By David Joel Miller.
Bipolar doesn’t mean moody.
Three psychiatric diagnoses (ADHD, Bipolar and Schizophrenia) have left the scientific literature and taken up residency in the media and in everyday conversation. The problem with these usages is it devalues the term and pretty soon it is being misused more often than it is used correctly. Bipolar is one of those terms.
Kids report that their peers call them or others “Bipolar.” We hear about it on talk shows. Sometimes parents call their children or their partner Bipolar with no clear idea what the term means. Children are being diagnosed with bipolar disorder at younger and younger ages. Early diagnosis and treatment is a good thing; it may reduce a life time of suffering. Referring every kid in first grade who is irritable for a bipolar evaluation is probably not warranted.
Lots of parents want their child “tested” for bipolar disorder. I wish there was a simple test, say blood or urine that would detect the disorder. There may be physical signs or markers, but so far no one seems to be able to detect bipolar disorder other than by a psychological evaluation that involves descriptions of mood and behavior. When many parents want to know if their child is bipolar, what they really mean is the child is irritable or difficult and they need help.
People refer to others who are moody as Bipolar. Bipolar disorder does not mean moody! Some people are naturally moody others get moody when something upsets them. Lack of sleep makes most anyone moody and grouchy. Not everyone with sleep disturbances has bipolar disorder by any stretch of the imagination.
When we talk about bipolar disorder we are talking about a condition not a person. A person may have bipolar disorder that does not make them “bipolar.”
So what is Bipolar – really? It used to be called Manic Depressive disorder. I see client questionnaires where they report they have family histories of both manic-depressive disorder and Bipolar. I won’t go into the politics behind the name change but it is important to note two things. Bipolar is a mood disorder so it is in the same “family” or chapter as Depression and other mood disorders. The second characteristic is that for the problem to be bipolar it must include Mania or its cousin Hypomania.
Update – In the DSM-5 they did away with the term “mood disorders.” More and more professionals are thinking that Bipolar and Major Depressive Disorder are for-sure two separate things. You may have periods of depression for a while before the mania but we need to be careful to separate the Bipolar from the Major depression.
So what is mania? I won’t repeat the whole DSM-4-TR criteria here, if you want that please go to the source. But a couple of things that separate mania and therefore bipolar disorder are important. For some clients this looks like someone on Meth – without the drugs. This is not a little bit thing that comes and goes. When it occurs the person is debilitated.
Mania involves a period of time where the client’s behavior is elevated, expansive or irritable. In short they are “off the hook” and this is not deliberate but uncontrollable. During this time frame they have a bunch of behaviors that are far too excessive. The DSM lists 7 characteristics and the person should have the majority of these symptoms. Not sleeping and not needing to sleep is a red flag. They are up all night doing things and they don’t even feel tired. They are likely to show grandiosity, and excessive self-esteem. They talk faster than those around them can listen and they think faster than they can talk. But the thoughts may make sense only to the person with bipolar disorder. They are likely to get “stuck” on things, too much work, buying sprees, excessive sexual activity and other risk taking activities.
Since mania is seductive, who wouldn’t like to be able to have fun twenty-four hours a day and not need to sleep, during manic episodes the client with bipolar may be strongly attracted to stimulant drugs like methamphetamine and cocaine. Alcohol abuse is also common which increases the crash when the manic episode ends. And it always ends.
Most people who truly have bipolar disorder are first diagnosed with a depression. One indicator that makes me suspicious is when a depressed client takes and anti-depressant and recovers suddenly and now is “better than ever.” A manic episode is about to occur.
So far talking about Bipolar disorder, with its depressive and manic symptoms makes it sound like the person runs from manic (which is not happy by the way) to depressed. That’s not the whole story. Kay Redfield Jamison writes about what we might call mixed states. It is possible, probably more common than we might think, to have both mania and depression at the same time. Think of the shifting moods like a tire on your car. When it is parked we could mark one side of the tire and call that the back, the other would be the front. But once the tire starts to move you don’t drive on the front or the back but the whole tire. So the person with bipolar may experience a mixture of depression and mania at the same time.
Another feature of Bipolar disorder that separates it from moodiness and depression is the tendency for the elevated thinking to become first delusional and then it may progress to include hallucinations. So the person with bipolar disorder is not only thinking odd thoughts but is very irritated with others that they don’t “get them.”
Hope this explanation got you thinking about Bipolar disorder. If you would like more information, check out the Depression and Bipolar Support Alliance.
As always your comments are welcome. If you like this blog spread the word. If not let me know what might improve it. Till next time.
David Miller, LMFT, LPCC