This is one of the most useful articles I have read explaining the reality of living with bipolar disorder and why the disorder is so extremely variable in different people.
Typically, people think of bipolar disorder as manic depressive illness, with crazy highs and crashing lows. But our emotions are much more complex than that. For example, someone may have varying episodes of high energy, but this high energy may coincide with a deadly, irritable depression, a miserable episode of agitated rage, or the more stereotypical euphoric mania of feeling fantastic, talking and thinking fast, spending a lot of money, having a lot of sex, drinking too much and driving too fast. If you look at the graph above, you can see how the high energy waves can intersect with any of the positive or negative affective states. This explains to people the concept of Mixed Mood States, probably the most common states in bipolar disorder, variations on Energy level and Mood states.
A third wave to think about this is extremely helpful is that of Intellect or Cognition. How fast or slow are thinking processes? Are thoughts racing, or so sluggish you can barely speak? Is word-finding difficult? Do you sit in a stupor? How clear or confused are your thoughts, your ability to make decisions?
Another factor in understanding one's bipolar disorder is the rate of change: how long or short are the "episodes."? Traditionally, Bipolar II involves an episode of hypomania that lasts four days to a week. Hypomania is not quite as severe as mania. Immediately following is depression. The higher the mania/hypomania, the greater the crash of the depression. Mania is exhausting for the brain and the period of depression is its chance to heal and rest, which is why a patient should take care of their depressions and not push too far too fast.
Controversy exists about the relationship between Borderline Personality Disorder and Bipolar Disorder. One cited difference is that Borderline mood cycles are extremely rapid, lasting hours or minutes. Witnessing borderline mood fluctuations is mind-boggling. Rage predominates, as does a terrible fear of abandonment, usually due to invalidating parenting. But when I went to a recent conference on Borderlines, I realized the differences are shrinking, partly due to a desire for larger insurance reimbursements by providers. Most Borderlines, too, suffer from traumatic histories. Borderline as a cross between PTSD and Bipolar seems reasonable. They respond more like Bipolars to Mood Stabilizers than anti-depressants. And now, of course, Borderline has it's own oh-so-fashionable Dialectical Behavioral Therapist which is merely CBT plus mindfulness and -- surprise-- seems to work for everyone!
9 comments:
Some of the symptoms you speak of are similar to what I process. The difference is that I don't respond to medications well. But that makes sense since my symptoms are not precipitated by chemical imbalances. And trying to check a particular chemical for a desired result just exacerbates other issues for me. When my thoughts race it's more like being adrift in an ocean, a flood of information due to overwhelming circumstances that's threatening to drown me out, and I find myself reaching for any twig or driftwood of a thought to keep me from going under. And when I'm slow it's because connections aren't being made quickly enough to get the information through. I may come up with the response to a questions five minutes after it's been asked and the conversation has moved to a completely different topic. Medication doesn't help, but I've developed a few internal and sensory controls that help keep me somewhere in a middle ground more often than I find myself in the extremes. I do cycle but not nearly as quickly as you describe, and the overlapping high energies with negative emotions... I hate myself during those overlaps. It makes me feel unstable and maniacal, and I'm not a very pleasant person to be around. I tend to self isolate when I hit those states. When the high energy overlaps with positive feelings, I'm irresponsible and irrational. I don't particularly care for that either, especially since any trigger can push me the former without warning. I tend to self isolate then too, and make sure I "lose" my debit card and don't go out shopping. Maybe that's why I run myself ragged all of the time. When I'm exhausted I don't have to worry about either of those two scenarios. I'd rather deal with the frustration of being slow on information retrieval.
Whoa! That is so exhausting! Mood disorders are so difficult to medicate. Note my recent Lithium overdose. PTSD wreaks havoc with moods. Most PTSD patients I know have the same complaints about medication. It's as if the toxic experiences made all medication toxic as well. You can have PTSD and a mood disorder, which it sounds like you do with all the miserable highs that are low and lows that are high. PTSD causes brain changes, so even though it was caused by external events, it can in many cases respond positively to medication, usually in the categories of mood stabilizers and antidepressants. But for some, it's just the hard work of coping skills. I'm trying to post more about coping skills because I think they can be life saving.
Yes they are.
Querulous, knowing about bipolar individuals, do you have any experience with, or have you experimented with willful (intentional, specific) self-adjustment of mood swings?
For example, if you are euphoric, can you convince yourself that there's no reason to feel that "overly high" and bring yourself down to reasonable levels?
ON the other hand if you're feeling depressed and dull, can you convince yourself there's not any reason to feel that down -----and actually have those thoughts change your mood closer to normal?
Both of those extremes require an individual to be coherent, alert and capable of identifying what is happening so the "self-instruction" can be applied. Would those individuals have to be diagnosed as only mild cases of bipolar?
What you are describing is the essence of cognitive behavioral therapy. For example, if you are feeling racey and irritable -- a bad manic -- you make yourself engage in relaxing, soothing, meditative behaviors. How well it works depends on both how sick you are and how skilled you are. One of the reasons bipolar is so miserable is that you rationally know your life sucks but you can't stop the euphoria. You rationally know your life is great but suicide is all you can think about. Strategies for that might be reaching out honestly to others. There is a very mild form of bipolar: cyclothymia that is very common among writers and artists. The cognitive approaches are most likely to work for them. On the other hand, for me, when I'm hypomanic, it is a physical and brain excitement I can't talk myself of. My depressions are the physiological come-downs from having been in a manic state. We are all so very, very different. Dialectical Behavioral Therapy, a type of CBT, also has good effects and there are many self-help books on it. I hope that answers your questions adequately.
My highs and lows are literally like someone else has taken the steering wheel. I know I don't like where I'm headed but I can't regain control of the vehicle that's taking me there. Dissociation is fun like that.
Querulous, thanks for that excellent explanation. That sounds like what I was describing to you. Sometimes I do wonder, being a writer and artistic person.. ":) Thanks again, your explanation is quite logical and sounds familiar ":).
Dissociation is a unique gift that way. If you've been able to make friends with it over your life, you can feel confident that you are in basically good hands.
Ray: Touched with Fire by Kay Redfield Jamison is helpful in its descriptions of mild mood disorders in artists through history.
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