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Bipolar Disorder

Bipolar Disorder

Woman with Bipolar Disorder Wins Court Case

Future discrimination of people with Bipolar Disorder may be more difficult

Score one (kind of) for Bipolar Disorder.  A federal jury awarded a woman who was fired because she requested time off from work to deal with a manic episode $32.5 thousand.

Bipolar Disorder StigmatizationBipolar disorder (and many other psychiatric illnesses) carries a relatively big stigma in the workplace.  Unless you are in the creative arts, likely, you will not want anyone at your job to know that you have bipolar disorder.

Three years ago, a nursing assistant who worked in an assisted living facility, named Charlotte Massey realized she was in the middle of a manic episode.  Charlotte had been diagnosed with Bipolar Disorder – and kudos to her for recognizing that she needed to do something about it before it spiraled out of control.

When she called her boss, the owner of the facility, her boss not only didn’t give her “kudos”, he gave her a pink slip.  She got fired because she asked to take a leave of absence to deal with her medical issue.

Unlike most people who have been fired for Bipolar Disorder – Charlotte didn’t lose her job because she went wacko.  Instead, she maintained enough mental clarity to notify her employer of her Bipolar Disorder Discriminationdisability and was rewarded with… firing.

It is certain that the owner of the facility was aware of the American with Disabilities Act.  It is likely that he or she was aware that he could not randomly fire employees with physical or obvious mental disabilities. But, it may be that he was unaware that “mental disabilities” includes illnesses such as bipolar disorder.

The ADA bars discrimination against persons with physical or mental disabilities who can perform the essential functions of their job with “reasonable accommodation” and without imposing an “undue hardship” on the employer.

From the outside, some may say… well she wanted to take time off.  In fact, she took a whole five days off, with herself or a family member reporting in each day with the supervisor.  When she returned to work after only a week of absence, she was fired.

Part of the law includes an evaluation of whether the employer would be subjected to “undue hardship”.  Is giving an employee time off to deal with a medical issue, an employee whose shifts could be made up by another person – an undue hardship?

Workplace StigmaThe court thought it was not.  The jury awarded Massey $25,000 in damages for lost wages and benefits and $7,500 in punitive damages.

The employer and his lawyer attempted to have the lawsuit dismissed by claiming that:

•    Charlotte Massey wasn’t fired; she resigned
•    She had a faulty memory of the events due to her disability
•    She never reported her disability to her employer

In fact, none of those were true.  Though the employer’s attorney repeatedly referred to the case as “frivolous”, the jury found otherwise.
This award may be the first of its kind, and it may be small, but it is a groundbreaking case.  With the ability to claim protections of the ADA, future discrimination may be more difficult.

Melissa Lind

More difficult for Bipolar Disorder stigma in the future!

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Borderline Personality Disorder in the News

In the news (and movies): Borderline Personality Disorder

Borderline Personality Disorder (BPD) doesn’t get a lot of “press” or screen time.

We have all seen movies and news stories about people with bipolar disorder. (Girl Interrupted, Mad Love, Borderline Personality Disorder Newsand the unforgettable Who’s Afraid of Virginia Wolf, drug addiction) (Chris Farley, Philip Seymore Hoffman, and Anna Nicole Smith), and major depression (Robin Williams, Owen Wilson, and Princess Diana).  Many of these movies or real-life examples also show how mental disorders are intertwined.

Depression comes with alcoholism, bipolar disorder comes with drug addiction, bipolar disorder comes with a lot of issues – but not much attention gets paid to Borderline Personality Disorder.

Borderline Personality Disorder has a few issues:

  1. It is a personality disorder and not a psychiatric disorder that can be treated with medication
  2. It is hard to diagnose and can often be confused with other disorders
  3. Borderline patients may misrepresent their behavior to medical professionals
  4. Borderline patients are often “difficult” to be around
  5. Borderline personality disorder is not well known – make it not well known… and, for this reason, there is no reason to write a news story or make a movie about it.

“Good news”;

I put that in parentheses because the diagnosis is not great – but it is good that BPD is getting a bit of attention.  Two notable examples – one not so great and one which may or may not be great.

Not So Great;

The trial of Jodi Arias.  In 2008, Travis Alexander was brutally murdered.  He was stabbed over 20 times, shot, and photographed after his death.  The alleged perpetrator: his girlfriend, Jodi Arias.

The case has been pending for many years – one of the reasons may be the development of a clear understanding of why Arias acted the way that she did after the murder.  Reportedly, Arias was witnessed immediately after Alexander’s memorial (including explicit text messages sent for “flirting”), and she has been pegged as a possible borderline patient.  This is in addition to Alexander’s former friends that reported her stalking behavior, and her statements that the boyfriend was a pedophile and a domestic abuser.

Arias’ own friends and a court psychologist have reported erratic behavior, similar to that of BPD.  No verdict has been issued as of yet, and we may never know, but it does bring BPD into the news (not in a nice way but into the light, however).

In fact, some mental health professionals have expressed the belief that BPD patients may be more dangerous – both emotionally and physically – than most other mental disorders, some likening it to a form of sociopathy.

Possibly good news;

Borderline Personality Disorder in the NewsOn the movie front, Kristen Wiig (of Bridesmaids –and the new, all-female Ghostbusters) has starred in a”dramedy”. Dramedy is  a combination of a comedy and drama that is centered around a woman with BPD.   In Welcome to Me, the character, portrayed by Wiig, wins the lottery and uses part of the money to start a talk show.

Along the way, she skips out on treatment, quits taking her meds and ends up living in a casino.  No word on reviews for the show, but it has some big names including Joan Cusack and Tim Robbins. It is produced in part by Will Farrell, and even though it premiered at the Toronto International Film Festival, theater showings have not been announced.

If you know a BPD patient – imagine what he or she might do after winning the lottery.  BPD is hard to diagnose, hard to predict and even tougher to be around.

Whether the movie is any good, whether the trial comes to a just end…

Melissa Lind

Borderline Personality Disorder has gotten some attention!

Bipolar Disorder and Exercise

Does Exercise Help with Bipolar Disorder?

Everyone knows that exercise is good for your health.  It is a no-brainer, and it is repeated so often that you have probably gotten tired of it.  I know I should do some physical activity. It is good for my heart, my bones… blah, blah, blah.

Bipolar DepressionOn the other hand, aside from needing to exercise because I am getting old and tired – the idea, that exercise might be good for my Bipolar Disorder, might just motivate me to do it.
Nothing else has.

A research study conducted in 2012 showed that exercise may have positive benefits for people with Bipolar Disorder.  I should have thought of that – but I didn’t (probably because I am bipolar and tend to ignore obvious things that might help me).

When asked – I have given advice to those who have depression (major depressive disorder, clinical depression, situational depression – or even bipolar depression).  What I tell those people is in addition to taking their meds, they should get up.  Get out of bed, get outside, and get some exercise – even if it is just around the kitchen.  Exercise increases the blood supply to your brain and helps to rise your energy levels – even if you don’t want to, it will do you some good.

Bipolar Disorder ShadowI give that advice to people when they are depressed, but I am not usually depressed.  My disorder tends toward mania or at least a mixed mood state.  So I don’t think about the need to increase my energy level.

Evidence has shown that exercise has some positive effects for people with Bipolar Disorder – even those that are not depressed.  In addition to the obvious health benefits, it can help to regulate your mood levels and “bring structure to chaos”.

As “bipolar“, we are often subject to disorderDisordered mind, disordered days, disordered environment.  One of the biggest tools for a bipolar patient to get and keep their body and mind regulated is the establishment of a schedule.

Go to bed at bedtime (and not at 2 am when you fall asleep in front of the TV). Get up in the morning, go to work on time, eat on a schedule – and take your meds when you should.
Establishing a routine does, in fact, help to keep from extreme ups and downs.

Exercise can be a big part of this – and physically reinforce a schedule on your body – that then affects your brain.  Just like getting up at the same time and going to sleep at the same time helps to establish a normal circadian rhythmexercise can reinforce that in a big way.

There are other benefits to exercise as well.  Physical activity naturally increases blood flow to the brain, which gives it the best chance of functioning at optimum level. It also helps to “clear out the cobwebs” that can be especially important if you are teetering on the edge.
Bipolar ExerciseExercise can increase your self-esteem that may have taken many blows in the past.  It can also increase social activity – that is apparently good for you, even if you don’t like people.  I don’t.

In my opinion, the biggest benefit may be “getting in touch” with your body.  When you exercise, you are more likely to stay within yourself.  One of the greatest problems in people with any mental disorder, and one of the reasons why people abuse drugs or perform any other risky behavior is the inability to be comfortable within your skin.  If you are exercising, you don’t really have a choice; you have to stay there.  Over time, you feel better about yourself, you feel more comfortable there, and you learn what is and isn’t “normal” within your body.

Perhaps this can lead you to better response when something is going amiss – when you may be slipping into disorder.

I tend to disregard the advice given by those who are not bipolar experts… either those with Bipolar Disorder or those who know the disease intimately, but this advice looks pretty solid to me.

Exercise and take your medicines!

Melissa Lind

Bipolar Disorder and Exercise as text to speech article

(Mental health video for blind and partially sighted people)

Bipolar Disorder and Suicide Risk

Physical Proof and a Big Shocker – Bipolar Disorder and Suicide Risk

Bipolar HeadI read a lot of news about bipolar disorder and other psychiatric disorders (OCD, ADHD, chronic depression, borderline personality disorder, etc.).  In my reading, I came across an article that describes brain scan abnormalities in teens and young adults who have attempted suicide but I found a lot more.

A study conducted at Yale School of Medicine examined brain scans of 26 young adults and teenagers with bipolar disorder who had attempted suicide.  These were compared with scans of 42 bipolar patients who had not attempted suicide and with 45 non-bipolar subjects.  The results were not really surprising – as many research studies are not.

The bipolar patients, who had attempted suicide, showed abnormalities when compared to the other two groups, specifically in the  which showed “less integrity”.

Frontal lobe animationThis means that the frontal lobe (which controls impulses) is not as “connected” to areas that control emotion, motivation and memory.  Researchers indicate that the brain abnormalities may disrupt the ability of the impulse control mechanism to filter emotion and motivational messages appropriately.

In short this means that those patients can’t stop negative emotions and impulses to do something drastic… like attempt suicide and not surprisingly, less integrity or more abnormality – likely means more suicide attempts.

While it is good that they are discovering some physical proof of actual defect, eventually to move bipolar disorder into a category that can be scientifically documented, it doesn’t offer a lot of real-life solutions.  Most of us who are bipolar or know someone who is bipolar, know that there is something wrong or at least different about our brain…and it only makes sense that a person, who is trying to kill himself, is probably a little worse off.

As usual, I found myself thinking “…and… the point is…” which I often do when I read a synopsis of a largely inconsequential research study but then something caught my eye.  It was something that was a lot worse than I thought – statistics.

About 4 percent of Americans are afflicted with bipolar disorder, though sometimes we feel like it is others who are afflicted.  That is not surprising either.  Some groups show a slightly lower percentage at about 2.6 percent of the population.

Bipolar SuicideWhat surprised me was the statistic regarding suicide.  The article – that is from a reputable source – indicates that 25 to 50 percent of people with bipolar disorder are likely to attempt suicide and that 15 to 20 percent are likely to succeed.  Wow.  I didn’t know that.  Funny thing that I didn’t know since of the 20 or so bipolar people I have been close friends with at one time or another – at least four of them are dead.

When searching for confirmation (which I found from the NIH that about 1 in 5 bipolar patients complete suicide), I also found a number of additional shocking statistics:

  • Bipolar disorder results in a 9.2 year reduction in lifespan
  • Bipolar disorder is the 6th leading cause of disability, worldwide
  • Bipolar disorder is found in all races, ethnicities, ages, genders and socioeconomic groups
  • A child with one bipolar parent has a 15-30% chance of having the disorder
  • A child with two bipolar parents has a 50-75% chance of having the disorder
  • There are 3.4 million CHILDREN with depression in the US but up to one-third of those kids may actually have bipolar disorder
  • Bipolar disorder criteria have likely been met for at least 1 percent of all adolescents

Maybe these aren’t shocking for you.  Maybe you already knew all this – but maybe you didn’t.

I have known I had bipolar disorder for a long time – and have known a lot more people with bipolar disorder and I didn’t know all this stuff or maybe like everything else, I chose not to remember.

Food for thought; Take your medicines!

Melissa Lind

What NOT to Say to a Bipolar Person

Stupid things said to people with bipolar disorder

Bipolar Disorder has become a bit more recognized lately, most likely due to the “coming out” of celebrities with outrageous behavior.  This has been good in raising awareness about bipolarity somewhat, but it has been bad because a lot of people think they know all about it.

In addition to not completely eradicating the stigma – it is also highly annoying when someone says something mean, wrong, funny, or even just plain stupid about bipolar disorder.  If you aren’t bipolar – don’t give advice to people who are.  Here are some of the things you should not do:

Don’t try to “join in”

Soo DepressedDon’t try to tell me you “know how I feel”.  Don’t relate your stories about how you were soooo depressed when your dog died.  Don’t try to tell me about how bad your insomnia is.  Don’t try to tell me about how you seriously almost destroyed a poster once or how embarrassed you were when…. Don’t.  Unless you are bipolar, you cannot understand the depression, the agitation, the anxiety.  I can understand that you want to show concern and make me feel “normal” but don’t.

Don’t tell me I should do better

Don’t tell me I can fix this.  Don’t tell me that I brought this on myself.  Don’t tell me to try harder.  Don’t tell me that it could be worse.  Don’t tell me that only religion can make me better.  I am doing the best I can; I didn’t want this disease, and frankly, I don’t want to hear it.

Don’t minimize

Don’t tell me to “snap out of it” or “get off my ass.”  Don’t give me platitudes like “this too shall pass” or “cheer up.”  Don’t tell me Not to Bipolar People“tomorrow will be better” or “everyone has a bad day sometimes.”  My disease, my experience is as bad as it is.  You can’t make it go away by acting cheerful or sympathetic.

Don’t try to shame me into being better

Don’t tell me that I am a real downer or that I am “dragging you down.”  Don’t tell me all about my bad behavior and how being around me is so painful – like “walking on eggshells.”  Don’t tell me about life not being fun…I already know.  If you don’t like it, it would be better if you just leave.

Don’t blame every disagreement on my disease

Don’t say anything about bipolar “shit” in the middle of an argument.  Just because I am angry doesn’t mean I am off my meds.  It doesn’t mean I am crazy.  Using my illness to win an argument is just plain wrong.  I have a right to be angry sometimes, and sometimes I am.

These are just a few things you should not do.  We have a lot of rules – some of which change just like us.

Happy Day!

Melissa Lind