Category Archives: Bipolar Disorder

Types of Mania and Dual Mania

Posted on by
Reply

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How many types of mania are there?

Just what mental health symptoms are illnesses and how many mental illnesses are there? Counting Manias is especially difficult.

We think we know mania when we see it, but it is such a diverse group of symptoms that it has become established as “manic episodes” that are building blocks of diagnosis, rather than separate diagnoses. It functions primarily to separate Bipolar Disorder, formerly called manic-depressive disorder from the other depressive conditions.

Mania has been described as the most heterogeneous mental health symptom there is, raising the question “When we say mania are we all talking about the same thing?” Are there types of mania that have different causes and indicate varying diseases?

Currently, there are over 400 recognized disorders or conditions that might be the focus of treatment in the DSM-4. As you may have seen from previous posts many of these disorders have lots of subtypes that look different in practice and may require different treatments.

Mania and Bipolar disorders are especially difficult because of their wide diversity of symptoms. For more on the DSM-4 and some to be DSM-5 descriptions see: What is mania? And What is hypomania?

Encarta Dictionary definitions of mania include:
1. An excessive and intense interest or enthusiasm for something and 2. A psychiatric disorder characterized by excessive physical activity, rapidly changing ideas, and impulsive behavior. The two uses of the word mania don’t have a lot in common.

Kraepelin, whose work has formed much of the foundation for modern efforts to divide up and diagnose illnesses, reported there were 6 types of mania. His distinctions seem to have been blended together into the one thing we now call Mania. But are all manias really the same?

Research has been less than helpful here as most researchers exclude a lot of people from their studies. If you exclude enough people, for enough reasons, the group left may look all alike. That does not mean the resulting study tells us anything about the various problems people with mania are undergoing.

One study (Haro et al., 2006) tells us that they found three very different forms of mania. The most common form of mania they called “typical mania” and this group contained 60% of the people in the study. But the other 40% had symptoms that were so different that the authors separated them into two additional subtypes of mania.

Psychotic mania is not like “Typical mania.”

Psychotic symptoms sometimes end up in making mania for a bipolar diagnosis but psychotic episodes can occur in other illnesses such as schizophrenia. It is common for families to have members who have been diagnosed with bipolar disorders and others who were diagnosed with schizophrenia. Psychotic mania looks a lot like psychosis and bipolar at the same time, but then we have another illness schizoaffective disorder to use for that also. This leaves the diagnosis of psychotic Bipolar in doubt. I have seen doctors record a diagnosis of schizophrenia – bipolar type.

Dual Mania is similar to other dual diagnoses

Dual Mania was described by Haro et al. as significantly different from other types of mania. Dual-diagnosis mania has been poorly recognized simply because most people who abuse substances are routinely excluded from research studies. Haro et al. report that this systematic exclusion of people with multiple problems leaves a huge gap in our understanding of mania and therefore Bipolar Disorder.

Dual Diagnosis client with mania spent significantly more days in the psychiatric hospital and had more suicide attempts. This is consistent with other studies that have shown people with Bipolar Two are at the highest risk for a suicide attempt and that people who abuse substances have higher risks also. Unfortunately acutely suicidal clients are also routinely excluded from studies of mania and Bipolar Disorders despite there being overrepresented in substance abuse treatment and acute psychiatric facilities.

Other characteristics of clients with “dual mania” included being male and younger than others with a manic episode. Dual mania resulted in higher disability levels. Dual mania was also more likely to cause job and relational problems.

Of those clients in the Haro et al study, 25% had a history of alcohol abuse. Of those with dual mania, 40% had a history of marijuana use or abuse. So that means many dual mania clients had abused both.

In substance abuse treatment the pattern of alcohol and marijuana use coupled with job, relational and legal problems is so common as to be almost universal. Among those in treatment for methamphetamine abuse, manic and hypomanic symptoms are commonly reported even when the client is not using drugs. Episodes of manic or hypomanic symptoms are also commonly reported as triggers for substance abuse relapse.

Of those with long-term mania and multiple hospitalizations the “aggressive type, ” all had histories of substance abuse (Soto, 2003.) This study did not specifically include a substance abuse type of mania but noted that among those with long-term mania and a history of substance abuse those who had not used in the last 30 days were no different than those who had used or drank. The suggestion to me is that there is something different about those who experience mania and abuse substances. Mania predisposes people to abuse substances and both conditions need to be treated.

My conclusion

The continued exclusion of substance abusers and those who are suicidal results in research data that excludes those at the highest risk and those who most use mental health services.

Comments on Mania, Bipolar co-occurring disorder, and recovery, and most anything mental health-related are always welcomed.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How is Hypomania different from Mania or a Manic Episode?

Posted on by
4

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Hypomanic Episodes.

In a post on Manic Episodes we talked about how episodes, according to the DSM are not diagnoses, they are “building blocks” out of which diagnosis is created. Someone could have either a manic episode or a hypomanic episode. The primary significance is the decision on labeling the condition as Bipolar one or Bipolar two. No Manic or Hypomanic Episode and you will not get the Bipolar label.

The Bipolar Disorder spectrum currently is very confused and confusing. It includes Bipolar I, Bipolar II, proposals for Bipolar III, IV, and so on, as well as hypomania, mania, Cyclothymic Disorder, Hyperthymia, Hyperthymic personality disorder, and so on. This spectrum is a very divergent group. Disorders involving an elevated mood may be the most Heterogeneous group there is (Van O’s et al. 2007.)

Lumping all these varieties together may be overlooking the possibility that there are “Types of Bipolar Disorders.”

Hypomania requires a specific time period in which someone has had the symptoms of “elevated, expansive, or irritable mood.” The difference is that for full mania the period needs to last for a full week, hypomania need only last for four days.

This creates some problems. What if you have manic-like symptoms for only three days? Do you get left out of the Bipolar spectrum? If someone has serious mania but it only lasts 6 days do they get Bipolar II not Bipolar I?

The effort to separate out conditions by the length of symptom duration may help psychiatrists decide what medication to prescribe but it does not make much difference to the client who has short but intense episodes of manic-like symptoms.

Since some of the changes in Hypomania may be subtle we take the word of others who know you or live with you to make this decision.

Most of the symptoms used to define hypomania are the same as those used to define a manic episode. The primary difference is the duration, four days to six is hypomania and a week or more is mania.

The exception here is that since hypomania is supposed to be a milder or different from mania.

If you have ever had hallucinations or delusions (not caused by drugs) then we skip the hypomania label and go directly to mania.

Here are the hypomania symptoms, then the exclusions. This narrative parallels the DSM but is my less technical, more colorful explanation.

The symptoms list is a lot like the list for Mania. I have italicized some of the differences.

A. For at least 4 days the person has an episode of “elevated, expansive or irritable mood.” Elevated does not mean happiness. There are lots of descriptions of these elevated moods and they vary from person to person but the key factor is that these episodes are not like other people and that there are times when this person is not like this. If this episode is really bad we may waive the 4-day rule.

B. Pick 3 or four symptoms from a list of seven.

Each of these symptoms can vary in intensity and it is a judgment call. The result is that diagnosis can vary from clinician to clinician and even from time to time for the same person and the same clinician.

Here are the 7 symptoms needed to make a manic episode.

1. Grandiosity and excessive self-esteem. They can make no mistakes and can’t understand why people question them.

2. Sleep changes. You don’t need to sleep. Someone with Bipolar I can stay up for days and is full of energy. They may only sleep three or four hours a night. And in the morning they are not tired.

This reduced need for sleep may be a little less than in mania but the result is the same. People who are going manic or hypomanic get accused of drug use but if tested they have no drugs in the system or at least no drugs that explain the excess energy.

This is a troubling part of the diagnosis. Research studies (Carver & Johnson 2008) say that a lack of sleep can “induce” mania. So the lack of sleep is both a cause and a symptom of Mania? This sleep mania question needs more research. If the definitive study of this connection has been done so far I have not found it.

Not sleeping and not feeling tired does not mean that the person is rested. The longer this below normal sleep episode goes on the more irritable and delusional the person is likely to get. They may even begin to hallucinate. Only they don’t know they are delusional. They are convinced they are right and other people are dumb to not see how smart they are. If the hallucinations or delusions are noticeable to others we call it mania, not hypomania.

3. They talk a lot.

In hypomania, you may be able to interrupt them but not for long. They have a lot to say. Sometimes they talk too loudly and too emphatically. This is not the same as the way we old people talk when wound up, but that might give you a picture.

4. They feel their thoughts are “racing.”

Too many things to think about. In kids, this looks a lot like ADHD.

5. Lack of focus and easily distracted.

They are in such a hurry they move from topic to topic, project to project, and can’t figure out what to do next. Lots of things left half-finished and on to the next one.

6. Increased goal-directed activity.

In mania it is excessive, in hypomania, those around them notice an increase but can’t explain why.

This can be trying to do too much at work, socially, sexually, or in most any area of life. This over goal-directed activity can lead to excessive physical motion like a person whose engine is always running.

7. Overdoing pleasurable activities.

Hard to believe that someone could have too much fun but what we are looking for here is not that they have a lot of fun but that they continue to do pleasurable things despite negative consequences. This could also be affected by the assessor’s values judgments.

Examples of excesses are overspending, reckless or dangerous activities, “sexual indiscretions” and so forth. This needs to be more than someone who just likes to do something, like collect something. There is an episodic nature to these activities and most everyone will agree that this person has binges of overdoing things despite them getting in trouble.

This characteristic is highly related to the continued use despite negative consequences we see in substance abuse. As a matter of fact, people with a Bipolar diagnosis are much more likely to also have addiction and alcoholism issues than the general population.

The result?

To be diagnosed with a hypomanic episode you need to have three of the seven symptoms. We want four if you are just irritable but not expansive or elevated in mood. But with hypomania, the symptoms can be milder, more of a judgment call, and can be briefer in time duration.

If you or someone you know has symptoms of hypomania please see a professional. This article is not meant to be enough for you to do “do it yourself diagnosis.” There are many effective treatments for Mania, Bipolar Disorder, and related conditions.

BIG QUESTION: What about people who have these symptoms for less than four days? Or those that move in and out of Hypomania very quickly? Are we missing some other type of Bipolar Disorder? Or is that moodiness something else?

Stay tuned for more on Mania, Hypomania, Cyclothymia and Bipolar Disorder, and Types of Bipolar Disorder and the things we know and don’t know about all these topics.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Do medications or drugs cause mania or Bipolar disorder?

Posted on by
7

By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

A connection between taking medication, abusing drugs, and Bipolar Mania?

The question of connections between “drugs” and various mental illnesses is a huge concern.  We have known for a long time that there is a connection between some chemicals and Mania. The connection to Bipolar Disorders, formerly called Manic Depressive Disorder, is more problematic.

People seem to think that because a medication is prescribed by a doctor or can be purchased over the counter, it is safe. The huge increase in abuse of prescription medication has made us question that. Now there is evidence that not just street drugs but prescription medications may be setting off episodes of mania.

We all pretty much intuitively know what depression looks like. But Bipolar Disorder that is something else. The official definition of Bipolar disorder requires a lot more than just moodiness.

To get the diagnosis of bipolar you need to have had an episode of mania or hypomania. But the DSM excludes from diagnoses symptoms caused by drugs of abuse. For Bipolar Disorder this includes Bipolar symptoms that were caused by prescribed medications.

Do prescribed medications cause Mania or Hypomania? They sure do.

The creation of Manic symptoms by the taking of medications is so common that some researchers have proposed a separate “type” of Bipolar Disorder, Bipolar III, for those times when taking a medication causes manic symptoms (Akiskal 1999, 2003, Williams 2006.)

Here is the Bipolar medication dilemma.

Most people who get diagnosed with Bipolar Disorder have had one or more episodes of depression first. Then they have an episode of mania or hypomania and the diagnosis gets changed. Taking antidepressants is well known to result in propelling some people into a manic episode. This happens to about 10% of all people prescribed some antidepressants. Also if someone has EVER had an episode of mania or hypomania that risk of sudden switching increases to 20% (Breggin 2010.)

That drug or medication-induced mania is specifically excluded from the diagnosis under the DSM-4.

In practice, it has come to be common that a person who has a sudden extreme reaction to an antidepressant is a likely candidate for a Bipolar Diagnosis despite the DSM-4 exclusion.

If it was only antidepressants that created mania things would be simple. Lots of other drugs and medications can result in manic or near manic episodes.

There is a huge difference between someone being “maniacy” when under the influence or while withdrawing and those people who take a medication one time and are propelled into recurring bouts of mania or hypomania.

We see manic-like symptoms in people who use and abuse stimulants. Even excess of caffeine can create those sorts of symptoms. But medications that we do not think of as stimulants can cause manic and hypomanic episodes.

Antibiotics have been shown to induce manic episodes. So have anti-anxiety meds and some over the counter medications. Other medications like steroids, both prescribed and abused have been suspected of creating this effect also. That connection remains uncertain.

So the question becomes, “Do prescribe medications create a manic episode?” It looks like the answer to that is yes, sometimes they do. Does that mean this is just an allergic reaction or side effect of that medication? This is iffier as some people have that response and others don’t.

Is it possible that people who have an undiagnosed Bipolar Disorder are likely to be propelled into a manic or hypomanic episode when they are exposed to a medication to which they are sensitive?  I am inclined to think so.

We also see a huge overlap between substance abuse disorders, especially alcohol abuse, and Bipolar Disorders. Does alcohol abuse cause a Bipolar condition? Are people with undiagnosed Bipolar Disorder more likely to abuse alcohol?

Does this medication-induced mania matter? Williams says it does and reports that the rate of suicide attempts by people who switch to mania as a result of taking an antidepressant is even higher than for those with Bipolar II.

But there is more

People with anxiety are sometimes treated with an antidepressant. They also can experience an episode of mania or hypomania.

All this points out to me that with all we know about Bipolar Disorder there is still a lot more we don’t know and a lot more research is needed in this area.

It also suggests that there may be multiple types of Bipolar or even several different disorders currently being lumped together under one name.

For more on Bipolar disorders see:

Hyperthymia and Bipolar Disorder

Do drugs cause mental illness?

Bipolar – Misdiagnosed or missing diagnosis?

Bipolar or Major Depression?

Bipolar doesn’t mean moody    

Or the category list to the right.

Anyone have the experience of taking or doing something and then having an episode of Mania which resulted in the diagnosis of Bipolar Disorder that you would care to share?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is Mania or a Manic Episode?

Posted on by
6

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Manic Episodes.

Episodes, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) are not diagnoses, they are “building blocks” out of which diagnosis are created.

Mania and its milder cousin Hypomania are linked, closer than most marriages, to the Bipolar diagnoses. To get the Bipolar tag you must have had either a manic or a hypomanic episode and there is only a hand full of other things that might create a Manic or manic-like episode that is not Bipolar.

Some of these symptoms are a matter of judgment and intensity. There has been lots of research on the area of Mania and Bipolar disorders but the more we learn the more questions we have.

Currently, there are no laboratory tests, not even brain scans that are clearly diagnostic of mania. There are some differences in some tests but nothing that so far is clearly convincing enough to make the diagnosis.

The DSM-4-TR tells us that there may be differences in the functioning of some neurotransmitters. Then it lists five different transmitters that may vary. There are lots of ways any one transmitter may vary and any one person could have variations in from one to five transmitters. That whole approach so far is not very helpful to the clinicians or the people who have mania.

So in practice, we look for a whole list of symptoms, add them up with exclusions, inclusions, and severity, look for other explanations, and when all else is ruled out what is left we call a manic episode.

If you have EVER had a Manic Episode for which we cannot find a medical cause you get the diagnosis of Bipolar I. First the symptoms, then the exclusions. This narrative parallels the DSM but is my less technical, more colorful explanation.

A. For over a week the person has an episode of “elevated, expansive or irritable mood.” Elevated does not mean happy. There are lots of descriptions of these elevated moods and they vary from person to person but the key factor is that these episodes are not like other people and that there are times when this person is not like this. If you get yourself locked up, usually this is in a psychiatric hospital; we wave the full week requirement.

B. Pick 3 or four symptoms from a list of seven.

Each of these symptoms can vary in intensity and it is a judgment call. The result is that diagnosis can vary from clinician to clinician and ever from time to time for the same person and the same clinician. For example, studies show that young children in the U.S. get diagnosed with Bipolar a lot. Show the same file to a psychiatrist in the U.K and the child is more likely to get OCD or ADHD (Dubicka et al. 2008.)

Here are the 7 symptoms needed to make a manic episode.

1. Big-shotism, to use a 12 step term. a sudden burst of confidence or thinking you are better, more intelligent, or smarter than others. Plans to cure cancer, run for president, and write a novel all in the same week. This can be fun for the person with Bipolar until others start disagreeing with you.

2. Sleep changes. You don’t need to sleep. Someone with Bipolar I can stay up for days and is full of energy. They may only sleep two, three, or four hours a night. And in the morning they are not tired.

This looks a lot like a Meth user only they don’t need drugs to stay up and they get to sleep just a little each night.

The DSM says this is the big one of all the symptoms. To quote the DSM – “Almost invariably, there is a decreased need for sleep.”

This is a troubling part of the diagnosis. Research studies (Carver & Johnson 2008) say that a lack of sleep can “induce” mania. So a lack of sleep is both a cause and a symptom of Mania? This sleep mania question needs more research. If the definitive study of this connection has been done so far I have not found it.

Not sleeping and not feeling tired does not mean that the person is rested. The longer this below normal sleep episode goes on the more irritable and delusional the person is likely to get. They may even begin to hallucinate. Only they don’t know they are delusional. They are convinced they are right and other people are dumb to not see how smart they are.

3. They talk a lot.

Not used car salesman or late night infomercial type rapid talk. Professionals call this “pressured Speech.” The person has so much going on in their head they can’t talk fast enough to say it all. The can jump from subject to subject, include extra unrelated stuff and just generally talk so only they know what they are talking about. Sometimes even they can’t figure out what they were trying to say.

4. They feel their thoughts are “racing” or they keep jumping subjects like that old-school record with a scratch.

This also gets mentioned by clients diagnosed with anxiety based disorders. Are Bipolar and Anxiety related? We know that depression and anxiety co-occur commonly, why not Bipolar and anxiety?

5. Lack of focus and easily distracted.

They are in such a hurry they move from topic to topic, project to project and can’t figure out what to do next. Lots of things left half-finished and on to the next one.

This sort of lack of focus reminds me of sitting with a channel surfer who keeps changing the T.V. channel in mid-sentence. This is more a matter of being over-interested in too many things than of losing interest in any one thing.

This characteristic looks a lot like a symptom of ADHD and so given the same person and the same symptoms one clinician may see this as Bipolar and another will see ADHD.

6. Excessive goal-directed activity.

This can be trying to do too much at work, socially, sexually, or in most any area of life. This over goal-directed activity can lead to excessive physical motion like a person whose engine is always running. This characteristic called “psychomotor agitation” also looks like the “hyperactivity” in ADHD further leading to the question are those two conditions related or do they just get confused?

7. Overdoing pleasurable activities

Hard to believe that someone could have too much fun but what we are looking for here is not that they have a lot of fun but that they continue to do pleasurable things despite negative consequences. This could also be affected by the assessor’s values judgments.

Examples of excesses are overspending, reckless or dangerous activities, “sexual indiscretions” and so forth. This needs to be more than someone who just likes to do something, like collect something. There is an episodic nature to these activities and most everyone will agree that this person has binges of overdoing things despite them getting in trouble.

This characteristic is highly related to the continued use despite negative consequences we see in substance abuse. As a matter of fact, people with a Bipolar diagnosis are much more likely to also have addiction and alcoholism issues than the general population.

The result

To be diagnosed with a manic episode you need to have three of the seven symptoms. We want four if you are just irritable but not expansive or elevated in mood.

But look at how many of these things are judgment calls. Was Steve Jobs grandiose? How about Bill Gates? How much can I work or write before it becomes “excessive goal-directed behavior.” Are all writers Bipolar? (I need to think about that one.)  How many books can I buy this week before it becomes excessive involvement with pleasurable activities?

Sorry, this post is running long. My short explanation of manic episodes leaves more questions unanswered than it answered. Like: How could you be manic and not have Bipolar disorder?  What is hypomania and how is it related to all this? Are their different types of mania? What is a mixed episode? What things cause mania? How will this all change when we get the DSM-5?

If you or someone you know has symptoms of mania please see a professional. This article is not meant to be enough for you to do “do it yourself diagnosis.” There are many effective treatments for Mania, Bipolar Disorder, and related conditions.

Stay tuned for more on Mania, Hypomania, Cyclothymia, and Bipolar Disorder and the things we know and don’t know about all these topics.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

You know your manic when–

Posted on by
1

Here is a really good description of one type of mania.

Lady Diana, Bipolar and Borderline Personality Disorder

Posted on by
4

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Lady Diana’s headstone.
Photo courtesy pixabay.

Did Lady Diana have Bipolar disorder, Borderline Personality Disorder, or what?

Some interesting questions from reader Gledwood about Bipolar, Borderline Personality Disorder, and Lady Diana. See the comments after Levels or Types of Borderline Personality Disorder.

I never met Lady Diana and am not so much a follower of royalty, so I can’t give you a specific diagnosis about her. In fact, it is considered unprofessional for therapists to give opinions on someone they have not assessed. But maybe I can give you some general answers on these two conditions and on how psychiatric labels may not fit celebrities very well.

1. Borderline Personality Disorder (BPD) and Bipolar are very different conditions.

There may be some small similarities and someone could have both but my thinking is there are quite different conditions.

BPD is like a volcano erupting. Huge uncontrollable emotions. They love you – then they hate you, sometimes the emotions change in the same hour. BPD has a huge pain component. Most people with BPD were abused, molested, or had a non-affirming childhood. People with BPD often self-harm and they do it to relieve the pain not to find pleasure. They have trouble coping with negative emotions and will frantically try to find ways to stop having to feel bad.

Medication may help BPD and so will therapy but it is a slow process.

Bipolar is like a ride through the mountain in a car.

Sometimes down in the valleys in the shade and other times up near the top in the sun. Bipolar also involves some irresponsible impulsive behavior when manic but it is more about impulsive over-seeking of pleasure than anger-driven. The ups and downs happen more slowly and someone with Bipolar can have years of depressed behavior and mouths or years of overactive pressured behavior. Bipolar Disorder often responds to medication. Over-responding to antidepressants is one characteristic that makes us think – Bipolar.

Someone with Bipolar can be trapped by depression for long periods of time and stay stuck there.

Diana Spencer and Lady Diana were probably very different people.

Public figures are often very different in their personal lives than their public lives. The Royals can’t very well hang out at the local bar (or Pub.) Take that press about what someone is like based on their public appearances with a lot of salt. Many comedians and singers are very shy in small groups but once on stage, they can assume a whole other “persona.”

Fans need to be careful to not confuse the person with the character they play. Celebrities have the same problem and start thinking they are their character. There is a difference between being “typecast” and always portraying the villain and those performers who play themselves while on stage. My guess is that having to play the role made it hard for her to maintain old friendships and relationships.

The diagnostic criteria professionals use and the popular meaning of terms are not the same.

I see way too many people who are being called “Bipolar” who are moody, irritable or just plain hard to get along with but they do not necessarily have periods of either depression or mania.

The DSM descriptions are a lot longer than the oversimplified description in most blog posts. There are 11 factors listed for mania and mania is only one factor needed for a diagnosis of Bipolar I Disorder. Professionals need a lot of information before making these decisions.

Symptoms of both these and other disorders are normal traits that get out of control.

Despite the fact that I get paid to treat people with mental illnesses and substance use disorders I think we are trying to turn a lot of normal human emotions into diseases.

Everybody gets sad sometimes. Most of us do impulsive things. If you have never acted on an impulse we think you may have a problem with being obsessive or compulsive. Lots of us get into disagreements and don’t want to be around or talk to others who annoyed us. Someone who has BPD has a pattern of lots of unstable relationships their whole life.

The labels Bipolar and BPD apply to people with severe forms of these conditions; there are a whole lot of other people who have a few characteristics, sort of like one of these conditions. If you have just a few symptoms, counseling or other preventative measures may help you avoid developing a full-blown disease.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Hope that helped with the case of Lady Diana, Bipolar, and Borderline Personality Disorder.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Is Dysthymia better in the morning or worse?

Posted on by
2

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Which depression is worse in the morning? – Morning Question #14

Having more depressive symptoms in the morning is a characteristic of “Atypical features” of a mood disorder. Atypical does not mean unusual it means “not melancholy.”

Atypical features include the hibernating-like-a-bear symptoms, overeating, sleeping too much, and being tired and grouchy in the morning. With atypical features, the person may be able to feel better temporarily if something they really like happens, but the happiness does not last long. They may also feel better in the evening but by morning the depression comes back.

Atypical features can occur during episodes of Dysthymia, Bipolar one or two Disorders, and Major Depressive Disorder. In practice, the only time I remember seeing this on a file is as part of the diagnosis of a Major Depressive Disorder but having atypical features increases the risk that this will eventually turn into a Bipolar disorder.

If your mood is customarily worse at a particular time of day, make sure you are eating and sleeping well, that there are not environmental problems like relationship issues that are causing this, and then seriously consider consulting with a medical doctor or psychiatrist. If the doctor rules out any medical problems then some counseling should help.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Is everyone Bipolar?

Posted on by
1

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Just how common is Bipolar Disorder?

There are people out there with Bipolar Disorder as we currently understand Bipolar. Some people who really have this issue never get diagnosed and miss out on the treatment they need. From some of the things on the web today it is hard to see how anyone could escape getting this diagnosis. For more on this dilemma see the post, Bipolar – Misdiagnosed or missing diagnosis?

If professionals give out a diagnosis too freely then it stops having any meaning. So just how common is Bipolar Disorder and what should we think about people who sort of have it?

Some perspective

Humans are not the only creatures on earth who act “bipolar.”

Think about some of the symptoms. Elevated expansive mood, reduced need for sleep, increased impulsivity and heightened sexuality. Hum—

It is hot here now, but only a few weeks ago it was spring. From the window in my office, I watch the birds in the trees and on the lawn. There are a lot of native doves in my immediate area. For a while, just after Valentine’s Day, those doves woke me up in the morning. They were cooing constantly and then mating – can’t describe that and stay P. G. rated. When pursuing and being pursued by mates their temperament can best be described as irritable. Are doves Bipolar? Are they only Bipolar in the spring time?

Every spring the days start getting longer, the creatures on planet earth respond by becoming more active, they and we humans with them, think about reproduction. If birds breed in February they have babies by Easter. Humans seem to breed just as fast but we take longer to get the babies done.

Then in the fall time, the doves seem to disappear. So do the humans on my block. All those exercise freaks stay indoors. As the days get shorter the mood among humans gets gloomier. This may be one reason we have so many holidays in the fall and winter, Halloween, American Thanksgiving, Christmas and New Years all in a couple of months. We do this to cheer ourselves up. We also see extra depression during those months of less light.

If birds are affected by the changes in weather, humans are affected, and other animals also, it is difficult to go on describing these mood fluctuations as a mental illness.

We know that some people are affected by the seasons more than others. The degree and magnitude of mania and depression vary from one person to another. When have we crossed the line and turned normal human emotions and feeling into a pathological disorder?

There are also milder variations in human behavior we call “personality.” Talking about personality types, wondering why we are the way we are, is an interesting study. One needs to be careful in learning about personality to not make the first year student mistake and start seeing pathology where none exists. Not everyone who is moody, sleepless, irritable, or extra sexual needs to be diagnosed and put on medication.

As a therapist, I know there are lots of folks who would benefit from talking to a counselor about their problems. We also know that insurance wants us to be sure they are mentally ill and meet the criteria for “medical necessity” before insurance pays for the treatment. The challenge is to stick to the criteria and make sure only people with a real mental illness get treated using insurance money, while still trying to help all the people we can. Professionals continue to debate exactly where the lines of a disorder should be drawn.

At this point, we have three for sure reasons why someone’s symptoms get severe enough that they get the diagnosis.

1. Your issue interferes with “occupational functioning,” which includes school, for children and volunteer work if you are disabled.

2. It interferes with “social functioning” which mainly means you have poor or no relationship with family and friends.

3. Your issue causes you “subjective distress,” meaning a whole lot of emotional pain.

Having a personality that is not as you would like it may be painful but I hesitate to throw that in with mental illness. So if you are too introverted, impulsive or have some such personality trait, you can work on that, but you are not likely to be severely enough impaired to be diagnosed with a mental illness.

Some people may have “bipolar trait” or a “bipolar temperament” these are things you may or may not choose to work on in yourself improvement projects. “Hyperthymic Temperament” and Hyperthymic Personality Disorder” is just such a condition. Hyperthymic Personality Disorder is a common name NOT a specific diagnosis. DSM Personality Disorders are far more severe than Hyperthymia.

My thinking is that if you have characteristics like this you may want to consider being screened by a profession and keep an eye out for the possible development of Bipolar Disorder.

One thing we professionals should avoid doing is turning everyone who is different, into a pathological condition.

So is everyone Bipolar? The DSM-4 reports that the prevalence of Bipolar I and Bipolar II combined is more or less 2%.  Irritable, moody, impulsive and sexual people – that is just about all of us.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Does an adjustment disorder produce depression and mania?

Posted on by
2

By David Joel Miller MS Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Morning Question #11 adjustment disorder, depression, and mania.

Adjustment Disorder is essentially an excessive reaction to a normal stressor. The DSM-4 currently lists 6 types of adjustment disorders. They all involve some combination of anxiety, depressed mood, or behavioral problems.

Once the reaction to the stressor becomes enough to cause symptoms of a Major Depressive Disorder that is what gets diagnosed. If there is any mania or hypomania, that would become a Bipolar Disorder.

Stress can trigger all sorts of mental health issues. Someone with a history of depression or mania or an underlying risk factor like family history could have an episode under stress.

So rather than adjustment disorder producing depression & mania, stress could cause any one of the three.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is Mania?

Posted on by
2

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How is mania related to Manic Depressive Disorder?

Manic Episode or mania, as it is commonly known, is a mood episode, not a diagnosis. Mood episodes are used to decide which Mood Disorder a person has. For all practical purposes mania and its milder cousin hypomania are only associated with one of the forms of Bipolar Disorder.

Having an episode of mania or hypomania is the defining symptom that distinguishes Bipolar Disorders from Depressive Disorders. The connection is so strong that for a long time what we now know as Bipolar Disorder was known as Manic-Depressive Disorder. Changing the name has confused a lot of people. I still see clients who say they have been diagnosed with Bipolar Disorder and Manic Depressive Disorder. Sometimes they also tell me they have Depression.

Once you have Mania or Hypomania we forget the Major Depressive Disorder diagnosis and use the Bipolar label only.

A Manic Episode is marked by a period of time of at least a week, or less if you get so bad you end up in the hospital before the week is out, where you have a really high, expansive, or elevated mood. This is not just a little happy or full of energy but a way “off the hook” period of time. Mania is not a good time. A little may feel like fun in the beginning. People with Bipolar Disorder may like a little mania but full-fledged mania is frightening.

Typically people who are manic have grand schemes to do things. These ideas make sense to them but they sound impossible to most other people. This is not the person who thinks they can sail around the world or invent an internet program. There have always been visionaries who plan to do great things and don’t get appreciated. These are people who try to run for president, cure cancer, and beat the house in Vegas – all in one week.

They have a decreased need for sleep, sometimes getting by on three hours of sleep a night and they try to do everything until they crash. This looks like a person on Methamphetamine but they don’t need drugs to be like this. Most people who get only a few hours of sleep may be able to function, but they will be tired and drag all day until they can sleep again. The person with mania can go days on little or no sleep and they feel fine. But the longer they are manic the crazier they act and sound.

Fully manic people talk a lot, pressured speech, the sort that erupts rather than is said. This is not a normal conversation. They know what they are talking about by not many other people can follow them. Because their mind is racing they become angry and irritable when other people cannot keep up.

In full on mania they become very goal-oriented, taking on lots of projects, rushing to do many things, but not always finishing anything. They have difficulty staying on one project, jump from task to task, and sometimes get stuck on something that to others looks meaningless or insignificant.

Since they know what they have in mind they think of themselves as brilliant and important, they become full of self-importance until the manic episode ends at which point they may become depressed and regret all they have done or said. This differs from narcissism in that the episodes of grandiosity go away leaving them ashamed or embarrassed.

A common characteristic of a manic episode is getting over-involved in things that are pleasurable. They may gamble, do drugs, or drink to excess. There is a huge overlap between alcoholism and manic or hypomanic episodes. During manic episodes, they may have excessive, unsatisfiable urges for sex and engage in sex with partners they don’t know.

Someone who is experiencing a manic episode may become so impaired that they have hallucinations. These hallucinations will go away when the mania ends, unlike psychotic hallucinations that are more long-term. It is also possible to have a “mixed episode” where the person is both manic and depressed at the same time.

If someone has these kinds of symptoms we reserve judgment as long as they are able to work, have friends, and are not upset about the episode. If it starts to affect functioning then the diagnosis is given. If someone is doing drugs or has a medical problem that is causing these symptoms then we don’t think that is mania and recommend they stop the drugs or get the medical problem treated.

If you have ever had a Manic Episode I would recommend you talk with a doctor, psychiatrist, or other mental health professional. Treated early you still can have a productive life. The longer you wait to go for treatment the more the risks that while manic you will do something you can’t take back and the mania will likely get worse each time you have an episode.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel