Diagnosis Of Bipolar Quotes

At least when I was an adult, I had a name for what was wrong with me: manic depression. It's easier to make sense of things - even very disturbing things like sexual acting out and suicidality - when there's a big, fat label slapped on top. But as a child, I knew nothing. I had no diagnosis. All I had was a vague and gnawing awareness that I was different from other children, and that different was not good. Different must be kept hidden.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

Like so many other high school discipline cases, he'd probably been given some hybrid cockamamie ADHD- bipolar diagnosis at a very young age and been medicated into submission for the benefit of his homeroom teacher. We've all read about them in the paper, the problem kids who get slapped with five disorders by the time they're twelve, and horse-pilled by a culture that has pathologized everything from PMS to teen angst.

In less than a year, the magic of being diagnosed had begun to wear off, and my bipolar disorder no longer felt like a story hook. It felt like a part of me I wasn't sure I wanted to sit with anymore. So the further away I got from the diagnosis and all that had led up to it, the more I downplayed the extremes or made them punchlines I could use before anybody else could. I came to resent the head tilts and looks of surprise that go hand in hand with sharing what I'd come to see as a particularly unglamorous part of my life. If this was what interesting was, I didn't want it anymore. I hadn't counted on the most interesting people not being able to opt out. I didn't want to be the woman who does everything despite her bipolar disorder. I wanted to be the woman who has many complexities, her bipolar disorder being just one of them. (You know, a person).

Bipolar disorder has a much greater stigma than mania alone, and after that diagnosis it will be difficult, if not impossible, to convince anyone that the person shouldn't be medicated for life.

DID may be underdiagnosed. The image derived from classic textbooks of a florid, dramatic disorder with overt switching characterizes about 5% of the DID clinical population. The more typical presentation is of a covert disorder with dissociative symptoms embedded among affective, anxiety, pseudo-psychotic, dyscontrol, and self-destructive symptoms, and others (Loewenstein, 1991). The typical DID patient averages 6 to 12 years in the mental health system, receiving an average of 3 to 4 prior diagnoses. DID is often found in cases that were labeled as "treatment failures" because the patient did not respond to typical treatments for mood, anxiety, psychotic, somatoform, substance abuse, and eating disorders, among others. Rapid mood shifts (within minutes or hours), impulsivity, self-destructiveness, and/or apparent hallucinations lead to misdiagnosis of cyclic mood disorders (e.g., bipolar disorder) or psychotic disorders (e.g., schizophrenia).

What makes our contemporary neurobiological concepts different is the extent to which they have been promoted by pharmaceutical marketers. You are not shy; you have social anxiety disorder. You are not absentminded, dreamy, or fidgety; you have ADHD. You are not moody; you are bipolar. Each diagnosis comes with a prescription. Your need for medication becomes part of your identity.

Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks. “Oooh, I like my pens in a line, I’m so OCD.” NO YOU’RE FUCKING NOT. “Oh my God, I was so nervous about that presentation, I literally had a panic attack.” NO YOU FUCKING DIDN’T. “I’m so hormonal today. I just feel totally bipolar.” SHUT UP, YOU IGNORANT BUMFACE. Told you I got angry. These words – words like OCD and bipolar – are not words to use lightly. And yet now they’re everywhere. There are TV programmes that actually pun on them. People smile and use them, proud of themselves for learning them, like they should get a sticker or something. Not realizing that if those words are said to you by a medical health professional, as a diagnosis of something you’ll probably have for ever, they’re words you don’t appreciate being misused every single day by someone who likes to keep their house quite clean. People actually die of bipolar, you know? They jump in front of trains and tip down bottles of paracetamol and leave letters behind to their devastated families because their bullying brains just won’t let them be for five minutes and they can’t bear to live with that any more. People also die of cancer. You don’t hear people going around saying: “Oh my God, my headache is so, like, tumoury today.” Yet it’s apparently okay to make light of the language of people’s internal hell

I’m so used to absolute freedom. I can shit anywhere. I can piss anywhere. I can take drugs. I can kill things. But in there I was nothing,” he says. “For the first time in my life I felt what Ned Kelly felt. The last month has been hell. I don’t think I was that mad. My own illness is news to me. They say that I’m borderline bipolar. That was odd – not to have the diagnosis but to swallow the diagnosis.

In studies of first-episode bipolar patients, investigators at McLean Hospital, the University of Pittsburgh, and the University of Cincinnati Hospital found that at least one-third had used marijuana or some other illegal drug prior to their first manic or psychotic episode.10 This substance abuse, the University of Cincinnati investigators concluded, may “initiate progressively more severe affective responses, culminating in manic or depressive episodes, that then become self-perpetuating.”11 Even the one-third figure may be low; in 2008, researchers at Mt. Sinai Medical School reported that nearly two-thirds of the bipolar patients hospitalized at Silver Hill Hospital in Connecticut in 2005 and 2006 experienced their first bout of “mood instability” after they had abused illicit drugs.12 Stimulants, cocaine, marijuana, and hallucinogens were common culprits. In 2007, Dutch investigators reported that marijuana use “is associated with a fivefold increase in the risk of a first diagnosis of bipolar disorder” and that one-third of new bipolar cases in the Netherlands resulted from it.13

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

The way we define their problems, our diagnosis, will determine how we approach their care. Such patients typically receive five or six different unrelated diagnoses in the course of their psychiatric treatment. If their doctors focus on their mood swings, they will be defined as bipolar and prescribed lithium or valproate. If the professionals are most impressed with their despair, they will be told they are suffering from major depression and given antidepressants. If the doctors focus on their restlessness and lack of attention, they may be categorized as ADHD and treated with Ritalin or other stimulants. And if the clinic staff happens to take a trauma history, and the patient actually volunteers the relevant information, he or she might receive the diagnosis of PTSD. None of the diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

20 years, we have experienced three unanticipated fads partly precipitated by DSM-IV: a 20-fold increase in Autism Spectrum Disorder,7 a tripling of Attention-Deficit/Hyperactivity Disorder (ADHD),8 and a doubling of Bipolar Disorders.9 The most dangerous fad is a 40-fold increase in childhood Bipolar Disorders,10 stimulated, not by DSM-IV, but instead by reckless and misleading drug company marketing. Twenty percent of the U.S. population11 is taking a psychotropic drug; 7% is addicted to one; and overdoses with legal drugs now cause more emergency room visits than overdoses with illegal drugs.

I also reached out to far-away family and friends for emotional support. You cannot imagine the feelings of un-worthiness and shame that the diagnosis of a mental illness had caused me. I knew intellectually that I was not at fault, but I judged myself nonetheless. I had internalized the stigma around mental illness.

You'd have to ask Leyla if you want to know more. She's a psychologist. One of a dozen on board. We don't just want our passengers to survive—we want them to be OK. We're dealing with a lot of trauma. So if you ever need to talk..." "I'll pass." "Bad experiences?" "Sort of." "What happened?" I shrug. "It took a long time to diagnose me." "From what I understand, autistic girls often don't run into trouble until a later age." I bark out a laugh. Oh, I ran into trouble, all right. I barely said a word between the ages of four and six. I hit three of my preschool and grade school teachers. In a class photo taken when I was seven, my face is covered in scratches from when I latched onto a particularly bad stim. Therapists and teachers labelled me as bipolar, as psychotic, as having oppositional defiant disorder, as intellectually disabled, and as just straight-up difficult, the same way Els did. One said all I needed was structure and a gluten-free diet. When I was nine, a therapist suggested I might be autistic, at which point I had already started to learn what set me off and how to mimic people; within two years, I was coping well enough to almost-but-not-quite blend in with my classmates. It's funny when people like Els have no idea anything is off about me, given that my parents spend half my childhood worrying I'd end up institutionalized. At the time, I thought the diagnosis was delayed because I was bad at being autistic, just like I was bad at everything else; it took me years to realize that since I wasn't only Black, but a Black girl, it's like the DSM shrank to a handful of options, and many psychologists were loath to even consider them.

Before the 1960s, bipolar disorder was hardly recognized in children, but by the 1990s, its incidence had exploded, much more than in adults. Was this sudden increase due to a real increase in prevalence, to better reporting, to applying the diagnosis more broadly, or perhaps to an ill-advised trend toward giving psychiatric medications to young people? We don’t know.

To become a fad, a psychiatric diagnosis requires 3 preconditions: a pressing need, an engaging story, and influential prophets. The pressing need arises from the fact that disturbed and disturbing kids are very often encountered in clinical, school, and correctional settings. They suffered and cause suffering to those around them—making themselves noticeable to families, doctors, and teachers. Everyone feels enormous pressure to do something. Previous diagnoses (especially conduct or oppositional disorder) provided little hope and no call to action. In contrast, a diagnosis or childhood Bipolar Disorder creates a justification for medication and for expanded school services. The medications have broad and nonspecific effects that are often helpful in reducing anger, even if the diagnosis is inaccurate.

What is actually observed in so-called 'biplar children'? If you read the research reports carefully, they describe broad and persistent emotional dysregulation. Although these children have mood swings, they do not develop manic or hypomanic episodes. They are moody, irritable, oppositional and likely to misbehave—like all children with disruptive behavior disorders. Their grandiose thinking usually consists of little beyond boastfulness. No evidence from genetics, neurobiology, follow-up studies or treatment response shows that this syndrome has anything in common with classical bipolarity.

The way the diagnosis is being made in America was not something we intended,” he said. “Kids with extreme irritability and moodiness and temper tantrums are being called bipolar.

In studies of first-episode bipolar patients, investigators at McLean Hospital, the University of Pittsburgh, and the University of Cincinnati Hospital found that at least one-third had used marijuana or some other illegal drug prior to their first manic or psychotic episode.10 This substance abuse, the University of Cincinnati investigators concluded, may “initiate progressively more severe affective responses, culminating in manic or depressive episodes, that then become self-perpetuating.”11 Even the one-third figure may be low; in 2008, researchers at Mt. Sinai Medical School reported that nearly two-thirds of the bipolar patients hospitalized at Silver Hill Hospital in Connecticut in 2005 and 2006 experienced their first bout of “mood instability” after they had abused illicit drugs.12 Stimulants, cocaine, marijuana, and hallucinogens were common culprits. In 2007, Dutch investigators reported that marijuana use “is associated with a fivefold increase in the risk of a first diagnosis of bipolar disorder” and that one-third of new bipolar cases in the Netherlands resulted from it.13 Antidepressants have also led many people into the bipolar camp, and to understand why, all we have to do is return to the discovery of this class of drugs. We see tuberculosis patients treated with iproniazid dancing in the wards, and while that magazine report was probably a bit exaggerated, it told of lethargic patients suddenly behaving in a manic way. In 1956, George Crane published the first report of antidepressant-induced mania, and this problem has remained present in the scientific literature ever since.14 In 1985, Swiss investigators tracking changes in the patient mix at Burghölzli psychiatric hospital in Zurich reported that the percentage with manic symptoms jumped dramatically following the introduction of antidepressants. “Bipolar disorders increased; more patients were admitted with frequent episodes,” they wrote.15 In a 1993 practice guide to depression, the APA confessed that “all anti-depressant treatments, including ECT [electroconvulsive therapy], may provoke manic or hypomanic episodes.”16

A few years later, researchers at Yale University School of Medicine quantified this risk. They reviewed the records of 87,290 patients diagnosed with depression or anxiety between 1997 and 2001 and determined those treated with antidepressants converted to bipolar at the rate of 7.7 percent per year, which was three times greater than for those not exposed to the drugs.17 As a result, over longer periods, 20 to 40 percent of all patients initially diagnosed with unipolar depression today eventually convert to bipolar illness.18 Indeed, in a recent survey of members of the Depressive and Manic-Depressive Association, 60 percent of those with a bipolar diagnosis said they had initially fallen ill with major depression and had turned bipolar after exposure to an antidepressant.19 This is data that tells of a process that routinely manufactures bipolar patients. “If you create iatrogenically a bipolar patient,” explained Fred Goodwin, in a 2005 interview in Primary Psychiatry, “that patient is likely to have recurrences of bipolar illness even if the offending antidepressant is discontinued. The evidence shows that once a patient has had a manic episode, he or she is more likely to have another one, even without the antidepressant stimulation.”20 Italy’s Giovanni Fava put it this way: “Antidepressant-induced mania is not simply a temporary and fully reversible phenomenon, but may trigger complex biochemical mechanisms of illness deterioration.”21

The McLean people recommend fluoxetine because they have diagnosed me with atypical depression. This diagnosis was not easy for them, or for Dr. Sterling, to come by, as the occasional appearance of manic-like episodes (for instance, during my energetic first month in Dallas) might indicate that I suffer from either manic-depressive illness or cyclothymia, a milder type of mood-swing disease. But in the end, the diagnosticians conclude that I’ve been too persistently down and not florid enough in my manic periods to be bipolar. Atypical depression is long-term and chronic, but the sufferer’s mood can occasionally be elevated in response to outside stimuli. This diagnosis seems a better way to explain the periodic occasions when I seemed happy or productive, but would always return to my normally depressed state in perfect boomerang fashion.

In the parking lot, I stared at the slips of paper Dr. Park had handed me. The confirmation of the diagnosis by a second doctor brought with it a grave finality. It was as if the gavel had fallen. And my verdict came with a life sentence. A lifetime of illness without a cure, one which brought isolation, shame, and an endless supply of medication to numb my being. Sure, I had had symptoms of bipolar disorder for as long as I could remember. And looking back now, I could also see symptoms of psychosis at various points in my life. The paranoia, the distorted thinking, the startling images, the occasional voice—they had been there since I was a teenager. However, I never had a name for it. Knowing it was psychosis changed the game completely. It was only a matter of time before I’d be locked up on the psych ward in a hospital gown with the rest of the psychotic people.

the drug companies had to get an indication for bipolar disorder and then they had to advertise a conception of bipolar disorder so broad as to be unrecognizable. Antipsychotics were soon being prescribed promiscuously, even by primary care physicians, to patients with garden-variety anxiety, sleeplessness, and irritability.

the absence of clear boundaries between schizophrenia and bipolar disorders has led some clinicians to prefer the term “psychosis,

Fourth, along these same lines, some diagnoses remind us of a more central role of the body in a person’s struggle. Psychiatric diagnoses remind us that we are embodied souls. We know this clearly from Scripture! But functionally speaking, we sometimes over-spiritualize troubles with emotions and thoughts. When you consider the spectrum of psychiatric diagnoses, it is clear that years of research demonstrate that some diagnoses may have a stronger genetic (inherited) component of causation than others. These include schizophrenia, bipolar disorder, autistic spectrum disorder, and perhaps more severe and recalcitrant forms of depression (melancholia), anxiety, and OCD.2 Another way of saying this is that although psychiatric diagnoses are descriptions and not full-fledged explanations, it doesn’t mean that a given diagnosis or symptom holds no explanatory clues at all. Not all psychiatric diagnoses should be viewed equally. Some do indeed have long-standing recognition in medical and psychiatric history, occur transculturally, and therefore are not merely modern, Western “creations” that highlight patterns of deviant or sinful behavior, as critics would say. Observations that have held up among various

I’ve got this thing for life, Mark.” She looked up at me, gracious and dignified under the weight of her diagnosis. “Call it ‘bipolar,’ call it a ‘disease,’ call it whatever you want, but the main thing is that it’s not going away. It will always be with me. But at least I’m not as scared of it anymore.

It’s Jenny- my daddy’s let her in. I walk into my room undressed, holding my wet towel in my right hand. Jenny looked at me and said- ‘I see we are going for the earthy look today; god you could have shaved a little.’ Jenny is lying bullied down on my bed, looking through my phone, with her legs up in the air, letting one fall and bounce on the Serta every once in a while. She looked up at me, she got that pissed-off look, eyebrows bent, I knew she saw I forwarded the message. I pay it off, acting like I was happy to see her, and in a way, I was, I would never want to see one of my girlfriends die- or be dead. Oh, Jenny- She looks so typical, so acquainted with everyone, yet on the inside is falling apart. Jenny is Bipolar and has Social Anxiety Disorder mixed with Bulimia, like every time she feels not wanted by a boy or feel overweight or something is not going her way, she has a hard time keeping her food down, she has even up-cucked on me and the girls at lunch, not meaning too. I am far from being a psychologist, yet those are my diagnosis, yet everyone just seems to ignore her faults. I know she saw the text because she ran down the hall to throw up, running my little butt over. If she asks why- I’ll just say- ‘Butt dialing!’ Jenny walks back into my room; she flops bully fist on the bed. I asked uneasily with curiosity- ‘So what transpired last night?’ She mopes for a second. ‘Yeah, sorry about that. I couldn’t call back. I didn’t get off the home phone with Ken until, like four am. And because my mom is a b*tch she took my cell away last night before staying out too late on a school night.

DSM-IV unwittingly contributed to three new false epidemics in psychiatry—the overdiagnosis of attention deficit, autism, and adult bipolar disorder.

Four specific lines of evidence have become standard in psychiatry: symptoms, genetics, course of illness, and treatment. Symptoms are the most obvious source of evidence: most of us focus only on this evidence. Was Lincoln sad? That symptom could suggest depression, but of course one could be sad for other reasons. Symptoms are often nonspecific and thus not definitive by themselves. Genetics are key to diagnosing mental illness, because the more severe conditions—manic-depressive illness in particular—run in families. Studies of identical twins show that bipolar disorder is about 85 percent genetic, and depression is about half genetic (The other half, in the case of depression, is environmental, which is why this source of evidence is also not enough on its own.) Perhaps the least appreciated, and most useful, source of evidence is the course of illness. These ailments have characteristic patterns. Manic-depressive illness starts in young adulthood or earlier, the symptoms come and go (they’re episodic, not constant), and they generally follow a specific pattern (for example, a depressive phase often immediately follows a manic episode). Depression tends to start somewhat later in life (in the thirties or after), and involves longer and fewer episodes over a lifetime. If someone has one of these conditions, the course of the symptoms over time is often the key to determining which one he has. An old psychiatric aphorism advises that “diagnosis is prognosis”: time gives the right answer. The fourth source of evidence is treatment. This evidence is less definitive than the rest for many reasons. Sometimes people never seek or get treatment, and until the last few decades, few effective treatments were available. Even now, drugs used for mental illnesses often are nonspecific; they can work for several different illnesses, and they can even affect behavior in people who aren’t mentally ill. Sometimes, though, an unusual response can strongly indicate a particular diagnosis. For instance, antidepressants can cause mania in people with bipolar disorder, while they rarely do so in people without that illness.

To my amazement, staff discussions on the unit rarely mentioned the horrific real-life experiences of the children and the impact of those traumas on their feelings, thinking, and self-regulation. Instead, their medical records were filled with diagnostic labels: “conduct disorder” or “oppositional defiant disorder” for the angry and rebellious kids; or “bipolar disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the underlying trauma being obscured by this blizzard of diagnoses?