, but there are still many discrepancies today.

I had no idea that this was an issue, but I have witnessed that the understanding many medical professionals have of bipolar disorder varies widely. It seems to me that defining the disorder in a way that everyone can agree on would be a really good place to start.

That may sound simple, but I realize there are many things standing in the way of that goal as well.

  • “Bipolar Disorder” covers a wide range of symptoms, and many different groupings of these symptoms. There are so many individual versions of this disorder that it would be impossible to create enough “types” to cover them all. The challenge I am currently facing is that what I experience doesn’t fall easily into any of those established categories, or at least not to my knowledge. I’ve been told that is increasingly common, but it makes it even more difficult to find a doctor who knows enough about the disorder that they can work with me. Likewise, when defining this sort of disorder, where do you draw the line? At what point do you fail to include those with similar symptoms?
  • The symptoms associated with bipolar disorder can be difficult to quantify. How many of you have been asked by doctors to remember situations or episodes that are hazy and hard to pinpoint? How many have related your symptoms to a doctor in a way that was skewed, either because of your current state or failure to comply (lying)? Even when charting my moods each hour I can have a difficult time discerning what I’m feeling or how long a feeling lasts.
  • With the research that is being done around the globe, there is no possible way to have everyone on the same page. Since our knowledge of this disorder is constantly evolving, we can’t have a static understanding. Yes, both manuals are being updated currently, but how long will they reflect our understanding now when “now” becomes the past? How many years will what is written be the norm, even after we’ve learned much, much more?

So we’ve established that it is impossible for all doctors to mean the same thing when they say, “bipolar disorder,” because of the simple fact of the lack of clear definition across the board on its own.

BUT on top of that, each doctor will have a varied amount of knowledge on the subject. Each will have biases, based on the patients they’ve seen or the people they’ve worked with. Each also has a different set of tools they use in regard to assessment, like which aspects of a patient’s history they look into. Family history, substance abuse, social history, screening tools (like quizzes), each doctor goes about seeking that final answer of a diagnosis in a different way.

The biggest frustration I’ve had, is that there is not only a huge discrepancy in knowledge between doctors, but also that there is a big discrepancy in knowledge between patients and doctors.

We’ll take the example of Dr. Mustafa from the conference. He has a more broad and substantial understanding of bipolar disorder than any doctor I’ve ever met. However, his understanding is entirely conceptual. He has the overview and knows which symptoms attribute the disorder, but there is obviously a distance between his own mind and the concept.

As a patient, my understanding of bipolar disorder is inherent, I only really understand the portions I have experienced. Even then, since they are part of my experience it can be hard to separate these symptoms from myself. It is confusing, I don’t know which elements to refer to as symptoms and I look at my experiences on an episode-by-episode basis. I rarely see what is going on, via some kind of overview.

I can appreciate and understand that this is why I need this kind of doctor. He sees the situation in a way that I can’t. At the same time, when I see these doctors I don’t know where they are coming from. I don’t know how much knowledge they have, or what their experiences are, or what their intentions are.

If I knew what they knew, I could better communicate. I could use the language they use, and save myself the trouble of wading around my brain in rubber boots looking for parts that either are or are not there.

One of the biggest things I felt at the conference last week was that there is a huge disconnect between what doctors know and what patients know. I realize that doctors go through medical school and everything, but I don’t think that is exactly what I mean.

Doctors know the big picture. What illnesses look like overall, and what can happen to them if they go untreated.

Most patients are much more familiar with the more intimate details of an illness, and are often blocked by looking at the past too much or the future too much because of what is going on immediately.

Maybe I just haven’t found the right doctor, but it seems like there should be a way to meet in the middle. It isn’t that I want the knowledge to self-diagnose, I just want to understand the medical process better, and utilize it better.

How can we rely on diagnoses when they are interpreted differently by each doctor we meet? That seems ridiculous. If our doctors can’t have a more standardized understanding, can we at least teach them to communicate better with patients? Or teach patients to communicate better with doctors?

Or both?

Seeking a Clear Diagnosis

It should be said that not all doctors were created equally, and just because someone has the title of “doctor” doesn’t mean their diagnosis should be taken as gospel.

There are many reasons why a doctor might give a misdiagnosis,

  • perhaps they are experiencing a stressful time constraint in the office
  • or having a rough day/having some kind of personal problem
  • they may not have as much experience as you expect them to, or
  • their experience might not be in the area where you are seeking a diagnosis
  • sometimes the patient might keep pertinent information about symptoms quiet without meaning to
  • or the patient might keep other symptoms quiet on purpose because of embarrassment
  • the patient might keep drug or alcohol use quiet when the information would be helpful
  • and sometimes the patient enters the appointment with a preconceived notion of what they believe the diagnosis should be

For any of these reasons (and many more) you may have found yourself at some point with a misdiagnosis.

It is important to remember that when seeing a doctor, you are paying for their educated opinion. Obviously things like technology and lab tests can help greatly in various medical situations, but it is up to your practitioner to come to any final conclusions.

That said, I largely encourage seeking a second opinion in any diagnosis that could prove to be life altering.

For example, a few years ago I was diagnosed by my general practitioner at the time with celiacs disease, basically a gluten allergy. I cut all wheat products out of my diet for nine months before I was finally able to see a specialist, and within 5 minutes of sitting in his office he told me I had been misdiagnosed.

Nine months of emotional turmoil about food, and in the end it was really for nothing. Nine months without pizza, beer, and donuts (which is a big deal to someone in their early 20′s) that I will never get back!

Beyond these sorts of situations is an area that is even more tricky: mental health.

Our knowledge of the human brain has grown considerably but we’re still a long way off from understanding many aspects of it. Unfortunately, this complicates the diagnostic process for most mental illnesses considerably. Beyond the reasons above for potential misdiagnosis, there are the personal beliefs of your doctor (which can vary wildly, trust me), and the fact that each human being is an individual.

Each person is different, and sometimes our symptoms don’t fit into neat little categories. Just speaking for myself, I’ve had at least 6 different diagnoses in the category of mental health alone. The Diagnostic and Statistical Manual of Mental Disorders (the text that sets the diagnostic standards for mental disorders) is currently being updated and will be released in May, 2013. Hopefully this will help make the diagnostic process easier for mental health patients, but we’ll see.

There are some things you can (and should) do, however, to help make sure you are receiving adequate care. These ideas hold true for any kind of doctor’s visit, though here I will focus on mental health:

  1. Research your doctor. Are they specialized in mental health (a psychiatrist)? How long have they been practicing? When seeking a new psychiatrist, you can try having a short meeting with two or three to see who you feel most comfortable with. It also doesn’t hurt to ask friends or acquaintances for referrals to the doctors that they really like.
  2. Keep an open dialog with your doctor about what they think your diagnosis might be. It may take several visits before they feel comfortable making any conclusions.
  3. Be completely open and honest with your doctor about your symptoms, as well as drug and alcohol use. Sometimes symptoms are embarrassing or frighting, but they will not be addressed if you keep them quiet.
  4. It is ok to have an idea of your possible diagnosis (based on reading or previous ones) but try to avoid pressuring/limiting your doctor to specific diagnoses.
  5. Reflect on yourself. Nobody knows you better than you know yourself, so taking the time to consider your symptoms and take note of what is hindering you the most will help give your doctor a better overview.
  6. You have the right to decide what course of action to take in regards to your health. You always have a choice when it comes to which medications to take (though there is some gray area if you are under 18, in which case I sincerely hope you are still allowed the final decision), so don’t be afraid to have an opinion.

Even if you aren’t a doctor, you have a right to your own opinion. If you disagree with your doctor, do more than tell them that. Tell them why. It is important to feel like you have a voice in this process, but it is also important to (again) reflect on yourself and consider if your doctor’s words might have some truth. When in doubt, always seek a second opinion.

And finally, do remember (as mentioned before), each person is an individual. Some people will not fit into one singular diagnosis, or even two. Though having a clear diagnosis can help begin the healing process, it isn’t always possible. A diagnosis doesn’t define us, it is simply an aid in receiving treatment. In my experience, knowledge and acceptance of oneself is the ultimate goal with this process, a diagnosis is just a tool to help a little along the way.

the claims of a disclaimer

After the intense emotional purge of yesterdays post I’ve decided to write something a little less personal today to give myself a bit of break. It occurred to me that most people probably don’t have much of a clue about what bipolar disorder actually is, so I thought I’d give a little bit of an outline about it. However, I might just do what one of my recent doctors did to me -though I wont print the pages for you, just send you on over to the Mayo Clinic website.

I am not a doctor and though in my youth I considered becoming one, the sudden lack of motivation caused by a major depressive episode made me reconsider taking on the enormous task of med school. I admit, though I am not a licensed professional, I do have something that many of those professionals don’t have.

I have eight years of experience observing a bipolar individual.

(Yep, me.)

With all of the experiences I have had with doctors who practice “modern medicine”, as well as exploring other “alternative” techniques (like acupuncture) all I can really say is this:

Each individual with bipolar symptoms is different. Unfortunately, what methods work to improve one person’s health might be entirely different from what will work for the next person.

The methods I use to improve my own health may not be suitable for everyone.

I just want to be very clear about that.