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Bipolar Disorder

Bipolar Disorder Has a Softer Side

Identifying bipolar disorder's "softer side" can be a challenge.

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It’s true. Bipolar disorder has a “softer side,” and that’s what makes the condition's diagnosis all the more challenging in people who have a wide array of what might be considered “finer symptoms.”

Classic bipolar disorder is characterized by dramatic, extreme mood swings—from high “highs” (mania and hypomania, “I can do anything”) to low “lows” (depression, suicidal thoughts, anxiety, paranoia). But what about people with symptoms considered more “common,” like periods of anxiousness, sense of uneasiness, irritability, boredom, poor decision-making, and feelings of meaninglessness intermingled with moments of energy and intensity, euphoria, a spurt of ideas, focus, brilliance, vision, and achievement? These are often missed in psychiatric examinations because they are not viewed as a connected whole. They fall beneath what might be called the “threshold of diagnosis,” failing to fit neatly within standard clinical tools like the Bipolar Spectrum Diagnostic Scale or the Mood Disorder Questionnaire.

As a discernible condition, bipolar disorder is considered rare, affecting only about 1 percent to 2.8 percent of the population. However, if the softer forms of this mental condition are considered, its prevalence may be as high as 7 percent or 8 percent, some experts contend.

Implications of Bipolar ‘Light’

Having “bipolar light” does not necessarily exempt one from both the negative and what some might call “positive” aspects of the disorder; as well as from the impact the condition can have on normal, day-to-day activities, including problems with intense anxiety; insomnia and wakefulness; substance abuse; and problems similar to those of autism spectrum disorder. As many as 50 percent of patients with bipolar disorder have abused drugs at some point in their lives. In more simple terms, bipolar disorder on any level, severe or moderate or mild, can be described as an energy imbalance; too much or too little during any given time period, that time period often lasting for several days in a row.

With its elevated moods, the condition can spark tremendous productivity, speed of thinking and movement, obsessiveness, a flurry of new ideas, enhanced self-awareness, a drive for perfection, even over-excitement. Some of history’s greatest thinkers and artists—painter Vincent van Gogh, writer Virginia Woolf, composer Robert Schumann, actress Vivien Leigh, and author Edgar Allen Poe—are believed to have suffered from bipolar-related symptoms, accomplishing their greatest works during energy peaks.

On the downside, the psychiatric disorder’s “highs” can lead to compulsive behaviors such as binge buying, poor judgment, irritability, and a general sense that people are moving much too slowly and, frankly, are in the way; this can result in a variety of life problems like aggressive driving and road rage. The patient is mentally moving at 100 miles per hour when everyone else is doing the speed limit of 55.

Even more impactful is the condition’s “lows,” leading to feelings of hopelessness, disinterest in normally enjoyable activities, fear and paranoia and a gnawing, overall belief that what was achieved during the patient’s state of high energy was simply not good enough. A fear of falling short of perfection can stymie action, and activity. Patients with the disorder also may experience problems in personal and family relationships, exhibiting over-sensitivity to comments and situations and becoming estranged from loved ones.

Treatment Approaches

In its mildest forms, bipolar disorder can still leave people with an array of symptoms that no simple diagnosis will explain or standard therapy can address. Patients are left blaming their personality, childhood and family life, other medical conditions or even what some religions refer to as a “sinful nature” for their range of moods and reactions. To find peace, they oftentimes seek unconventional treatments such as ketogenic diets, ketamine infusion therapy for depression, LSD micro-dosing, cold showers, even spiritual retreats.

When the condition causes difficulties in a person’s personal, professional, or work life, then medical assistance is needed. In analyzing these cases, physicians must go beyond what appears to be, at its surface, generalized anxiety or depression, because many of the medications for these more common psychiatric conditions actually can worsen the agitation in bipolar disorder. Psychotherapy also can prove helpful in managing mood swings, although the approach is much more effective with an accurate diagnosis.

Meanwhile, tools that go beyond current diagnostic scales and questionnaires are needed to help practitioners recognize bipolar disorder’s less pathological, finer symptoms. That’s why we are developing a “Rockstar Bipolar Questionnaire,” which hopefully will prove clinically useful in illuminating the softer nuances of bipolar disorder.

Greater awareness of “bipolar light” should give us increased understanding of what is normal, what is too little, what is too much, and what makes a person an incredible “Rock Star.”

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