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Bipolar Through the Years – Getting Your Diagnosis Right

Difficult to diagnose Bipolar Disorder?

I am not bipolar!  I am (insert other diagnosis here)

I received my first bipolar diagnosis when I was about 30… ish minus a few years.  I am 40… ish plus a few years, so for most of All About Bipolar Disorder20 years (yes I know the math doesn’t work out but this is a true story), I have known that I have Bipolar Disorder.

If you are bipolar yourself you will know that when I say “I have known” it really means “I was told”.  I didn’t believe it at first.  I thought of every other thing it might be and tried really hard to convince the therapist “that isn’t me… not really”.

As an untreated, newly diagnosed bipolar, I felt compelled to express clear objections to specific parts of the diagnosis that did not fit.  I was trapped by the details… a problem which I have often suffered – or more like, caused others to suffer because of.

Over the years and through several different diagnoses and many periods of “those” risky behaviors, going on and off various meds, wrecking certain parts of my life – and recovering once again, I find that those details don’t matter anymore.

I used to have a vitriolic reaction to the suggestion that I should want to be “normal”.  NORMAL, I said… I don’t want to be Bipolar TherapyNORMAL.  Normal is boring.  I was many things but boring was not one of them.

I no longer have that reaction.  My life would have been easier if it were normal.  I would have missed all the bright, scribbly colors.  I would have missed all the scary but fun stuff… but then maybe I wouldn’t have gotten so tired.  Maybe I wouldn’t have had to shut the curtains and hibernate.  Maybe I would have missed all the scary and dark stuff.

Anyway – as usual, I veer off of my topic.  Today, I am 99 percent sure that I am bipolar but I do reserve that remaining 1 percent – just in case.

Over those years – starting before (way before) I was diagnosed as bipolar – I sought treatment.  At 14, I asked my parents to take me to a psychiatrist because there was “something wrong with my brain.” They said “no, there isn’t” effectively telling me that I was just a mouthy, disgruntled, histrionic teenager – which I was, but I was also bipolar.

I often wonder what might have been if I had been treated then and do watch my kids for the same occurrence.  Unfortunately at that time, a proper diagnosis was highly unlikely and probably wouldn’t have changed much.  Except I would have felt heard – and I didn’t.  I do try to hear my kids.

Once I was able to seek treatment for myself, I was diagnosed with several other things long before they hit the jackpot.  The first was “dysthymia” – oddly, this diagnosis came in the middle of a severe depression.

Dysthymia for a bipolar

I was in college, just a hair short of being suicidal, and had to sit down one day and decide if I was going to kill myself – or study.  Serious DoctorLacking concrete plans and lacking a sincere wish to die, I decided to study – but I did go to the student health center the next day where a kindly graduate student decided I was dysthymic and would benefit from group therapy.  Being the mixed-manic that I am, I was in a temporary state of “not so bad” and failed to mention the depth of my despair.

I went to group therapy with a bunch of whining college kids and two well-meaning graduate student supervisors for almost a year.  To be fair, some of these people may have had real problems.  A homosexual boy who was still “in the closet”, a secret cross-dresser, a bulimic, a giant athlete with a sever anger issue and mommy problems… and a couple of other whiners.

I never once mentioned that I was hallucinating at night… or that I couldn’t keep my thoughts going in a straight line….or that I was living in a dark grey fog… or that despite all this, I still wasn’t sleeping.  My dysthymic self simply whined away with the others about parents, childhood, professors…it may have kept me from killing myself but mostly it was just entertainment.  It also kept me from failing out of college, as the dean of my college was informed that I was “in counseling”.

Major Depression for a bipolar

When I finally admitted the hallucinations – that got some real attention.  It also got the notice of a physician – and her medical Medical Doctorstudent who proceeded to ask me stupid questions like “how much LSD have you done?”  I also got a very “fun” visit to a sleep clinic — where the results were inconsequential even though my case was examined by a neuropsychiatrist – or a psychiatric neurologist – whatever that is.

Still, I got the diagnosis of Major Depressive Disorder… I still wasn’t sleeping – and people were literally terrified of me.  Describing me as agitated would be like saying the Niagra River is a stream.  Major Depressive Disorder.  They did give me meds though, stopped the hallucinations and got rid of all that grey fog and I managed to finish college.

Codependent for a bipolar

Moving on a few years on and off antidepressants and anxiety medicines – never feeling right….risky this, risky that….institutionalization (not jail or at least not this time, but still…).  After a particular disturbance, one “therapist” told me I was “codependent”… little did he know how dependent I was…or on what.  I ignored him.

The “intensive treatment” did get me the diagnosis for bipolar disorder which I denied, and did so for many years.  On and off meds, risky this, risky that…back on meds…off…on.

ADHD for a bipolar

A few years later I was pregnant (married too, woo hoo) and had to go off the meds.  After I had my kids – the doctor that I saw said that I was ADHD – not bipolar.  Still not wanting to be bipolar, I took the prescription he gave me….which was of course an amphetamine.  Well that worked well – nuf said.  To be sure, my kids are fine.

Bipolar HeartbeatEventually, I came to reality and the bipolar diagnosis and back to the right meds.   This has required honesty.  Honesty with health professionals and honesty with myself and it requires taking my meds.  I am tired from all the bright squiggles and the darkness.  I do want to be normal.

Now, as a bipolar, I get to watch my kids and see if they have “it” or something else.  Either is scary, both are scary but I hope I will be more help than my parents were.  I still take my meds but I also still retain the right to act on the 1 percent in case something better than bipolar disorder comes up.

What Type of Bipolar Disorder Is It?

Each bipolar disorder illness is unique!

Uniqueness of Bipolar DisorderWhen nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder.  Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.

One big problem with bipolar disorder is that each illness is unique.  Psychiatrists may classify them into categories – but they don’t always fit.  Here are some case scenarios: (bipolar episodesbipolar groups)

•    Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much.  These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
•    Max has had periods of depression before.  A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior.  His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
•    Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
•    Sandra’s mood state can switch erratically.  One day she is all about shopping and the next time you call her, she is still in bed at noon.   This is a constant issue – and you never know what you are going to get.

These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern.  None of these patients seems to be “regular” bipolar.

Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:

Bipolar Disorder TypeBipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization.  This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category.  Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category.  Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.

Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder.  He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.

Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS.  She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.

There is also a very mild form of bipolar disorder known as cyclothymia.  It is a cyclical pattern of hypomania alternating with periods of mild depression.  Many people would not even realize this is a problem.

Bipolar disorder is hard to classify.  It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis.  Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.

Melissa Lind

Diagnosis and Symptoms of Bipolar Disorder

Bipolar disorder is difficult to diagnose.

The average bipolar patient will see three mental health professionals before getting the right diagnosis. In fact, one-third of bipolar patients will not be diagnosed with the disorder until more than 10 years after they first seek treatment.

There is a lot of similarity between the symptoms of bipolar disorder and other psychiatric conditions, but that isn’t the only reason why it is so difficult to diagnose. Here are some of the complicating factors:

Bipolar Disorder PatientThe patient only talks about depression – as bipolar disorder is a condition that has periods of depression alternating with manic episodes, many patients present when they are depressed. This is particularly true when a patient seeks treatment for themselves. Manic patients feel good or at least energized and are unlikely to believe that anything is wrong. Either they feel terrific, or they are in a heightened “bad” mood – and likely to blame that on other people or life circumstances. Consequently when they first seek treatment – they only profess to the depression as that is most bothersome.

Bipolar disorder looks like anxiety – in actuality, many, if not most bipolar patients also have some type of anxiety disorder. Consequently it may be very difficult for mental health professional to root out bipolar disorder. If patients are seen as agitated, hyperactive or fidgety, they may be only asked about anxiety or given a self-rating scale for anxiety. This would immediately lead the practitioner to diagnose an anxiety disorder – unless careful investigations were done.

Substance abuse can be complicating the issue – many bipolar patients spend years self-treating with substances of abuse. This includes prescription medications, recreational drugs and alcohol. There is not any particular drug that is more often abused by bipolar people as a whole – some will choose alcohol, some will prefer stimulants, some will choose pain medications – all of which will mask the symptoms to some extent. In some cases, the substance abuse appears to be more problematic than anything else and in cases of addiction; the substance abuse must be treated before an accurate evaluation can occur.

Denial is very common – Denial is a nice way of saying dishonesty. That would be lying. This sounds very harsh but in many cases, bipolar patients will not be honest about difficulties that they have had. It may be subconscious dishonesty in that they, themselves do not really know what the problem is. Lack of awareness is common but outright denial is also common. Many bipolar patients absolutely refuse to accept the diagnosis when it is first presented – even after years of not being treated properly. Oddly, this may make it more likely that the practitioner believes that the patient has bipolar disorder but such outright denial delays treatment.

These are just a few of the reasons why bipolar disorder is so difficult to pin down and, unfortunately, delayed treatment can have huge life implicationsBipolar disorder is one of the riskiest psychiatric illnesses to have and can have severe consequences for the patient who is not properly diagnosed and medicated – including job losses, family disturbance, institutionalization, jail and even death.

Bipolar disorder affects not only the patient himself – but family and loved ones as well.

Why is it so difficult to diagnose bipolar disorder?