Friday, March 15, 2013

Lucid Analysis – Trials in Therapy: Everything Sucks


I just want the world to stop. I am SUPER snarky, angry, and irritable about EVERYTHING. Everything. Snarky Haven is at least funny. Angry, irritable Haven is a landmine waiting to take out large populations of unsuspecting general stupidity.

I had a lot of catching up to do with Therapist because I missed therapy last week so it’s been 3 weeks. I missed mostly because my car has been in the shop and I’ve had a screwed up ankle so I’d been relying on other people for transportation. I had a rental for a little while but holy crap expensive. So where did I leave off with my life updates?

New Girl? New Girl is gone. I did go out with her one more time. However after our first date she ended up having to check herself into rehab because she had a relapse (Painkillers from two very bad car accidents that her doctors didn’t regulate her properly on, not like heroine or anything). She had been super need, and emotional, and assuring me she wasn’t like this and would feel better when she was out of the hospital. I don’t know if it was some kind of morbid curiosity or if I’m just a glutton for punishment but I agreed to go out with her one more time. She wanted to get dinner and go to a movie. Harmless enough. I met her at Penn. I was super irritable waiting for her then the second she showed up it was mood change to smiles. We went to a nice pub. Had a couple glasses of wine, which I definitely needed. She said all kinds of things, stepped all over me trying to say anything at all, the whole time my tipsiness and my need to make people feel accepted and happy taking over and letting her believe that that the way she is, is what I could value in a partner. I did draw the lines at a few things, but not enough to actually feel like I was being honest with myself. Then we went to the movie. First of all, she started to change her mind about going at all because she wanted to continue drinking and talking. For me, I needed to see that she was at least a tiny bit capable of doing something she said she would do. I need some margin of stability and reliability. If you say we will do something, can we please just do it? So we went to the movie. And I had it. She committed just about the worst sin of all the sins. And I don’t even believe in sin. She talked through the entire first half of the damn movie. Talked. Through it. HATES IT WE DO! Then she fell asleep through the second half. I let her sleep.
A day or two later we talked. I told her that this wasn’t working for me in the most tactful way I could muster. I really liked her, but I didn’t feel like I could be myself and things were too emotionally intense for me too quickly. I liked her, but I didn’t see this working. Blah blah blah. She was understandably stunned. Her responses were short. And then she started to get snippy with me.

Her: “I think the line you’re looking for is ‘It’s not you, it’s me.”

In my head: It’s not me at all, It’s all you.

Me: “No actually, it isn’t just me, it’s both of us.”

Don’t get snappy with me if you don’t want to meet snappy Haven. She’s a bitch and bitch Haven is one fierce motherfucker. Fortunately things calmed down after that. She seemed to accept it. Until later she begged me to call her and talk to her because she didn’t understand.

So I did. I called her and explained a whole bunch. Read it here. Closure. Yay! Then the next day she texts me. “So why didn’t you just sleep with me?” My response, “Because that would have been a shitty thing to do as we clearly weren’t on the same page.” No no no…what she meant was, why don’t I just sleep with her, as friends with benefits, no emotional attachment.

Right. Because I totally believe she can handle that. How about we just be friends. K, thanks. This is my life.
Everything about her near me is chaotic. I am so aware of the energy people and situations bring that I internalize it as my own. Being around her was like a nuclear reaction in my brain that caused my emotional center to meltdown. Just, no. This was a much harder break up than it should have been for two dates. Fortunately we seem to be on good terms and everything is ended in a non-stalking way.

So I just ended that when the next thing crept in. I get a lot of letters from Readers and people seeking advice. Way more than I’m capable of addressing lately, for which I sincerely apologize, but it’s overwhelming and I’m having an incredibly hard time keeping up. Anyways, one in particular caught my attention. A representative from the Dr. Oz show contacted me because she found my blog posts about Body Dysmorphic Disorder. She wanted to talk to me about it. I’m pretty much all about mental health advocacy and raising awareness so of course I accepted. I told her my family (really just my brother, but whatever) was coming to visit me this weekend so I wouldn’t have time to talk but would be available after 4p during the week.

Saturday around noon. She calls. 1. Phone Anxiety. 2. I said I wouldn’t have time. 3. I was in the grocery with my brother and couldn’t hear. Figured it out, stepped outside and talked for a few minutes. She was extremely pushy with wanting to do a phone interview that night.

This is how my day was supposed to go. Wake up. Go to the grocery with my brother. Get food with my brother. Take my brother to work to show him the projects and stuff that I do. Cook a 4 course meal for 10 people. I had all the minutes planned out. You need a type A minute by minute planning personality to cook the way I do.

I told her I could probably find some time around 4. She was SO pushy and clearly aggravated that I couldn’t talk earlier but finally acquiesced to that time. IL had to double time all my prep and was stressing out quite a lot. She called me. We talked.

This woman. Obviously not a clinician. She immediately started bombarding me with questions about my experience. Some of her questions included:

“When you look in the mirror do you hate yourself?”
“What is your height and weight?”
“What is it that you hate so much?”

…and then of course plenty of other things that you would normally expect in an interview trying to discern the severity and expression of your Body Dysmorphic Disorder. Look. I get it. She’s trying to produce a television exposee or whatever. She has to ask questions to figure out if I would be good to go on. But hot damn, it was like she look up the most rudimentary understanding of the disorder and asked me checklist style if I had various symptoms in the most direct and insensitive way possible. The whole time I was thinking, “Holy crap, Therapist would never talk to me like this.”

This woman clearly had zero idea that the way she was conducting this interview, while on the topic of a clearly psychologically distressing topic, was actually very psychologically distressing to me at that very moment. It was like she thought maybe it was something I could turn off and think about objectively without actively feeling it? And then, and then… after having explained to her that my BDD has been so severe at times that I have been physically and emotionally incapable of going out in public for months, months, and more months at a time because the mere thought that people might look at me causes a sense of anxiety so debilitating I panic and hyperventilate…. She asks me to take a full length photo of myself to send to her and asks if I can take off work the next Monday to come to the show.

I’m really abbreviating this, and I feel it doesn’t do the level of anxiety I felt any justice or the irony I was feeling, but up until the end of our nearly 40 minute conversation I thought I might be able to do this. The idea of having to take a photograph of myself when I don’t feel absolutely 100% excellent about myself though? It broke something and my anxiety started to take over. The thought of having to send her a picture was the final thing I couldn’t take. I ignored her calls the next day and finally told her Monday that I wouldn’t do it.
The insensitivity of the whole things was just mind boggling to me. How does a person come to believe that after being told that; Going out in public, even going out in front of a small group of people that I know cares for me, can fill me with so much dread and anxiety that I can no longer function or go out at all….  How do they then believe that shoving me onto a stage in front of a live audience and cameras that reach millions of people will somehow be a good idea? 

I felt so completely disgusting after that conversation. I’ve had 3 different binge/purge episodes since. Oh! Which by the way, I was strongly discouraged from discussing. Eating disorders are a different episode you see. They don’t want to associate eating disorders with BDD. She was still adamant that I would be perfect for this? Yet, she didn’t want me to discuss the extent of its severity? Just the hand-picked aspects they deemed worthy for presentation? Fuck you. I’ve also cut myself and injured myself because I felt I needed to be punished for eating too much which altered my body shape in a way that was a particular fixation for me. I doubt I would be able to say that either. No. I am clearly more than willing to discuss my issues, but not only the parts you find acceptable for television. That’s not the whole issue or the whole truth. That really pissed me off too.

Unfortunately the whole experience was incredibly triggering for me. I’ve been beyond self-conscious. Especially as my ankle is still swollen and in a brace so I can’t exercise the way I need too. The only way I could have possibly convinced myself to go on the show would have been to completely starve myself for a week and exercise despite my ankle. I’ve fallen into a worse episode of self-loathing and body hatred than I’ve felt in ages.

I held it in for a few days and finally had to tell someone so I talked to xRoommate. As usual she was very supportive of my decision and made me feel much better. MUCH BETTER. Then in a crazy surprise twist of openness… I told Tech Boy too.

Tech Boy and I went out for sushi (veggie sushi for me) and drinks. He knew I was having a bad week but he didn’t really know why. After a little hemming and hawing I finally spit it out. I didn’t give him the fully gorey spectrum of details, but I explained a lot of it.  It’s not something I talk about with almost anyone, and it’s not something I let anyone see in me… as I’ve said before the woman most people know is a witty, beautiful, charming person with a slightly twisted sense of humor, not a debilitatingly self-conscious one that can’t stand to have people look at her. He did the slightly confused thing, and definitely expressed that it wasn’t something that he understood because, well, look at me (yeah the old but you’re so beautiful…) but he was surprisingly receptive to the fact that this was actually an issue for me. More surprisingly, it didn’t alter the tone or course of the night at all. It was kind of nice to get that out there. He always manages to surprise me when I’m able to do that whole “be open about my issues” thing. He’s much better at it than he gives himself credit for. My opinion is mostly based on his assessment of himself and the way he tells me he doesn’t like to think or talk about stuff like that, but when I do talk about it, he manages to roll with it pretty okay and be as supportive as he knows how to be. It was pretty nice.

Then we went back to my place and watched movies, snuggled a bunch, had lots of sex. The usual. I know I like being around him. I’m still not quite immediately comfortable with him without a drink yet. And I can’t figure out if it’s okay for me that we don’t have a ton in common but that he’s nice to me and that we have a good chemistry, or if I’m just lonely and reaching for what is familiar. I’m so confused.

I did tell him that I wasn’t sure what I wanted from him though. I have a guilty conscience for pretty much everything so I had to make sure I was at least clear that I didn’t know what I wanted from him, I didn’t know where this was going, I didn’t know what he wanted from me… but I liked seeing him. He agreed with me and said he was just happy to have me in his life again. So I don’t know. Maybe for now I’ll just try to not overthink it.

Therapist still just, really likes him for me. He’s very down to earth, not dramatic at all, clearly cares about me… I don’t feel like I need to be someone else for him/I feel like I can be [mostly] myself around him – by that I mean I still feel that I hold a lot back but I don’t feel that I am someone else entirely like I did with New Girl.

I’m not even all that sure what I want or what I need so it doesn’t make a lot of sense for me to go about judging what it right and wrong for me when the things that are happening relationship wise aren’t destructive. Bleh. Idk. I just wish I had some clue what the hell I was doing.

Also, lots and lots of work stress. My life is pointless. The world is completely pointless. It’s all just meaningless. All of it. I’m so bored and so discontent and so unmotivated I don’t want to do anything. I don’t want to get out of bed. I don’t want people to see me. Not to be confused with me not wanting to see people. I’m angry and irritated and I just want to kick small children for laughing too much. I’m pretty sure that’s the definition of a horrible person, but I swear I won’t actually do it. I mean, I don’t even know any small children.

Love my little brother even if he is a foot taller than me. 
But Therapist wanted to end therapy on a good note so we talked a bit about my brother visiting for the weekend. It was a lot of fun. We didn’t get along so well growing up. Mostly because I didn’t get along with anyone so much when I was growing up. I was an angry, angry, violently angry young lady. He was the star athlete spotlight golden child and I was this rebellious gothic black sheep that refused to be normal. We’ve grown up though. Amusingly those labels haven’t changed all that much but our acceptance and appreciation of them in each other I think has definitely evolved in a good way. My brother is admirably ambitious and outgoing and I think he’s even found an appreciation for my quirky style and rebellious nature. Anyways I think we get along really well now. He’s doing some big things with his life and it’s pretty awesome the directions he’s allowing it to go. He even seemed pretty impressed with the things I’m doing with mine.

Which is funny because I’m not always.  I mean, I do these massively intense research and development projects but when all is said and done, I feel like it’s someone else wearing a Haven suit that has the credit for it. I don’t think Therapist always understands just how different I feel when I go to work. I put on my work clothes and it’s like putting on a costume. My work clothes are not like anything I would choose to wear on purpose if I wasn’t going to a place of professional occupation. I dress well, but I don’t dress “like me”. I don’t act like me either. Part of me, the part of me that I feel that matters, is not present, it’s compartmentalized and sectioned off to be let out later once I punch out.  The “me” that people see at work is a projection of who I need to be to get my job done. All the work I know is technically done by me, doesn’t really connect to me though, it’s hers. I recognize those achievements from a distance but they don’t remain as an internalized sense of accomplishment. Meh. Idk… we didn’t have much time to continue going into this.
 
In fact. I’m tired now. I’m gonna wrap this up. It’s way too long. You deserve a cookie if you got this far. Good job.

Side Note: Therapist and I got into an argument about whether or not I was “quirky”. I think she thought the word meant “flaky” when to me it means like bizarre or strange but in a kind of cute and charming way? Idk. She was making me so angry. So so angry.

Cope constructively. Not Destructively. Mantra. Mantra. Mantra. 

Thursday, March 14, 2013

Medication Experimentation - Topamax


We interrupt this newly developing series for some Life Stuff – Psychiatry and Medications update.

Hello darling Readerfaces. It’s that time of year again where everything is bad because the universe hates me. Stupid insensitive universe not giving a shit about me. Grr. Fortunately I had an appointment to see Psychiatrist at this exact time. In an extraordinary twist of behavior I actually talked to Psychiatrist about stuff. I blame this on being both highly, highly irritable and a bit impulsive.  Lately everything has just been….

  • Everything feels empty and utterly pointless. All things. Especially my life. (This causes extreme levels of snark)
  • My Body Dysmorphic Disorder has been extra bad… you’ll hear more about this tomorrow.
  • With a direct correlation – my bulimia has been worse, not terrible, but 3 times in the last week as opposed to once or twice in a month is a step backwards.
  • Everything makes me angry. Everything. I screamed at the wind today for blowing too hard. I wish that was an exaggeration.
  • So, so irritable. I want to shove socks into everyone’s mouths and duct tape them all shut. Everyone in the whole world.
  • I’m not handling stress very well.
  • My boredom has reached a soul level (and I don’t even believe I have a soul). I just want excitement to happen. I have no desire to pursue making it happen.
  • I’ve been having all of the sleep. All of it. I never sleep. Now I sleep all the time. This is wrong.


The good thing is, I’m noting it and I’m not letting it rage out of control, even though I really want to let everyone know just how much everything their doing is extra douche-tastic. Behavior is controllable.

Another good thing, Psychiatrist is kind of starting to redeem himself. First, he gave me the option of just getting through this with therapy, or I could try additional medication. That in itself surprised me. So I asked him what my options would be. He went back through everything I’ve taken before, and mentioned without me saying anything that because I’m very concerned with my weight that he wouldn’t want to give me anything that would add to that distress! Score!  So what’s my new drug?

Topamax

It’s an anticonvulsant originally used to treat epilepsy. It’s also approved to treat migraines. It’s also been used to treat bipolar, and sometimes to augment psychotropics, or counteract the weight gain associated with antidepressants. Recent clinical reports indicate that it may have mood stabilizing properties. Other off-label and investigational uses of topiramate include the treatment of essential tremor, bulimia nervosa, obsessive-compulsive disorder, alcoholism, smoking cessation,  idiopathic intracranial hypertension, neuropathic pain, migraine headache, cocaine dependence, and Borderline Personality Disorder. Topiramate is also being studied with a mixture of phentermine to form a drug called Qsymia for the treatment of obesity.

If it can help me with my migraines, potential alcohol problems, bulimia, and help me lose weight… I would be hyper impressed.

That being said. Let’s look at what can go wrong too!

Side Effects!

Side-effects reported by > 10% of subjects in at least one clinical study (listed by prevalence):

Parathesia (numbness & tingling) (23.7%) At nearly 25% this one is probably likely
Upper respiratory tract infection (17.5%) Hmmmm.
Cold symptoms such as stuffy nose, sneezing, sore throat.
Diarrhea, weight loss (16.8%) Ew.
Nausea (15.4%)
Anorexia (loss of appetite) (13.3%)
Memory Problems (11.2%)
Dry mouth, increased thirst, drowsiness, decreased sweating, increased body temperature, and hot, dry skin; (So what you’re saying is it’ll make me hotter? Haha)
Confusion, slowed thinking, memory problems, trouble concentrating, problems with speech or balance; (Who needs to not blow up society with my job anyways)
Vomiting (not such a deterrent for a bulimic), loss of appetite (hopefully), tired feeling, irregular heartbeats, feeling like you might pass out; or (and the rest are fail)
Severe pain in your side or lower back, painful or difficult urination. Sudden vision loss, pain around or behind your eyes;   (how do these things count as acceptable to give to the public?)

Less serious Topamax side effects may include:

Mild dizziness, feeling nervous;
Numbness or tingly feeling;

Side-effects most frequently leading to discontinuation of therapy with topiramate:

Psychomotor slowing (4.1%)
Memory problems (3.3%)
Fatigue (3.3%)
Confusion (3.2%)
Somnolence (Drowsiness) (3.2%)

On the plus side there are way fewer side effects than most of the other drugs I’ve been given. And I actually would mind having some of the others. We’ll just have to wait and see how this whole thing goes and I will keep you updated with my progress. I’m a little excited that that this one has actually been used in trials to treat BPD. Here goes nothing. 

Wednesday, March 13, 2013

Borderline Personality Disorder versus Bipolar Disorder: Types of Bipolar


Before I start my compare and contrast of Bipolar vs. Borderline Personality Disorder I wanted to elaborate on the different subtypes of Bipolar Disorder. It’s necessary because some of them are quite similar to BPD while others are extremely similar. ::wink:: So let’s get to it.

Criteria and Subtypes in Bipolar Disorder

Bipolar I Disorder

 
Bipolar 1 is the standard expression of Bipolar that people recognize as Manic-Depression. It’s categorized by having one or more manic episodes. A depressive or hypomanic episode is not required for diagnosis, but periods ranging from mania to depression are common. Most people are in their teens or early 20s when symptoms first appear. 

According to WebMD People in manic episodes may spend money far beyond their means, have sex with people they wouldn't otherwise, or pursue grandiose, unrealistic plans. In severe manic episodes, a person loses touch with reality. They may become delusional and behave bizarrely.
Untreated, an episode of mania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months. Depression may follow shortly after, or not appear for weeks or months.

Many people with bipolar I disorder experience long periods without symptoms in between episodes.

Depressive episodes in bipolar disorder are similar to "regular" clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks or months, but rarely longer than one year.


Bipolar II disorder

Bipolar II is characterized as having no manic episodes, but one or more hypomanic episodes and one or more major depressive episode. Essentially it’s the same as Bipolar 1 except the “ups” never reach full mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.
In between episodes of hypomania and depression, many people with bipolar II disorder live normal lives.

People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the "life of the party" -- making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.

What's so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. People in hypomanic episodes might spend money they don't have, seek out sex with people they normally wouldn't, and engage in other impulsive or risky behaviors.

Also, the vast majority of people with bipolar II disorder experience significant depressive episodes. These can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.

Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.

Depressive episodes in bipolar II disorder are similar to "regular" clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks, months, or rarely years.

It’s been suggested to me before that perhaps I was Bipolar II because while I’m chronically depressed, I have a long cycle of reaching an even deeper depression at a very specific point every year. It was believed that this could just be one long bipolar depressive cycle. As it turns out… no. Those “ups”, even to a milder extent never really get over the mildly depressed stage. At least not without medication.

Cyclothymia

Cyclothymia -- or cyclothymic disorder -- is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity of major depression or mania. Cyclothymia is a "bipolar-like" illness. People with cyclothymic disorder have milder symptoms than in full-blown bipolar disorder. A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes is necessary. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning. For most people the pattern of mood fluxuation is irregular and unpredictable. Not really a pattern at all.

Cyclothymia can straddle the line between mental illness and normal variations in mood and personality. Some people with mild symptoms are highly successful in life, driven by their hypomania to express individual talents. On the other hand, chronic depression and irritability can ruin marriages and professional relationships.


Mixed bipolar  

Mixed bipolar episodes are periods that simultaneously involve the full symptoms of both a manic and a full depressive episode. It's marked by grandiose feelings with racing thoughts. At the same time, the person is irritable, angry, moody, and feeling bad.
           

This next one is my favorite.

Rapid-Cycling Bipolar Disorder

Rapid-cycling bipolar disorder is characterized by four or more mood episodes that occur within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes.  Some people also experience changes in polarity from high to low or vice-versa within a single week, or even within a single day -- the full symptom profile that defines distinct, separate episodes may not be present (for example, the person may not have a decreased need for sleep), making such "ultra-rapid" cycling a more controversial phenomenon. Rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness. Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts. Antidepressants are thought to trigger and prolong rapid cycling in bipolar disorder. However, that theory is controversial and is still being studied.
           
Bipolar disorder NOS (not otherwise specified)

This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.



So you see… the impulsivity and risky behavior, the erratic mood swings, potential for  promiscuity, especially with the hypomanic “life of the party”, rapid-cycling shifting moods, and the same time up and down elements of Mixed Episode, co-morbid depression and anxiety, it’s easy to see how the similarities can be confused with Borderline Personality Disorder…. Which we shall get to next ;) 

Tuesday, March 12, 2013

Borderline Personality Disorder versus Bipolar Disorder: What is Bipolar?


Alright Folks. Today I’m going to start a series that has been on my mind for an extremely long time. Not only here on my blog, but in my actual life. 

Borderline Personality Disorder versus Bipolar Disorder

This is a subject that is near and dear to my heart because while we all know that I’m Borderline, it’s a lesser remembered thing that my sister is Bipolar. In fact, the reason we finally bonded in friendship was over shared emotional distress and maladaptive coping mechanisms. There are a lot of things about Bipolar that look very similar to Borderline Personality Disorder, which often and unfortunately, leads to a lot of misdiagnosis in both directions. It gets even muddier because it also appears that you can potentially have comorbid Bipolar Disorder AND Borderline Personality Disorder. There’s always something fishy about that one to me though.  Anyways, let’s get started with the big question first:

What is Bipolar Disorder?

The Mayo Clinic defines:  Bipolar disorder — once upon a time called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

Episodes and transitions between episodes can occur slowly averaging about one transition per year, to something much faster (and therefore more easily confused with BPD).

So what exactly is this idea of a manic phase for bipolar disorder?

Mania is arguably the defining feature of Bipolar Disorder. Mania is a distinct period of elevated or irritable mood and can even take the form of euphoria, that lasts for at least a week (unless hospitalization is required). It’s very common for someone that is manic to experience an increased amount of energy and a decreased need for sleep, even leading to  a mild insomniac effect. People often only get 3-4 hours of sleep a night, even going days without sleep!


Racing thoughts can contribute to the effect of pressured speech (speech being garbled and a little incomprehensible because getting words to physically express at the rate that they race through the mind is physically improbable).

It’s common for someone experiencing mania to have a low attention span and be easily distracted. Impaired judgment and impulsivity are also common. Spending sprees, risky behavior that isn’t typical for them, indulging in drugs and alcohol, stimulants, or sleeping pills isn’t uncommon.

Behavior can be aggressive, intolerant, or intrusive into the lives of those around them. Feelings of grandiosity, maybe even with delusional ideas, can manifest. They can feel uncontrollable, unstoppable, or like they’ve been “chosen” in some way. People can experience hyper-sexuality. At the most extreme end of mania there can even be a psychosis, or a psychotic break from reality, where thinking is also affect alongside mood.

The experience of mania is different depending on the person and even the time of year. For some people mania translates as severe anxiety and get very irritable, even to the point of rage, while for other people it’s more of a grandiose feeling of being invincible and euphoric.

The biggest thing to remember is… this experience of full blown mania, disrupts the person’s life for a period of time.  It’s not just an experience of having a really good day. It’s not just being over-stimulated for a while. And while you can be diagnosed bipolar with only one noticeable period of Mania, it’s more than likely to be a cyclic occurrence throughout a person’s life.

Depression

Now for it to be “bi”polar, there’s that accompanying idea of an up with the down. Depression. We’ve talked about Depression before because depression is often co-occurring with Borderline Personality Disorder as well. All those signs and symptoms of depression that we talked about before, are the same. Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal thoughts. All things we’ve noticed before with depression.

Bipolar depression in severe cases may become psychotic, which is a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. These hallucinations can be auditory, visual, and even olfactory. One particular expression of depression, that often gets bipolar confused for BPD, is the expression of self-harm. It’s not as common with bipolar as it is with BPD, but it can definitely manifest.  A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.

Mixed Affective Episodes

Finally there is the idea of Mixed Affective Episodes. This happens when, in the context of bipolar disorder, a mixed state condition of having simultaneous symptoms of mania and depression occurs. Typical examples include weeping during a manic episode or racing thoughts during a depressive episode. Individuals may also feel very frustrated in this state, for example thinking grandiose thoughts while at the same time feeling like a failure. Mixed states are often the most dangerous period of mood disorders, during which the risks of substance abuse, panic disorder, suicide attempts, and other complications increase greatly. Imagine feeling the darkest despair of suicidal depression coupled with the impulsive recklessness of a manic state! That can easily lead to fatal devastation.

I’m going to let you in on a spoiler here when it comes to the difference between Bipolar Disorder and Borderline Personality Disorder – Chemistry and Genetics. With Bipolar Disorder this is the prominent factor, though environmental factors can contribute as well.

The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.

Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.

Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. (One of our grandmothers distinctly presented as Bipolar.)

Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder. These things can trigger and exacerbate the onset and expression of severity of bipolar symptoms. When people who are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities in bipolar disorder due to stress along with other environmentally exacerbated neuro-effects. They can also lead to a greater expression of other co-occurring  disorders such as PTSD.



So there you have it. That’s probably the most basic breakdown of Bipolar that I can give you. Before I get into comparing and contrasting Bipolar with BPD I want to talk about the different subtypes of Bipolar as well, because this also contributes to the confusion. 
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