Tag Archives: Bipolar Disorder

Bipolar Disorder or Borderline Personality Disorder?

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

personality disorder

Bipolar or borderline personality disorder?
Photo courtesy of Pixabay.com

Bipolar Disorder or Borderline?

There are several differences between these two disorders. But it is important to remember that it is possible for someone to have both problems which greatly confuses the issue.

The largest differences between the two are sleep and time. Ego strength and character structure also play roles in this choice of diagnoses. I have exaggerated the differences to make the distinction clearer.

Sleep matters.

To be Bipolar you must have had a Manic or Hypomanic episode. The key characteristic of those episodes is long periods (time) of above-average energy and decreased need for sleep.

In hypomania, the person may be able to get by on a few hours of sleep, 3 or 4, and they feel fine. In full-out mania, they may even go all night without sleeping and still be just fine. At least they think they are fine. Others around them may notice they are irritable from lack of sleep but they think they are just fine.

Also in Bipolar when they are up they feel great, expansive. The same person may have episodes of depression and during those times they may sleep too much or too little but the telling point is that in the up times they will tell you they are on top of the world, full of energy, and can just do so much without needing to sleep like lesser people.

With those Bipolar manic episodes comes tons of energy. They like to go up in the attic and swing from the rafters. They might work all day then go to the casino and gamble all night only to go back to work the next day like nothing has happened.

Time.

People with Borderline have many moods within a day. The can be “touchy” easily set off and others may hurt their feeling without meaning too or even knowing why. People with Borderline Personality disorder are full of pain and rarely have a good day. They can be so bruised that a look or word can hurt them.

People with Bipolar have longer periods of up or manic feelings. When times are good for them they are really good. They may go weeks, months, or even years when they are on top of the world. But eventually, the crash comes and there will be long periods of time when they are depressed, possibly unable to get out of bed. Recurring episodes of depression is a common feature of Bipolar Disorder.

Ego strength.

Borderline Personality Disorder is pain based. Many borderlines were abused, neglected or deserted. They are needy in relationships but always distrustful that the person they are with will leave them.  Borderline may threaten to kill themselves if you leave them.

Bipolar people mostly don’t care what you think of them, at least not when they are manic. They know they are smarter than Einstein and better looking. They believe they can work miracles. This overvaluation of themselves and their abilities gets them in trouble a lot. The take excessive risks not because they want to hurt themselves like the borderline but because they really believe they will win.

Borderlines are anxious, Bipolar people could care less. Let this one leave and they will find another.

Sex.

People with Bipolar Disorder are often hypersexual. They can’t seem to get enough. This will lead to sexual indiscretions that ruin their established relationships. When manic they just can’t seem to stop themselves. When you’re manic the whole world looks good.

Borderlines are rarely secure in a relationship, fearful that if this partner leaves them, that confirms their fear, they don’t deserve a partner. They will stick with a partner, often an unworthy one, because they fear that if they were to break up they just could not take it.

Who loves their disease?

Someone with Bipolar disorder resembles a Vegas Gambler when they are on a winning streak they want to ride it forever. When the crash they hate themselves and can’t face the wreckage they have created. Bipolar people like being manic. They frequently quit taking their meds just so they can feel manic again. Mania is seductive like a new lover, but one who keeps treating you wrong. Still, you want to recapture that allure.

Borderlines are more like characters from a soap opera, bad stuff keeps happening to them and they wish the pain would end. They live in a world of pain and hurt. They wish they could find a way to get things to change. They are often angry and feel others don’t treat them right. Frequently they are correct. They have been mistreated by someone somewhere and they keep trying to find a way to make it right, to make the pain go away.

Do they ever not have symptoms? – Character structure.

Someone who has Bipolar disorder has a “Mood disorder.” They have specific times (Periods) when they have mania or Depression but at other times they have no mood symptoms. These times of apparent “normal” behavior may last for months or years and then something kicks off another episode of mania or depression.

Someone with Borderline Personality Disorder has a “Personality Disorder.” The presumption here is that they learned to be this way and are like this most of the time. They learned to protect themselves, store their anger, and release it in bursts and other survival techniques. The trouble is that the way they handle emotion makes them and those around them miserable.

The younger you were when you learned basic ways of being with others the harder it is to change. Most people with Borderline Personality Disorder continue to have some symptoms even after treatment, though with good care they can and do get much better.

Please check out my other posts on Bipolar disorder and Borderline personality disorder the list of categories is to the right.

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

Mania in children?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Do children really have mania?

Parents bring children into the emergency rooms and the psychiatric facilities because their child “flips out” and begins damaging property. Say the child begins breaking out all the windows in a row of buildings. They are angry and out of control. Efforts to get them to stop are unsuccessful and they may continue even when threatened with violence. Is this an early sign that the child has Bipolar disorder?

Diagnosing Bipolar Disorder in children is highly controversial. To make that diagnosis we need to know if children really have episodes of mania or hypomania. No mania and there should be no Bipolar Diagnosis. Anger and mania are related; they may overlap but are they part of the same thing? The researchers in this area are clearly not in agreement. I will save my opinion for the end.

Children have temper outbursts. If we reduce the level of symptoms needed to include those outbursts as a mental illness all children would get the label and the diagnoses would become meaningless.

To be considered Mania it should last 7 days, for Hypomania an episode needs to last for at least four days. This rules out all those brief temper outbursts from consideration.  It also excludes those times when any and all of us might have a time period of excitement when we sleep less or are excited to pursue a new activity, like a new love interest.

Recently there has been an increase in the use of the Bipolar NOS diagnoses in children because this allows for some judgment calls as to the length of the episode needed to make the diagnosis. One study (Stringaris et al. 2010) looked at children who had been diagnosed with Bipolar and concluded there was no evidence of mania in children under the age of thirteen, meaning no child that young should be getting the diagnosis of Bipolar. Other researchers disagree.

Stringaris did find that of those children who had brief episodes, too brief to meet criteria for a hypomanic episode, fully 25% did go on to develop all the symptoms needed to diagnose Bipolar Disorder within two years. His conclusion is that we should wait until the teen years and the full criterion is met before diagnosing Bipolar Disorder.

This is a problem for me. Why would we begin treating a child if they do not have an illness? No diagnosis no treatment. So to get the family the help they need, we need the diagnosis. If not Bipolar Disorder then what would we call this child’s problem? Also, the study tells us that 25% of these brief episodes will develop symptoms in 2 years. What about 10 years or 20?  I have not yet found research that answers those questions.

Early-onset researchers come up with a different answer. Telling us that – Mania, Bipolar one mostly starts in the adolescent period (McNamara, 2010.) This study goes on to cite 6 factors that may constitute risk factors for the early development of Bipolar Disorder.

One significant risk factor is a history of being the victim of abuse and neglect. We know that early childhood experiences can induce changes in the wiring of the brain. So can later life traumas. Psycho-social stressors are also listed as risk factors. These are also risk factors for personality disorders and other mental illnesses.

This tells us that experience and learning can be risk factors for developing Bipolar Disorder.

A family history of Bipolar is also a risk factor. Not just family members living in the home, but first-degree family members who have any mood disorder, whether in the home or not, appear to increase the risk of developing Bipolar.

That says that heredity is a risk factor for Bipolar Disorder.

A history of substance abuse, prescribed antidepressants and stimulants, and dietary deficiencies all have been implicated as having a connection to Bipolar disorder.

See: Do medications and drugs cause Mania or Bipolar Disorder and other Co-occurring blog posts

Lastly, McNamara sums up the argument for diagnosing Bipolar Disorder in children by saying that most people who go on to get the diagnosis had “prodromal” or early symptoms 10 full years before they were diagnosed.

We know from other mental health research that the sooner an illness is recognized and treated the better the chance of a full recovery.

My opinion

Children who have a brief – one day temper or behavioral outburst are unlikely to be having Bipolar disorder. This is anger or bad behavior and you should try treating them for anger and behavior first. But the pattern needs monitoring.

There are dangers from over-treating psychiatric illnesses in children and there are dangers of under-treating. Pick a provider you trust and listen to their advice and judgment. I especially recommend a consultation with a child psychiatrist whenever possible.

Don’t adopt a wait and attitude, even if you decide to skip the medication for now, if your child has these kinds of symptoms get the child counseling or therapy.

Care to share or comment?

Has your child had outbursts that looked like mania or hypomania and have you considered the possibility they may have Bipolar 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

Types of Mania and Dual Mania

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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?

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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

What is Mania or a Manic Episode?

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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

Is everyone Bipolar?

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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.

Dysthymic Disorder –chronic sadness untreated

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24

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Dysthymic Disorder, a forgotten Mood Disorder.

Mood disorders are separated into two groups, Depressive Disorders, and Bipolar Disorders.

Major Depressive Disorder gets all the press while it’s craftier and more insidious cousin Dysthymia gets almost none.

In Dysthymia the person feels pessimistic and “down in the dumps” but the condition is not yet severe enough to be recognized as full-fledged Major Depressive Disorder. In children, this disorder is likely to be missed or to be misdiagnosed as a learning disability, attention problem, or poor behavior.

In adults, we call these people pessimists or grumpy old men. People often have been suffering from dysthymia for so long they come to believe this is simply the way they are. They think the sadness is a part of their personality, and don’t know that dysthymia is a treatable condition. They can’t imagine feeling happy as others do.

Diagnosable Dysthymia is a long-term overall sadness that interferes with having a happy life. As a Cognitive Behavioral Therapist, I am sure a faulty belief system either creates or perpetuates this disorder.

Dysthymia is not an occasional “BAD HAIR DAY.’ It involves someone who, while not always depressed, is sad and down more of the days each week than not. It is also not just a rough patch in the road. We may all have weeks or even months of tough times that make us sad. People with Dysthymia have at least two straight years of mostly sad, depressed days but somehow they keep trudging on. If they would just give in and stop trying they might get the diagnosis of Major Depressive Disorder.

For kids, we reduce the two-year requirement to one year, if the child can avoid the “ADHD, heavy meds, hits someone and become a bad kid” trap.  In kids, the mood is more likely to be irritable all the time than obviously sad or depressed. Kids show pain by being irritable. They may also become pessimistic and stop trying to complete their work. Their grades drop and their sad mood leads to missed school days and few friends.

This is a chronic condition and without treatment, it rarely goes away. About half the time Dysthymia deepens and becomes Major Depressive Disorder. The combination of both is sometimes referred to as Double Depression and even when the Major depression lifts the person may still have the overall sad mood of dysthymia. This makes it important that they get treated not just for the Major Depression but for the Dysthymia also.

Just being down, depressed, or irritable for two years is not enough to get you this diagnosis. This disorder will also probably not get you disability, as people with Dysthymia keep trying and are able to go to school or work even when they hate life and are chronically unhappy.

People with Dysthymia will also have features similar to Major Depressive Disorder in being rather Melancholy or having atypical symptoms. They either eat-and-sleep like bears hibernating for the winter or they can’t eat and can’t sleep.

One common characteristic of people who have dysthymia is low self-esteem. They don’t have much self-confidence and they don’t think they can accomplish much; as a result, they give up trying. This can be the result of a difficult childhood, bullying, or simply a lack of having had the experience of succeeding at little things in life.

People with dysthymia are often hypercritical of themselves, others, and the world in general. They may complain a lot and have difficulty having fun. This leads to low productivity and a lack of positive relationships with others.

People who failed a lot or who were never told that what they did was good enough are prone to Dysthymia. Lack of praise was supposed to make for more accomplishment. Some parents ask me why they should praise a child just for doing what they should be doing anyway? The answer is that without praise kids begin to think that no matter what they do, or how hard they try, it will never be good enough. Eventually, they stop trying.

People with Dysthymia don’t get much pleasure out of life. As a result, they avoid doing anything that might be stressful or involve a risk of failure. They become increasingly sad and withdrawn. They find it difficult to make decisions and to start or finish projects. No use in trying if “nothing is going to turn out all right anyway.”

This may be hard to spot, as people with dysthymia avoid social situations and lack of social support is a factor in perpetuating dysthymia. It is hard to make new friends when you are sad, feel bad about yourself, and don’t have a belief in your ability to succeed.

Families tend to share their mental illnesses. If one member of the family has depression, major or minor, then other members of that same family may have dysthymia. This suggests that there is either a hereditary risk factor for Dysthymia or an environmental risk factor. Families provide both.

Dysthymia is extremely common among alcoholics and substance abusers. People who are sad a lot are more likely to abuse substances and people who abuse substances have plenty of reasons to be sad. What brings these people to treatment is an out of control addiction or when the dysthymia becomes Major Depressive Disorder. Many people with Dysthymia have psychical illnesses and conditions also.

Dysthymia frequently starts in childhood and affects both functioning and development. It is important for a child’s healthy development that they know it is possible to succeed and achieve. Having good, positive, and close friends is also an antidote.

The elderly are at increased risk to develop Dysthymia as they lose family and friends, become more isolated, and may have difficulty providing self-care. Changes in appetite, fatigue, sleeping problems, and isolation can all be mistaken for the usual results of aging instead of being recognized as symptoms of Dysthymia or depression in the elderly.

Treatment for Dysthymia is possible and has been shown to be highly effective. Group counseling and support groups are helpful. Individual therapy and medication are useful, though medication appears to be less effective with Dysthymia than with Major Depressive Disorder.

Because of the chronic nature of Dysthymia and the high risk, this will turn into Major Depressive Disorder early treatment is important.

Related articles: Mood Disorders, Depressive Disorders,

Major Depressive Disorder, Bipolar Disorder or Depression?, Bipolar or moody?, Am I Bipolar?, Hyperthymia, Are you hyperthymic? 

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 the difference between depression and Major Depressive Disorder?

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20

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Depression, Mood Disorder, or Major Depressive disorder?

Major Depressive Disorder is a specific diagnosable disorder listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders.)  Sometimes we use the term imprecisely to refer to both the common-sense feeling of sadness and a series of specific mental disorders that we professionals call mood disorders.

The dictionary definition of depression is essentially sadness. In the mental health field, it means so much more.

The differences in mood or depressive disorders are largely a matter of certain specific features that the person has rather than saying anything about the cause. There are also some related conditions that are not currently official “depressive disorders” but for which depression is a feature.

Confused yet? It takes 4 years of college and two more of grad school to make it all this complicated.

Mood problems often occur in “episodes” so they can come and go with or without treatment. The episodes don’t get specific diagnoses, but they do get used to seeing if you have all the features of a specific diagnosis.

Now if you are depressed and suicidal, which specific mood disorder you have may not matter to you, but it matters a whole lot to the insurance person approving your treatment. Since not everyone agrees which things are severe enough to require treatment, the list fades in and out with time.

What makes depression into a Major Depressive Disorder rather than a garden-variety depression is a few key factors.

How long you been feeling that way?

To be major depression it should have lasted for more than 2 weeks AND there should be at least 4 other symptoms of impairment. The effort here is to separate normal life problems from an illness that needs treatment.

How has this affected you?

There needs to be some problem in your life over and above just being sad. Being over sad all the time but not quite getting bad enough to be diagnosed with Major Depressive Disorder is called Dysthymic Disorder.

So we look to see can you work? Do you have friends and family? Do you still do some things for fun? These things separate out the sad moods and the sad-for-a-reason from the sad-way-to-much-and-too-long that characterizes Major Depressive Disorder.

Major Depressive Disorder is also separated into “single episodes” and “recurrent.” The first time someone has Major Depression we look more for causes. If they have repeat performances of depression we look at this as likely to be something produced by the person, either biologically or thinking wise.

Depressive Episodes, hence Major Depressive Disorder can also be “graded” into mild, moderate, and severe. For the treating professional this helps plan treatment. For the insurance company, it helps them known how big a bill they are getting for this treatment.

Sometimes the depression gets so bad that the brain starts making up stories. This looks a lot like the psychosis in Schizophrenia but it only happens to some people and then only when they are severely depressed.  This is called with (or without) psychosis depending on whether you have or do not have psychosis.

People who have Major Depressive Disorder do not all look or act the same. Some people become so depressed they have trouble moving. This is called Catatonia which is also associated with sleep paralysis.

The old fashion name for depression was melancholy. This is typically very severe in the morning but gets better as the day moves forward. People with this variety also wake up early. They don’t feel like eating and they either sit unable to summon up the energy to do anything, or they pace aimlessly about.  Often they also feel guilty about everything and hate to bother people.

People with atypical features are more like bears hibernating for the winter. They are hungry when awake and they sleep day and night but are still tired.  They are likely to feel that people are rejecting them and don’t what them around. People with atypical features can brighten a little for a while if you dangle something they like in front of them, but this improved mood doesn’t last long.

Postpartum Depression is also a recognized type. This is easy to understand in women soon after the birth of a child, due to the changes in the hormones in the woman’s body. It can also be seen in men especially after the birth of the first child as there is a change in the primary relationship. The fairy tale is over. Some men become excited about fatherhood, others feel like they have lost a lover.

There is also a seasonal pattern associated with depression. Sometimes this is referred to as Seasonal Affective disorder or “winter blues.”  This pattern can occur in the summer or at the spring and fall changes of weather, but those changes are more likely to be associated with Bipolar Disorder than Major Depressive Disorder.

For more on related conditions check the categories list to the right of the posts or watch for words to turn blue indicating they have been linked to other posts about this topic. My plan is to add links as quickly as I can finish the posts on these other topics.

Feel free to leave comments or email me about your questions. While I can’t provide therapy or counseling over the internet, you need to come to see me in the office for that, I will be glad to try to answer questions of general interest.

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

Tests for mental illness

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

Mental illness.
Photo courtesy of Pixabay.com

Have you been tested for Bipolar disorder or Schizophrenia?

More and more people come in and want to be tested or have their family member tested for a specific mental illness.

We wish there was a specific test, maybe a blood test, someone could do, and then we could look at the lab report and say yes, you have Depression with a touch of ADHD. Unfortunately, it doesn’t work that way.

Mental health diagnosis or mental illness if you prefer that term. is arrived at by piling up symptoms and looking at the time you have had them to see what pattern of mental, emotional, and behavioral problems the client has been experiencing.

Not everyone with the same symptoms might have exactly the same disorder. Let’s illustrate this process with a physical disorder. If you are coughing and you go to the doctor and he diagnosed you with “Major Cough Disorder.” This may have been caused by a cold, asthma, or a touch of Tuberculosis. While you might take some cough drops to reduce the symptoms of the cough, regardless of the cause of the cough, you would want a different treatment for Tuberculosis or Asthma over the long run.

Treating the tuberculosis cough with a cough drop could make the problem worse by letting the bacteria get a hold and as a result, shorten your life.

With a Mental illness, we go the other way. We give everyone with the symptom more or less the same diagnosis regardless of what caused the symptoms. Does it matter if you are depressed because your spouse died or because you lost your job? What if you got depressed over time because your life was just not going the way you had hoped?

For each of these causes, we would diagnose depression and prescribe eventually the same treatment regardless of the cause. So you would get an anti-depressant medication and talk therapy. If you were grieving over a loss we would let you have a period of time to grieve, say 90 days and after that, if you were still grieving we would want you to get on with life.

Parents want their kids tested for ADHD. That should be simple from one point of view. The child does not pay attention when the adult wants them to. The child does not do their work – Ipso-presto they had ADHD. Not so fast loony breath.

If we look only at the symptom then yeah, sure, all kids have ADHD some of the time when they don’t pay as much attention as the adult wants them to. But it matters a whole lot if they are not paying attention because they are being bullied on the way home or if mom and dad fought all night last night or is everything in their life fine and when they try they just can’t focus.

Bipolar Disorder is another one parents want their kids tested for. One of the symptoms of bipolar is not sleeping or getting by on almost no sleep. Kids stay up all night a lot. Watching too much internet does not make you bipolar. (On second thought can I get a grant for a million-five to study that?)

This excess energy and lack of sleep are called mania or hypomania. A manic person looks a lot like someone on Methamphetamine but they get that way without the drug.

Kids also don’t get enough sleep because pound for pound elementary school kids take in more caffeine than adults. All that caffeine comes from the sodas they drink.  That much stimulant can make a five-year-old act like a drug addict on speed. Add many MG’s of an amphetamine salt to the caffeine and watch Johnny go like a cyclone. Expect that when he crashes he will get really irritable and hit someone while he is detoxing.

See why it is important to find out not just what behavioral symptom this child has but what else is going on in the family and in the kid’s head?

So as time passes and the facts come in the diagnosis might change, or not.

Also compounding this situation is the possibility that the client could have more than one problem. Could the Person with asthma catch a cold? Could they also catch Tuberculosis if exposed to the germ?

Someone could be depressed, have ADHD, and still take in too much caffeine or do drugs. This makes unraveling the diagnosis a problem sometimes even for a professional.

So till a reliable blood test come along for Bipolar Disorder, ADHD, and the rest, we will just have to limp along counting up the symptoms and looking for other possibilities to build the correct diagnosis up over time, and even then not every person responds to every treatment in the same way.

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

Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder.

Posted on by
44

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Does you temperament predispose you to mental illness?

Hyperthymia person

Hyperthymia, hyperthymia personality disorder, and bipolar. Photo courtesy of pixabay.

Personality characteristics may be a risk factor for certain mental illnesses but the exact connection continues to be far from clear. Psychologists have long been interested in various personalities. Are you outgoing – let’s call that extroverted. Psychopharmacologists look for connections between meds, drugs of abuse, and temperaments or personalities.

For the mental health community, the connection becomes more problematic. We are reluctant to diagnose someone as “mentally ill” because they are introverted, extroverted or have some other “personality type.” We really want to know that your personality issue or temperament is somehow interfering with your life, job, and friendships or making you miserable before we start saying that the way you are and were born, is somehow a disorder.

We know, or think we know, that some personality characteristics might increase your risk for certain disorders. To the extent that genetics plays a role in mental illness your temperament just might be a factor in developing mental illness.

Hyperthymia is one of those possible risk factors.

Hyperthymic people are those people who have so much energy, do so many things, and get so much done they annoy others. Goel, Terman, and Terman (2002) defined Hyperthymia as equivalent to Hypomania but without the impairment. So if you lose control it is hypomania and you get diagnosed with a mental illness (Bipolar.) But Hyperthymia by this definition means you are able to hold it together.

In their discussion of Bipolar and creativity, Shapiro and Weisberg (1999) define Hyperthymia as those people who have had periods of hypomania but there had not been a period of depression. This inconsistency in definition for Hyperthymia leads to a lot of inconsistencies in our understanding of this personality dimension.

Does that mean people with Hyperthymia are mentally ill?

A Hyperthymic personality has been suggested as a possible precursor for Bipolar Disorder. Currently, the DSM-4 includes diagnoses for Bipolar I, the most severe kind, and the Bipolar II variety with less visible mania, but not necessarily less severe, as the choices. Some theoreticians have suggested that there are also some “soft bipolar disorders.” They have suggested designations of Bipolar III and Bipolar IV for the less obvious forms.

Enter Bipolar III.

Shapiro and Weisberg suggested a diagnosis of Bipolar III for people who have depressive episodes and then when given antidepressants, experience hypomania. For them, the only time Bipolar III’s are manic is when on meds. Other authors suggest or imply that most any person with Bipolar Disorder will react quickly and dramatically to antidepressants.

Could Hyperthymia be Bipolar IV?

One area of research has been the search for connections, precursors, or predictors of future mental illness. These precursors are sometimes called “premorbid” conditions. If we knew that some currently small symptoms meant you were at high risk to develop a mental illness maybe we could begin treatment early and reduce the severity and length of a mental illness. Hyperthymia just might be such a precursor.

Hyperthymia seems to be one of several personality characteristics that increase the likelihood of developing some symptoms of Bipolar Disorder. But an increase in risk does not equal you having or getting the disorder.

People with Hyperthymic personality characteristics who experience depression, even a mild depression may “overreact” to antidepressants. Doctors have been warned to look out for high energy people who have an episode of depression and when given an antidepressant are propelled into mania or hypomania. An excess reaction to antidepressants could be one way of diagnosing Bipolar Disorder. One research study (Hoaki et al. 2011 published in Psychopharmacology) suggests that doctors should consider giving these Hyperthymic type people a mood stabilizer rather than an antidepressant.

Risk factors for Hyperthymia.

These researchers also found some other risk factors for developing Hyperthymic personality and presumably a soft form of Bipolar Disorder. Now, this is my understanding from reading this and other studies but a lot more research is needed in this area. Remember this is my opinion not necessarily the researchers.

When subjects for research were first screened there seemed to be a connection between how much they exercised and how “Hyperthymic” they were. Presumably, if you exercise more you have more energy. This did not end up in the lists of the risk factors for Hyperthymia so at this point it does not seem likely that more exercise will push people with risk factors into a Bipolar Disorder. But frankly, at this point, any connection between exercise and Hyperthymia or Bipolar Disorder seems like a wild guess. If anyone out there with Bipolar Disorder has seen a connection please drop me an email or leave a comment.

More light- More Hyperthymia.

Hoaki and his colleges found the relationship between light and Hyperthymia to be fairly strong. Even people who did not exercise much, when they were in brighter surroundings, had more energy and more Hyperthymic personality traits. So being outside or around more light might improve your energy level. We know that lack of light is one reason some people suffer from SAD (Seasonal Affective Disorder) but this makes us wonder, could changes in light level provoke Hyperthymic episodes, and might this be a risk factor for a hypomanic episode?

More variation in sleep – More Hyperthymia.

One diagnostic marker for manic and hypomanic episodes is a decreased need for sleep. What Hoaki’s article seems to suggest is that it is not just that a reduced need for sleep is a problem, but fluctuations in the amount of sleep from night-to-night may be a risk factor to set off Hyperthymic characteristics. Hoaki frames this as changes in bedtime; presumably, his subjects have a constant time to get up for work or school. Studying sleep fluctuations in people who have no set time to get up might clarify this issue.

Could fluctuations in the amounts of sleep be a risk factor for inducing Mania and Hypomania?

Hoaki et al. speculate that a consistent amount of sleep might be a preventative for developing Bipolar Disorder.

People with a Hyperthymic personality or temperament also had a tendency toward Serotonin Dysregulation. So the way in which Serotonin is used in the brain may be an important marker for Hyperthymic Personality as well as for mood disorders. Hoaki notes that other authors have suggested that people with a Hyperthymic personality may also have differences in the way their brains regulate dopamine. The more we learn about the brain the more neurotransmitters seem to be involved in the way our brains work.

The conclusion of Hoaki’s study is that light, sleep, and serotonin activity are all factors in Hyperthymic personality characteristics and in Bipolar disorder, so there is likely a connection between these two conditions. How the two conditions are related we are just not so sure.

Is Hyperthymia a personality disorder?

The lists of Personality Disorders listed in the DSM-4 as diagnosable mental illness is short and specific. Hyperthymic personality is not recognized as a disorder. It would be correct to consider Hyperthymia a personality characteristic or someone’s temperament but not as a disorder.

Those very energetic people may be annoying to some but they are just not considered mentally ill at this point.

More on the recognized personality disorders to come

Hope this helped to clarify Hyperthymia, Hyperthymic Personality characteristics and why there is not a recognized Hyperthymic Personality Disorder.

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