Tag Archives: diagnosis

A Live/Work Balancing Act

I’ve been very lucky, to some degree, with this new job because even though it is full time, there is an element of flexibility to it. The hours are not exactly set, which means on a day like one I had last week when I woke up feeling horrendous, I can go back to sleep for a couple hours and see how things pan out the next time I open my eyes.

With bipolar disorder, I feel a lot of the time like opening my eyes after sleeping is something of a lottery.

I don’t know how it is for most, but  I would say that at least 75% of the time, I feel better after sleeping than I did the night before. That other 25% of the time, though, if I don’t get enough sleep, or if my sleep is full of bad dreams or waking up every 30 minutes, I wake up with the wrath of bipolar hostility sitting on my chest and within moments I can tell something isn’t quite right. That unruly jerk sitting on my chest bangs a spoon on a kitchen kettle until I am ready to strangle it.

In the past it has been common for me to respond in this way when awoken in the middle of the night from a deep sleep, it is like some kind of murderous being appears and takes my place (we call her Sleep Sarah and she is a bitch). 

Every once in a while on the verge of or on the tail end of an episode she follows me out of sleep in the morning, and I instantly know that going out or being around people is the worst possible idea I could have. The only real solution is going back to sleep, rolling the dice, and hoping some other mood is present the next time I open my eyes.

One of the days last week (and honestly I can’t remember which because they’ve all become a blur at this point) I woke up with the stomach ache from hell, and Sleep Sarah was right along side it. Normally at 5:30 in the morning it is hard for me to discern how level-headed I am feeling, but right away I knew something was seriously off. I went back to sleep for two hours and then felt infinitely better, so I went to work late.

I am extremely grateful that I have the ability to make these sorts of decisions with my new job, but it opens a door into something I am not particularly familiar with dealing with. In the past I have often opted for placing a heavy amount of weight on working, and just a pinch on taking care of myself. Looking at it now, that could be why I have had trouble with such intense burnout.

It is difficult, though, and I am sure many of you have experienced this, when your boss or manager is the sort of person who considers illness a weakness of character, or has (possibly from dealing with untrustworthy employees constantly calling in “sick” in the past) a serious skepticism for anyone who claims they might be ill, to feel justified in taking care of yourself. Being in an environment where taking care of yourself is constantly considered the wrong thing to do, knowing how to go about taking care of oneself in a reasonable way seems backwards and can be difficult to learn.

I know I’ve talked about this before, but I think this sort of thing makes a huge contribution to how people feel about themselves and things like mental illness, after all if someone has told you for years that being sick means you are weak or that people who take time away from work because they are sick are awful employees who are not to be trusted, you can be damn sure the people on the receiving end are going to do everything they can to hide the fact they have a mental illness and will probably (to put it bluntly) treat themselves like shit because of it too.

Anyway, a lot of that fear still lives inside of me. I may not be afraid anymore that people hear the words “bipolar disorder,” and I may feel a little less guilty for taking time to take care of myself, but I can’t seem to curb the nagging feeling that once theory becomes practice (if I have to miss a lengthy chunk of work, for example, because of an episode) that I might be pushing my luck too far, and suspicion and anger might make their way into the minds of those that have told me to “take care of yourself.” I realize that this is probably unlikely, but it is the only response I’ve ever experienced up to this point and it can be hard to imagine a different one occurring.

In the meantime, getting the work done and taking care of myself has become something of a balancing act, and I am extremely grateful to begin working with a new therapist this week to help me navigate it.

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A Diagnostic Swamp – Defeated

The question of my diagnosis (at least, my particular bipolar diagnosis) has been something that has been under discussion for a long time. A lot of what I wrote in the early stages of this blog was centered around attempting to discern my true type, and if there was, in fact, one for me to fall into. After a time I gave up and forced myself to stop thinking about it because trying to recall episodes and memories was a tad too overwhelming to allow me look at things objectively on my own.

This issue suddenly came back up on Monday when I scheduled an appointment with a local psychiatric medication research team. My intention was to talk with them about what they do and how I could potentially fit into the research they are conducting around bipolar disorder, but upon making my appointment I was told that there would be a psychiatric evaluation and full physical to determine my eligibility for any of the current studies at the time of my appointment.

I was immediately filled with dread, something about the words psychological evaluation always send a jab straight to my stomach that spreads up through my chest. All at once I was terrified that the answer to the question I had been asking myself for years, my final bipolar diagnosis, would be revealed to me. Sure, it could mean a sort of closure or silencing of the nagging caused by not really knowing, but it could also mean having to face a series of specific words. What if those words felt defining? What if all of the research I’ve done has led me in the wrong direction -what if they weren’t what I was expecting?

Already nervous on Tuesday when I arrived at my appointment, what little enthusiasm I had vanished the instant my evaluating psychologist walked in the door. It was a man, and though my usual psychiatrist is a man, I have spent enough time with him that I am able to trust him at this point. Most men, however, I have zero trust for by default, something compounded exponentially when they work in the medical field. My anxiety gets too high and I have trouble being open with them when I first meet them, and I instantly took this as bad news for my psychological evaluation.

To my delight, however, he turned out to be quite the sarcastic oddball, which promptly brought him from intimidating straight down to nerd-level where I knew he wasn’t a threat. My body relaxed, the nervous jitters slowed, and I said, “just a minute, I brought some visual aids!

I showed him the color-band chart and as I hoped, he was delighted.

Right away he asked if I was type I or type II.

“I’m not sure, to be honest,” I said. When he began describing the difference to me I could only shake my head. “No,” I said, “I understand the types. The trouble is that this is tricky.” I didn’t want to rant about how different doctors see different things in me, something like a kaleidoscope. How I don’t know how to best get the truth across, or how there are periods and episodes where I genuinely can’t remember how much time had passed, or how I felt when they did.

We spent an hour while he deduced. He asked me questions about past manic experiences and lit up like a little boy under a Christmas tree when I told him about running away from home to live in the woods. About hiking for 8 miles a day because it was all I could do to keep from being engulfed by the energy. About feeling like a werewolf (yes, I had a psychotic manic episode where I thought I was a werewolf).

To these things he replied, “you have fun ones.

“You’d think that, wouldn’t you,” I said. “And actually,” I added, “they were all pretty fun at the time. Less fun, though, after.”

This is where the trouble always comes from in these situations, because the duration of these episodes vary. Many of them, the most intense portions may last for a couple days, but as I mentioned, there are many areas of my memory which are blank, and many times (like when I lived in Colorado) where time is not accounted for.

That, and the odd 2nd hospitalization where I excitedly convinced a woman to admit me to the psychiatric ward of the Boulder Community Hospital, and then after several hours I excitedly convinced her to let me leave again. My recollection of this situation and the lack of my recollection of the surrounding period of time leads me to believe that I was in the midst of either a mixed or manic episode (though I expect manic based on the manner in which I entered and exited the hospital), recognized it, and tried to seek help -only to be greatly un-amused once I entered the hospital, so I left.

Like I said, it is tricky. There are wild cards, and I don’t know that I remember things right, or at all.

“Bipolar type I, most recent episode mixed,” he concluded, scribbled it on his sheet, and moved on.

I left the facility feeling overwhelmed. Conflicted. Type 1? Are you sure? But he just met me, could that be right?

I mean, I was glad for an answer, but was this the right answer? After all, I had also once been given a bipolar type II diagnosis (many years ago), and another time a bipolar NOS diagnosis (a bit later). I only discovered these by reading the old files from prior hospitalizations. Nether of the doctors had spoken to me about why they diagnosed those things, or asked me questions about what I had been feeling. Their diagnoses were based largely on the feedback of others, while I was completely unaware of both the diagnoses and what bipolar disorder was at all.

Still, I had honestly expected his conclusion to confirm one of those two diagnoses, and I most expected NOS.

This whizzed through my head as I kept second-guessing what this man had concluded. My mistrust grew again. On top of that, I didn’t know if I wanted to be in a research study, especially since the study is for people with bipolar type I. What if I’m not? What if that is what I am today, will that still be me tomorrow?

Honestly, I was so confused that by Wednesday morning I couldn’t write a blog post. I had too much to say with no answers, or at least, no answers that I trusted.

(Paranoia, my psychotic symptom of choice, can you tell?)

I am extremely lucky that I had an appointment with my usual psychiatrist on Thursday or the whole thing might have gotten the better of me. I concluded I was going to walk into his office, tell him I wanted to take a break from trying new medications for a bit (at least for a month to give myself a rest after the trileptal fiasco), ask his opinion about the idea of me participating in a research trial, and to politely request he clarify the diagnostic swamp I had suddenly found myself in. After all, he had been seeing me for over a year, so if anyone would be able to get a good sense for my symptoms to make a diagnosis, he could.

You might wonder why I haven’t approached him sooner about this… and in honesty, I might have. My memory doesn’t work much anymore, so it is possible we had this conversation already. And if not, it would be because of

a) the aloofness of psychiatrists in general
b) my overwhelming anxiety about asking
c) my lack of trust in medical professionals

It would be fair to say this mess is of my own making, but even so, when I walked into the waiting room Thursday my anxiety was fast approaching panic attack level. For the first time I found myself feeling grateful he was running late, and spent the extra 15 minutes pulling myself back down into a relatively calm, only slightly-shaky state. I still had to clear my throat a few times too many before getting any words out when I entered his office, but the enormity of his windows (which I always find baffling) helped stun me into conversation.

First, he suggested I take a break from trying anything new.

He read my mind, I thought, this is clearly a good sign. We are totally on the same page!

So I asked how he felt about me doing a research study.

“You have tried SO many medications, I think that is a great idea,” he reassured me before telling me he has a high opinion of the man who runs the research facility I had visited Tuesday. “It would undoubtedly give you access to medications I can’t provide to you, and I heard they are researching several promising ones right now.”

Great! Two for two!

“So,” I went in for the final question, letting it out all in one breath, “I met with someone there and I just hoped you could clarify something for me because he gave me a bipolar type I diagnosis. I was wondering, since I have also seen possibilities for type II or NOS, if you would agree type I would be accurate for me.”

He looked stunned. I’ll never forget it, he actually sat back in his chair like something knocked him there, and then he blinked as if coming out of a stupor.

(And this is the part where I am pretty sure we must have had the conversation before, because he looked genuinely surprised…)

“I have considered you type I since the first day I started treating you,” he said, “and I am genuinely sorry if we haven’t talked about it before now. But yes, I agree with him.”

This time I felt relief.

By this point I had stopped caring what the diagnosis is, as long as I could get a clear answer from anyone. I feel like I’ve gotten the run-around for a long time by many doctors I’ve seen, and it did appear as if he was genuinely either concerned (because we’d already had this conversation) or sorry (because we hadn’t), which either way made me feel much better about the situation.

He said that it is the nature of my manic moments (the fact that they are intense and psychotic) that has led him to this diagnosis, and when I look back on my most recent episodes, their length may be as short as they have been because when any whisper of mania comes on I quickly bombard it with intense antipsychotics and forced sleep. It is likely at this point that if left unattended (as my episodes were previously) they would be as severe as they were in the past, possibly even more so.

So, that makes me two for two this week.

And that, would be just a portion of my intense week in a nutshell, as I find myself inducted into the bipolar type I club.

I don’t know that this is where I ever expected to find myself, but for me a diagnosis is just a tag, just a business card I can pass on when someone needs to know more in a hurry. It doesn’t make things feel any less complicated, and it doesn’t change the fact that none of the medications I’ve tried have worked out. What it does feel like is validation that someone has recognized that I have a genuinely hard time living my life, and acts as something of a reminder that the things I perceive to be my failures are sometimes outside of my control.

 

 

It has been 9 years, 4 months, 3 weeks, and a pocket full of change since my first hospitalization. It is almost funny that I didn’t wind up with this fortune cookie until now.

Mood Charting – The Color-Band Mood Chart

As most of you who have been reading this blog for a while know (and for those of you who are new comers, I expect that makes this an introduction) I am probably more than a little bit obsessed with my mood charting. 

Since my last round of mood-charting posts (Chart Week) I’ve been introduced to another charting technique that is seriously tickling my fancy. I spent the better part of my weekend translating a block of time from my earlier charts & data to compile a chart using this new technique to get an interesting new overview.

This technique was inspired by a friend who is tracking the sleep patterns of her new baby by shading in areas on a grid of squares. Her chart is hourly, but it struck me to make a daily chart with the same technique. Instead of shading in or not shading in a square to denote action, I’ve chosen a series of colors to reflect what action has taken place.

The result looks something like this:

March 2011 - June 2012

Color-Band Mood Chart, March 2011 – June 2012

Each band represents a month, with each square representing a day. You can see that some days are broken into two or three pieces, and that is because those days contained sometimes two or three easily distinguishable periods of different moods.

The breakdown of the colors is as such:

Dk Blue = severe depression
Lt Blue = mild-moderate depression
Green = stable/normal mood
Yellow = hypomania
Red = full mania (possibly including psychosis of some kind)
Brown = moderate mixed episodes
Black = severe mixed episode (possibly including psychosis of some kind)
Empty = no data available

Needless to say, it becomes very clear that the first few months shown on this chart were no walk in the park. There is a pretty big shift you can see in October 2011 where I began having my first big chunks of stability that I had in months (in fact, far beyond what is shown here). I’d be willing to venture that played a large role in the birth of this blog, as that is when it began.

It appears that cycling has began slowing down as well, which is definitely a good thing (more full big blocks instead of little choppy ones) though things were definitely shaken up again down at the very bottom in June, last month, when I began taking Trileptal.

It can be difficult for me to see patterns in mood charting with the traditional line graph -primarily periods of episodes. By classifying my mood ratings by the type of episode I am in at the time and placing them side by side, it become much easier for me to see periods of several days within one mood, or where one mood continues through several chunks broken up by a day or two with a different mood.

Since the DSM classifies episodes as a block of time with the majority of days in a period of time in a certain mood, the color-band mood chart has definitely helped my understanding of the length of my episodes and how they interact with one another.

One of the conundrums I have is that I do not have many squares containing red (full manic moods), which means I technically would not have enough to quantify a “full manic episode” (which must take place over a number of days) and therefor would not qualify me for the the diagnosis of Bipolar Type I. However, the fact that these manic moods occur at all means (as far as I have been told) that I do not qualify for the diagnosis of Bipolar Type II (where full mania is not present). This is a situation where I am hoping this chart will help my medical team’s understanding of what I deal with on a daily basis.

The best part, I think, about this charting technique is that all you need is some graph paper and some colored pens or pencils. Heck, even crayons. If you are starting this fresh and coloring one square daily, it may take a while before you have any significant chunks of information to look at, but it is easy to use any past data from other mood charting techniques to create one of these charts with information you’ve already gathered!

As I mentioned, I am totally tickled by this. I am going to bring mine to my next appointment with my psychiatrist (Thursday), I am hoping this will give him a better overview as well since we’ve both been struggling a little with the sporadic nature of my episodes. I’d really love it if someone else wants to throw one of these together and either write a post about it or shoot me an email, I’m really just curious to know what someone else’s chart would look like!

Making a Map

I know I have been talking about this a lot lately, but honestly I am a little surprised at how much of a difference creating a sort of road map for my symptoms and episodes has been making for me. It has made the whole gamut easier, from trying new medications (and seeing if I am experiencing a change or not in my symptoms) to knowing when to say no to participating in stressful events (and thereby avoiding aggravating my anxiety).

Sometimes I get stressed out because I like to know myself, but there are times where I have felt like I didn’t know myself at all. Feeling like someone else (just an elusive someone, nobody in particular) has been overwhelming in any number of ways, and it is something that if I think about too hard I wind up feeling ten times more mad than I probably really am.

The trouble is that I knew myself, but I didn’t know the part of myself that was experiencing bipolar episodes. Depression is something that has a long history for me (going back to 13 or 14 years old, if not longer) so it is something I have been fairly familiar with, but the introduction of things like psychosis or full-on mania has been confusing as all hell.

Getting to know this portion of me has been interesting, to say the least, though extremely helpful and not quite as scary as I once had imagined. In any case, I’d recommend it.

I spent about 10 years having episodes, getting caught up in them and confused, and then feeling triumphant and forgetting about them as soon as they passed, so I didn’t spend much time learning about what they were or how they worked. I know there are people out there who have experienced this sort of thing for a long time but haven’t really wanted to turn and look these episodes in the face. That is totally ok, nobody can force you to do anything to learn about it, but from my experience the knowledge really does make things easier.

(Yuck, I feel a little bit like a commercial here!)

Also, there are those of you who are new to bipolar episodes and may have this overwhelming feeling that you don’t quite feel like yourself all the time anymore. Or, maybe you feel like an enhanced, really awesome version of yourself sometimes, but a stranger at other times. I really tried to keep a distance for a while between myself and these other sorts of… episodic occurrences of me, but that meant they were free to cause whatever mayhem they wanted. This might sound a little nutty, but now that I know how these episodes operate, I am able to negotiate with them better and find a common ground.

What has helped me the most with the understanding of bipolar disorder (as I experience it) is creating a map.

The map lets me know what to expect when I have an episode. It can help me notice an episode coming on, or that one is worsening. Basically the map is information about you, the different sorts of symptoms you have when different episodes occur, how long a typical episode is, how frequent, and more. Once you have a good idea of what to expect (which I call a good map) you can step into a place where you have a bit more power over what happens. That might mean predicting an episode before it is fully present, being able to take specific medications or talk to your doctor before an emergency occurs, or avoiding situations that will exacerbate your current state.

I know this sounds simple on one hand, and possibly a little ludicrous on the other, but it has really helped me, -a lot.

You might think this sounds all well and good, but how does one get from point A to point B? Or from somewhere in the middle to point B?

The catch is that this knowledge is not immediate. It takes time, but if you pay attention you probably don’t have to do much more than that, after a while it becomes easy to connect the dots on your own.

One thing that has really helped me is Mood Charting, something I talked at length about during Chart Week a few months ago. If you want more detailed information, doing a search for Chart Week here should give you more than enough.

What helps me in mood charting is that I don’t just track my mood itself, I also track what symptoms I am having, and when. I can reference this information to put together what symptoms happen early on in an episode, and can help me distinguish a low-level mixed episode from a low-level depressed episode (for me it is irritability and energy level that mark the difference).

Now that I know that irritability is an early warning sign of a mixed episode for me, I know not to go out on the town if I’ve been feeling irritable earlier in the day.

Mood charting is also great for understanding how long your episodes last, and how frequently they occur. There are a few people I know who experiencing cycling that they could set a clock by, while others (like me) cycle almost entirely at random. Are you someone who can count on an episode to be two weeks long, for example, or does it fluctuate? Are you stable for a few weeks at a time, or do you go straight from one extreme to the other without stable periods?

Journaling is a great tool for understanding what symptoms are associated with which kinds of episodes as well. I have a hard time re-reading journals, but many people find them very helpful.

It may well be that you don’t know what your symptoms are. Or, you know you feel something but you can’t quite put your finger on it. This is an arena where I really like to journal, because you can describe your symptoms however you like. I like to give mine names (if I don’t know the real name) and I also give the types of episodes I experience names as well, depending on how they make me feel. It might sound curious, but check out any posts involving “crazy girlfriend” for an example.

For a very simple exercise, I like to wake up and try to distinguish how I feel right off the bat. Am I leaping out of bed? Am I begging to go back to sleep? Is this normal for me? How do I feel? It wasn’t until a month or two of doing this that I recognized that my moods in the morning are significantly different than the moods I have in the evening.

As I said before, this isn’t something that one can really learn over night, but practice makes perfect …improvement. Setting up a map with signs for yourself to see what is coming can be very helpful, and can definitely give you an edge when dealing with bipolar episodes.

To me, the best part about learning about my symptoms and episodes is that it has helped me distinguish the emotions I am having as unjustified when I’m experiencing them in an episode. The emotional part of bipolar disorder is what has yanked me around the most, and not knowing when I could trust my emotions and when I couldn’t was extremely frustrating and detrimental. If I can identify a mixed episode before I start being ultra rude to those around me, I’d classify that as a win!

A Biopsy, Emotional and Otherwise

About a week ago I visited the dermatologist for the first time. I wasn’t really sure what to expect (getting poked with cold metal sticks? A giant skin magnifying glass? Maybe I watch too many science fiction films…) but I knew I wanted to ask a few questions.

After my general skin questions were answered (yes, the dermatologist said the most likely cause of my acne was the lithium I have been taking the last two years, surprise surprise) I asked about moles. Who should get them checked? When should they be checked? How does it work?

Instead of telling me she just began to look at them, and then quickly decided (though I am not at big risk for skin cancer, living up in Seattle where the sun never reaches my skin anyway) there was one mole that she wanted to biopsy.

For those of you (like me) who have never been to a dermatologist, biopsy just means they want to cut it off and study it, apparently.

I had no problem with it, jumped up on her table, she did her thing, and I walked away with one less mole.

The thing was, though… as I walked to the bus I found myself feeling increasingly alienated.

This is the first physical piece of me, I quickly concluded, that has ever been removed. Well, apart from teeth. But really, how often is a slice of your physical being removed?

Nausea crept in, and by the time I reached the bus stop the world began spinning and I had to collapse on a bench, sharing it with a silver life-size cast-iron statue of a naked man.

Over the course of the last week, this horrified feeling about a portion of me being taken has returned any time I needed to clean the area and replace the dressing.

After thinking long and hard about it, I don’t know that this is necessarily an unfamiliar feeling. True my horror and slight up-chuck reflex is a bit more present on the physical side of things, but that mental feeling of something being taken is what really bothers me the most.

I can’t help but wonder if anyone else has associated this feeling of loss, or damage to one’s being in response to receiving a diagnosis of mental illness?

I don’t remember many of the moments where I have been handed a new diagnosis of mental illness, bipolar disorder, OCD (which I remember slightly I think), PTSD, the anxiety disorder… but I do remember a range of different feelings upon hearing these things.

Initially;

  • Disbelief
  • Skepticism
  • Excitement (as weird as that is, I found it exciting to have potential explanations to what I was dealing with)

The same reactions I had when I heard the dermatologist wanted to remove my mole.

It wasn’t until the moment I’m alone and faced with whatever obvious wound remained after the discussion;

  • Racing thoughts
  • Depression
  • Panic Attacks

Suddenly I could see it in the face, this oozy, gross place, uncovered by the emotional biopsy done by whatever psychiatrist, Doctor X. 

And my response is the same as looking at the place where that mole was. Horror, a grimace, and the overwhelming nagging feeling like I have just been robbed of a piece of me. A piece of what would have been a normal life, perhaps.

What confuses me the most is that I’ve had time to look at this yuckiness enough to get used to it. The emotional yuckiness, anyway, -the mole thing still grosses me out. Over the last 10 years, I’ve had time to adjust (though, somewhat slowly) to living with this “missing piece” or “wrong piece” or whatever one might call it (maybe just an odd piece), and it is something I’ve integrated into my life.

So I admit, when the mole biopsy happened I didn’t think right away of that old emotional biopsy of a mental illness diagnosis. My thoughts went straight for the idea that there may be one day I could go to the doctor who would do an emotional biopsy that slices off my bipolar disorder. They will check it in the lab, and I will receive an envelope in the mail that says everything went well.

If these irregularities in me are removed, would I react in horror? Would I feel overwhelmed with the notion that a part of my being was now lost, the way I felt about a little meaningless brown piece of skin?

They say the mind grieves when a diagnosis of mental illness is given because of the loss of a life and many dreams that will no longer realistically happen. We have to adapt, to evolve as our lives continue -with whatever comes our way.

So would the mind grieve the loss of mental illness if it was suddenly removed? Absolutely.

Part of me feels terrified to think about that, but the answer is just the same as in the opposite situation. We adapt. We evolve. Life continues.

So I will adapt and evolve with my (minus one) mole situation. Maybe I’ll be gifted a really cool scar, but until then I’ll just keep cleaning it and throw a dab of ointment on there.

Discovering Harm OCD

I’ve just stumbled upon something I’ve never heard of before.

I’m sure I mentioned this before, but my first diagnosis was one of Obsessive Compulsive Disorder (OCD). I am fairly certain I was already experiencing depressive/hypomanic episodes by that point, but it wasn’t until I was given an antidepressant for the OCD that I began having the psychotic episodes that resulted in the Bipolar diagnosis.

My understanding at the time of how these things (these things being diagnoses) worked was that my Bipolar diagnosis cancelled out the diagnosis of OCD -in fact, I never dreamed that I could be lucky enough to be blessed with both (and then some).

This is why my most of my understanding of OCD is quite stunted. I never took the time to research it the way I researched Bipolar Disorder, and for years I am sure I claimed that even if I experienced both it was the Bipolar Disorder that was making my life hell. The more I learn about things like anxiety and OCD, the more I am finding out I am wrong.

So this is a true “Eureka!” moment for me, because when I was reading Variety’s review of OC87 (something I am going to talk a bit more about next week) I stumbled upon the following lines,

“The pic’s title comes from what Clayman considers his watershed event: the 1987 arrival of an obsessive-compulsive disorder that shut down his remaining social skills, bringing with it an intense anger and violent thoughts he’s constantly afraid he’ll act on. (Unlike most people, “Harm OCD” sufferers have great difficulty grasping that negative thoughts won’t equal actions — even though, as in Bud’s case, they never actually do act on them.)

I was struck by lightning. Harm OCD? What is Harm OCD?

Harm OCD is apparently one of the major components of what I’ve been dealing with without knowing what it was called, or that it was linked to OCD.

The obsession around staying in control and attempting to avoid hurting others (pretty much at all costs) comes from barrages of repeated violent thoughts.

In my own case, there was one point where I was having extremely disturbingly violent nightmares and became so terrified that I would carry out the violent acts that happened in my dreams that I refused to leave the house for several days. Apparently, this is a classic Harm OCD scenario.

The fear is of impulse, that I could unknowingly or unintentionally do something that causes anyone else (or myself) harm. I don’t even like going on balconies because I become terrified I might throw myself off of one for no apparent reason (even if I’m not feeling the least bit suicidal). Irrational? You bet.

The feeling for me is very much like this nagging anxiety that I might just snap at any moment, and the more prominent it is, the less likely I am to be around others or go outside or chop some vegetables.

The most interesting part for me, though, is that I don’t know that this fear, for me, is entirely unwarranted. I mean, obviously I’ve never snapped and done anything particularly brutal to anyone, but when I was younger I did have a pretty intense temper with some pretty explosive blowups. At the same time, I have had mixed episodes that have removed my sense of control, and left me doing some pretty bizarre things.

So is this obsession unreasonable? I don’t know. Out of proportion, definitely yes.

Something to ponder for the weekend.

You can read a little more about Harm OCD here…

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!