Bipolar Disorder

I have given a lot of thought to bipolar disorder over the last day, since I have been asked to blog on it. One thing that I have noticed about the disorder is that it is the new trendy diagnosis is psychiatry, along with Aspergers disorder. Ten years ago I noticed that ADHD also had its moment of fame. Many of my adult clients, who were children ten years ago were diagnosed with ADHD and it significantly and negatively altered their lives... Many of them didn't have ADHD, they were just boys! (See "Raising Cain", and excellent documentary on this phenomenon, PBS.com). I fear that in many ways a diagnosis of bipolar is following the same trend.

Maybe I should highlight my personal bias: I rarely diagnose people in my practice of psychotherapy. In many instances, I find diagnosing people with a disorder to be counterproductive, since many people will conform themselves to a diagnosis and become dependent on that diagnosis. For example, I had a client who was diagnosed by another practitioner to have borderline personality disorder. This client began to use this diagnosis as an excuse to avoid personal responsibility. I attempted to resolve the clients thinking errors of "I can't work anymore because of my severe problems with emotional regulation and distress intolerance". The client hadn't a problem working before the diagnosis, in fact, the client was a very successful accountant.

Anyways, back to bipolar. Although I feel clinicians should be rarely diagnose their clients, it is necessary, at times, to establish a good working treatment plan, but a clinician should focus on the treatment plan, not the diagnosis. When a client suffers from bipolar disorder, a good combination of medication and psychotherapy needs to be utilized. Oftentimes, someone suffering from this issue will only utilize one or the other, more often taking the medication route over the psychotherapy route. The combination needs to addressed, because a client who has bipolar often has a chaotic environment and disruptive interpersonal relational style.

I have also found, as with many other psychiatric disorders, bipolar is misunderstood. Although, I feel that it has recently been over-diagnosed, I also feel that many who truly have this disorder have minimized it. Here are some misconceptions:

1. Everyone has their ups and downs, so mine aren’t that serious.

Yes, everyone has good days and bad days, but when these ups and downs seriously interfere with your ability to work, relate to others and function effectively, it is advisable to seek out a psychiatrist.

2. Bipolar disorder is a mood disorder.

Half true. Bipolar disorder certainly affects mood, but it also affects cognition and the ability to perform mental tasks. Some days we can out-think Stephen Hawking. Other days we make Forrest Gump look like an intellectual.

3. Yes, but bipolar disorder is still a mood disorder.

Granted, but for most of us it is also part of a package deal that may include anxiety, substance and alcohol abuse and sleep disorders. Also, researchers are finding smoking guns linking the illness to heart disease, migraines and other physical ailments.

4. Bipolar disorder is characterized by mood swings ranging from severely depressed to wildly manic.

Not necessarily. Most people with bipolar disorder are depressed far more often than they are manic. Often, the manias are so subtle that they are overlooked by both patient and psychiatrist, resulting in misdiagnosis. People with bipolar disorder can also enter long periods of remission.

5. Mania is like being on top of the world—if you could only put it in a bottle and sell it.

You wouldn’t want to with most manias. True, some forms of mild mania are characterized by feelings of elation, but other types have road rage features built in. More severe mania turns up the heat, resulting in different kinds of out-of-control behavior that can ruin your career, relationships and reputation.

6. Bipolar disorder is caused by a chemical imbalance of the brain.

This is the simpler explanation—what you tell your family and friends. What you need to know is our genes, biology and life experience make us extremely sensitive to stress. Various stressors, such as personal relationships and financial worries, have the potential to trigger a mood episode if not effectively nipped in the bud.

7. Medications are all you need to combat bipolar disorder.

False. While medications are the foundation of treatment for bipolar disorder, recovery is problematic without a good lifestyle regimen (diet, exercise and sleep), effective coping skills and a support network. People with bipolar disorder also benefit from various forms of talking therapy and religious/spiritual practice.

I will make more comments on this in a future post... I've got to get some sleep!