By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Am I Bipolar?
Occasionally I get asked this question. More often the person asking the question is asking if their child, spouse or friend is Bipolar. Almost no one ever asks me if they are depressed. Why the difference?
Most of us know when we are depressed. We know that we can be a little depressed and get over it naturally or we can get a lot depressed and need help. It is also easy to see that there is a difference between being a “little depressed” and suffering from Major Depressive Disorder which is the technical term we professionals use when we diagnose clinical depression that needs treatment. We also have some other lesser degrees of depression we can diagnose like Dysthymic Disorder. No so much with bipolar disorder.
Even my more liberal colleagues are uncomfortable with the idea that people could be “a little bit bipolar” even though all people have some of the characteristics of bipolar from time to time. It would be more comfortable to think that there are “those people” meaning the mentally ill – over there and then “us people” the normal ones over here. Forget for a moment that our friends and family may think we belong with the over-there folks. Why is it so hard to accept that most of the symptoms of mental illness are on a continuum from a few to a lot?
With depression, we all accept that if someone in your family dies – say, grandma, for instance, you should be sad. That is assuming, of course, you like grandma. If someone close to you dies we expect you to be sad, depressed even, we have a special name for that – Bereavement. But if five years later you are still stuck at home, to depressed to go to work because of this loss, then we think there is something excessive going on here and you will be diagnosed as depressed, probably diagnosed with Major Depressive disorder. So why don’t we do that with Bipolar disorder?
One caution is in order. DO NOT ATTEMPT THIS AT HOME! Diagnosis is not a do-it-yourself project. This blog is meant to be informative and as you will see below most of this is not a matter of yes or no answers on a questionnaire. Some “clinical judgment” needs to be used, which is why even professionals sometimes need to consult with other professionals on close calls.
Let’s look at the criteria for Bipolar and see how someone might have all the signs or symptoms and still not qualify for the diagnosis. Some of you who read my earlier blog about Bipolar Disorder will remember that the main difference between depression and bipolar disorder is the occurrence, at least one time, of an episode of large mania or small mania (Hypomania.) I have simplified these descriptions so if you want the long form, check the DSM. After the 7 criteria will come the big stuff.
Here are the 7 criteria:
1. Inflated self-esteem or grandiosity.
So this sounds like an occupational disease. Wouldn’t all politicians, entertainers, and sports personalities fit this description? So thinking a lot of yourself could be good self-confidence or it could be grandiosity depending on whether you win or not. Certainly, people with bipolar disorder may be attracted to these kinds of occupations but not everyone in those fields should be diagnosed with bipolar disorder. As with all the other symptoms, this is not a yes or no answer, it is a matter of degree.
2. Decreased need for sleep.
Many people experience a night or two when they are doing something exciting and they get by on less than normal sleep for a day or two. As a society, we like people who get a lot done. But eventually the novelty wears off and the need for sleep returns. Bipolar people have extended periods of high activities with reduced need for sleep. Parents with bipolar children report the child never slept that much. Though most parents don’t think their child sleeps enough when the kid keeps waking you up at night. So again the sleep issue is a matter of degree.
3. More talkative than usual or a pressure to keep talking.
Now we have all met people who talk a lot. And when you are with someone who has not seen you for a while you both may feel the need to say a lot. Some kids are so needy for attention that once the mouth opens they will talk nonstop. None of these things meet the criterion of it only happens occasionally. To really be bipolar disorder the person needs to have an out of control need to do these things.
4. Racing thoughts.
This is from the client’s point of view. They feel that even they are having difficulty keeping up with their own thoughts. Writers have this happen sometimes; the muse strikes and we have trouble getting it down on paper. That is not the same thing. Being a writer does not make you Bipolar. (We are not all bipolar are we?) These fast thoughts are also called flights of ideas, hard to stay on track when you ideas jump from subject to subject.
This involves being pulled away easily or getting stuck on irrelevant things. Now, this is perilously close to ADHD. Kids with bipolar disorder are sometimes given an ADHD diagnosis the first time until the symptoms of bipolar disorder become clearer. More on ADHD at another time.
6. An increase in goal-directed behavior.
This is also a tricky one. If it means studying a lot and getting all “A’s” or making lots of money we may let this go. But if you are really good at having sex with lots of people or working so many hours you forget where you live – then you get diagnosed.
7. Excessive involvement in pleasurable activities that may cause you pain.
The official guide lists too much sex, buying sprees, sexual indiscretions, and foolish business investments. This leaves out gambling, substance abuse and some other impulse control problems. What is a foolish business investment is also open to question. Should we dump the internet stock and invest in a sound carriage manufacturers stock? So see how some interpretation is needed?
Now all the above notwithstanding, for anything to be diagnosed – yes you heard me right – for anything to be diagnosed as a mental illness it must cause one of three things.
A. The problem keeps you from having or keeping a job. For kids, this includes going to school. In fancy-speak, we call this interfering with occupation functioning.
B. It keeps you from having good relationships with your friends or family this is called social functioning.
C. It causes you pain. So if the problem is causing you pain we are much more likely to think it is a mental or emotional disorder than if you and your friends are OK with your difference and you can keep a job.
More next time on some of these problematic diagnoses and on some other relationship issues that you have emailed me about.
Bye for now
David Miller, LMFT, LPCC