Understanding Bipolar Disorder

by Catherine “Katie” Ness, MA, LCPC

Bipolar Disorder is a mood disorder in which individuals experience extreme moods ranging from depression to mania. It is helpful to conceptualize Bipolar Disorder, and mood in general, as a pendulum that swings back and forth on an emotional continuum that ranges from depression to mania (see graphic below).



In individuals who do not have a mood disorder the pendulum gradually swings from happy to sad and is usually in response to external events, such as feeling really good after getting a promotion at work or feeling really low after an unwanted break-up. These emotional states are usually temporary and a person’s mood eventually returns to a more neutral state. In Bipolar Disorder the pendulum can swing to extreme emotional states where sadness becomes depression and happiness becomes mania. The rate at which the pendulum swings can be rapid and can get stuck at either emotional extreme where it seldom returns to a euthymic state (a resting state in which there is no emotional extreme). External events can contribute to these severe emotional swings or they can be experienced for no obvious reason.

There is an additional emotional disorder (see above graphic) called Cyclothymia that falls in between the “normal mood” range and Bipolar Disorder. Individuals who have Cyclothymia have moods that range from mild depression to hypomania and, similar to Bipolar Disorder, the changes in mood can be rapid and can get stuck at either emotional extreme.

Listed below are some of the symptoms of depression, mild depression, Mania, and Hypomania.

Depression
• Depressed mood most of the day for most days
• Increased need for sleep or insomnia
• Fatigue and loss of motivation
• Difficulty with focus and decision-making
• Feelings of worthlessness or guilt
• Significant and unintentional weight loss or weight gain
• Hopelessness
• Recurrent thoughts of death or suicidal ideation

Mild depression
• Change in appetite
• Insomnia or hypersomnia
• Fatigue
• Low-self-esteem
• Difficulty focusing
• Lack of “joy”managing bioloar Disorder
• Apathy

Mania
• Irritability or anger
• Euphoria
• Decreased need for sleep
• Racing and tangential thoughts
• Hyperverbal speech (talking too much/too fast)
• Impulsivity/risky behavior
• High anxiety
• Anger
• Psychosis

Hypomania
• Rapid speech
• “Really good” mood
• Difficulty sleeping
• Difficulty with focus
• Inflated thoughts of self-worth
• Anxiety

As explained by the above graphic and list of symptoms, individuals with Bipolar Disorder are continuously trying to manage emotional extremes, which can be an exhausting and lifelong battle. It is not as easy as simply willing oneself to “cheer-up” or “calm-down.” Bipolar Disorder frequently has a negative effect on employment, school, developing and maintaining relationships, and overall self-care. Learning to manage the symptoms of Bipolar Disorder is essential to improving one’s confidence, relationships and overall quality of life. Learn more about managing Bipolar Disorder by meeting with a licensed therapist who specializes in treating affective disorders.

I’ve been diagnosed with Bipolar Disorder – Where do I go from here?

by Catherine “Katie” Ness, MA, LCPC

A diagnosis of Bipolar Disorder can be overwhelming. You may have suspected over the years that your moods seemed more intense than those of your family or friends, but actually hearing the diagnosis out loud can confirm that underlying fear that something is not quite right. It also means that you need to take action and find a way to manage your mood. The idea that you need to seek out formal treatment to feel more in control can feel simultaneously overwhelming and relieving. If you have gone to the trouble of getting a formal evaluation or you are at the point that you are considering an evaluation, there is at least a part of you that is ready to change and work towards keeping your mood from dictating your life. However, there may also be a part of you that keeps saying the moods are not that bad and I’ve been functioning fairly well up until now without support. This reaction is understandable, since making the decision to enter into treatment requires a commitment to prioritize your mental health and make some significant life changes.

Do I have to take medication?
One of the most common questions for someone newly diagnosed with Bipolar Disorder is, “Do I need medication?” This is a reasonable concern, since the idea of being on a mood stabilizer for a significant period of time is not appealing to anyone. And although every individual’s situation varies, the simple answer to this question is “yes.” Bipolar Disorder is a mental health issue where neurological differences can be observed between those who have and do not have this diagnosis. Although there is likely a genetic component (there is probably someone in your family that also struggles with Bipolar Disorder or another significant mood disorder) and environmental component that can play a role in how Bipolar Disorder is manifested, the preexisting or resulting neurological differences can be effectively managed with medication.

Is medication enough?
Again, each individual is different, but the simple answer to this question is “no.” Research has demonstrated that a combination of medication and psychotherapy (talk therapy) yields the highest success rates in mood management. Having a trusted professional who is able to understand the depths of your depression, the intensity of your anxiety, the frustration of not meeting your personal goals, and every feeling in between, makes the journey towards emotional stability significantly less daunting. In addition, a therapist can assist in helping you understand the triggers for your mood swings, offer tangible coping skills and address any additional underlying issues that can be masked by the symptoms of Bipolar Disorder.

So once my mood is stable, I’m cured?
Learning to manage Bipolar Disorder goes beyond just mood management. If you have suffered through severe mania or psychosis, your working memory and ability to focus may have been compromised, and learning skills to strengthen these areas can be helpful. Additionally, if you have been living with undiagnosed Bipolar Disorder for years, there is a significant chance it has impacted your relationships, schooling, or career. Learning to interact confidently with others when you are not in a manic state, or remain at work even though your boss is a jerk, may be skills that are underdeveloped because your actions have always been dictated by your mood. Furthermore, any underlying trauma, substance abuse issue, etc., that may have predated the mood swings or was in response to the development of Bipolar Disorder, needs to be addressed or these issues are likely to continue to interfere with reaching personal goals. Even in situations where there have been few consequences from mood swings, there is still a transition into living with “mood stability.” A client of mine once quipped that she spent over a decade trying to shut off all the noise in her head that was a result of Bipolar Disorder, but upon achieving this goal, she then spent the next few years figuring out how to add more excitement to her life because she found the quietness disconcerting.
The journey to emotional wellness is different for everyone. Although there are basic guidelines (like working with a psychiatrist and psychotherapist), and strategies that seem to be universally helpful in managing Bipolar Disorder, your personal goals, expectations and needs are uniquely your own. If you have contemplated moving forward in learning to manage your symptoms, I encourage you to take the next step and seek treatment. “The first step in getting somewhere is to decide you are not going to stay where you are” -JP Morgan

Listed below are strategies that are helpful in learning to manage your mood.

Essential skills when trying to stabilize mood
• Chart your mood
• See if there is a pattern to your mood. Look for specific triggers that push your mood to either extreme and then be mindful of those triggers.
• Learn to manage stress
• Stress and anxiety are two of the primary triggers for mood dysregulation. Check in with yourself 3 times a day and rate your level of stress. On a scale of 1-10, anything above a 4-5 (or whatever level you see as triggering), needs to be addressed. Take a break, go on a short walk, take some deep breaths or experiment with other strategies to decrease stress in the moment.
• Establish a daily routine
• Figure out what time of day you feel most productive and when your energy is lowest. Schedule difficult tasks and exercise when your energy is high and focus on self-care when your energy is low.
• Manage Sleep Hygiene
• If circadian rhythms get out-of-whack, there can be an enormous impact on emotional stability. Have a structured and relaxing bedtime routine (avoid electronics and anything too stimulating). Going to bed at the same time every night and getting up at the same time every morning also goes a long way in regulating mood.
• Develop a support system
• Have a group of trusted individuals who understand how your symptoms affect you. These support people can help alert you if your mood seems to be affecting your thought process and/or just be available to talk to if you need support or are feeling overwhelmed.
• Identify thought patterns that match emotional states
• Write down common thoughts in each mood state (depressed, “normal,” manic). For example, when feeling depressed you may feel like everyone hates you, when feeling “normal”, you may feel like most people get along with you and when feeling manic, you might think you are God’s gift to the world. Being able to match thoughts with an emotional state can help you identify if your mood is affecting your thoughts. Someone in your support system can also be useful in pointing out these patterns.

Recently, NAMI Barrington Area participated in the Health Fair at Conant High School in Hoffman Estates.  It was fun interacting with these amazing young people.  They loved grabbing a bit of inspiration from our inspirational quotes jar.  They also helped us create a Self Care Board through providing ideas as to how they take care of themselves physically, emotionally, personally and with regard to school life.  Check out their list of insightful ideas here.

By: Aleene Shirley Morgenthaler

Before my psychotic break in 2013, I never had to think to myself “ground yourself.” Now it is a practice that I’m so grateful for.

I first learned about grounding at an outpatient program. The facilitator was using words and inflections I was foreign too. She seemed like a very spiritual person. It really annoyed me but she planted a seed. I would use the grounding technique I learned - sitting with feet flat on the ground. The physical aspect of grounding allowed me to train myself to be grounded mentally. Which allowed me to listen to grounded thoughts: you are one (with self & others), I am most powerful when I surrender to groundedness, and there is peace in balancing voices in my head. I learned about tool boxes in these programs and being grounded is one of them. I benefit from it in times when I feel out of touch and/or chaotic. To be grounded is to be peaceful.

Here’s a link to understanding grounding techniques - to start & strengthen your practice: CLICK HERE

Before my psychotic break in 2013, I never had to think to myself “ground yourself.” Now it is a practice that I’m so grateful for.

I first learned about grounding at an outpatient program. The facilitator was using words and inflections I was foreign too. She seemed like a very spiritual person. It really annoyed me but she planted a seed. I would use the grounding technique I learned - sitting with feet flat on the ground. The physical aspect of grounding allowed me to train myself to be grounded mentally. Which allowed me to listen to grounded thoughts: you are one (with self & others), I am most powerful when I surrender to groundedness, and there is peace in balancing voices in my head. I learned about tool boxes in these programs and being grounded is one of them. I benefit from it in times when I feel out of touch and/or chaotic. To be grounded is to be peaceful.

Here’s a link to understanding grounding techniques - to start & strengthen your practice: https://drsarahallen.com/7-ways-to-calm/

By Aleene Shirley Morgenthaler

With ten weeks left of my college career, I experienced mania for the first time.  Two years after were marked with six hospital stays and out patient programs.  It’s been three years of recovery and I am happy to be able to share my voice through NAMI-Barrington Area’s Blog.

I’ve always been a dreamer – it’s what made me optimistic and energetic.  I would dream about choreography, relationships, and goals.  Everyday I take time to dream.  I think for a couple years I dreamt too much…but who knows?  It’s gotten me very far.  It’s allowed me to be thankful everyday.  Because a life without dreaming is a life wasted.  We only get one chance in this life and if we don’t dream we’re missing out on a beautiful part of life.  Sure there can be disappointment but I believe it’s worth dreaming anyway.  I’ve realized that I don’t necessarily get my dreams but I get what I need in the hope to one day bask in the glory of my life. Dream for your health.

By: Catherine Ness LCPC

 

Struggling with Bipolar Disorder is an on-going and exhausting battle for the affected individual; Watching someone you love struggle with Bipolar Disorder can be equally challenging and exhausting. Seeing your loved one experience hopelessness, frequent crying spells, social and career frustrations and feelings of worthlessness can be heartbreaking. Conversely, being the target of anger and anxiety and witnessing successive poor life choices can be frustrating. Never knowing how your loved one will feel on any given day makes you feel equally helpless and puts you on perpetual egg-shells.

The first step in supporting someone with Bipolar Disorder is gaining a deeper understanding of Bipolar Disorder (see Understanding Bipolar Disorder). Bipolar Disorder is not a fluctuation between sad and happy, but between manic and depressed; extreme mood states over which the individual has little control. Attending family counseling sessions with your loved one can be hugely beneficial in better understanding how these emotional extremes affect your loved one and how you can offer effective support.

Be Proactive

It is infinitely easier to help your loved one remain in a euthymic state (stable mood state) than to help them recover from a manic or depressive episode. If your loved one has been diagnosed with Bipolar Disorder, accepts the diagnosis and is motivated to seek treatment, individual psychotherapy in conjunction with medication management offers the best treatment outcomes. Encouraging your loved one to remain compliant with medication is extremely helpful as stopping medications is one of the biggest triggers for relapse.

Ask your loved one how you can offer them support if their mood becomes unstable; although there are general techniques that can be helpful, individually tailored supports are most effective. This will involve the loved one working in counseling to identify what interventions have been helpful in the past and what interventions they think could be helpful in the future. Writing down what to do if your loved one is depressed or manic can be a good reminder. For example

When I’m feeling depressed . . .
DO
1. Give me a hug and tell me you love me
2. Sit down and watch a comedy with me
3. Encourage me to leave the house and go out with friends

DON’T
1. Try to problem solve for me
2. Tell me I have no reason to be depressed
When I’m feeling manic . . . .
DO
1. Point out my mood seems too high
2. Ask me to reach out to my psychiatrist and therapist
3. Remind me to prioritize sleep
DON’T
1. Tell me I’m acting crazy
2. Encourage me to make big decisions

It is also helpful if your loved one can provide you with information about what their thought process is a depressed, neutral and manic state. Frequently, an individual does not recognize that their thoughts are not “logical” when they are experiencing a severe mood swing. It can be beneficial if you assist your loved one in recognizing that their mood is affecting their thoughts. “The Bipolar Workbook” by Dr. Monica Ramirez offers tangible CBT (cognitive behavioral therapy) interventions that assist individuals in identifying these type of thought patterns. For example:

1. When I feel depressed . . . I feel like everyone hates me
When I feel manic . . . . . . I feel like everyone loves me and wants to be around me
When I feel “ok” . . . . . . . I know I have some close friends and acquaintances

2. When I feel depressed . . . I sleep 12 hours a day and am still feel exhausted
When I feel manic . . . . . . I barely sleep, but still have lots of energy
When I feel “ok” . . . . . . . I sleep 6-8 hours and feel a little tired when I get up

Helping the loved one recognize that their thoughts and behaviors have changed and reminding them with their own words that they may be experiencing a mood swing, can help convince them that an intervention is needed.

How to help a loved one who is actively depressed or manic
Even when someone diagnosed with Bipolar Disorder is doing everything right and their mood has been stable, they can experience break-through symptoms. The return of symptoms can be a result of a change in medication, increased level of stress or can occur for no obvious reason.
Frequently when I work with family members who are trying to learn to support someone with Bipolar Disorder, they complain that they offer logical feedback or solutions to their loved ones, but this type of feedback is either dismissed, or in some cases makes it worse because the person struggling feels like they are not understood. The reason logical solutions do not work, is because a person in a depressive or manic state is not thinking logically. The emotion is so overwhelming that it skews the way they look at themselves and the world in general. There are no satisfying solutions, and therefore, the focus should not be problem-solving, but instead diminishing the current emotional state so that the individual can be more open to logical suggestions.

If your loved one is talking about self-harm or is psychotic, they need to go to the hospital; there are no other options. If the mood is so extreme that it puts the person’s health or well-being at risk, they require a supervised environment and medication to break the severe mood state.

If the mood is not this extreme, reminding your loved one to take any prescribed PRN (as needed) medication can be helpful and relatively immediate way to deescalate the emotion. The ultimate goal is to get the individual to stop ruminating on whatever distressing or obcessive thought is stuck in their head. If the loved on has put together a list of coping skills, remind them of this list and encourage them to try each skill until something is helpful. Any significant change in mood should be reported to the loved one’s therapist and psychiatrist as soon as possible. The more people working together to support the loved one, the more likely the mood can me resolved quickly. Managing Bipolar Disorder is a challenge for the individual and for those who care about him/her, but is a worthwhile pursuit.

Parent voice

Aleene Shirley Morgenthaler

Before my diagnosis with Bipolar 1 Disorder in 2013, I was impassioned with serving my communities with my skills and talents.  Now, the Mental Health Community has become my focus. My posts are concepts that helped me and continue to – as mental health is a lifelong journey. Hope you enjoy the read.

In losing who I was from my Bipolar diagnosis, I had to relearn how to be an advocate for myself, in my thoughts.  This was a hard course.  Not only did I have to learn who I was again (a different/better version of myself), I had to learn to take ownership of the voices in my head.   My mind contains many voices.  Some I love.  Some I despise.  It was learning about these voice’s personalities that helped me advance myself mentally.  And helped me be able to choose which voice takes lead in any given situation.  My parent voice became one that strengthened me.  It comforted me in times of pain and encouraged me to grow.  Now I benefit from understanding this voice that I am so grateful of it.  This all would not have come to fruition without my therapist and our work together.

Aleene Shirley Morgenthaler

 

In 2013 my life changed forever in a big way.  I was diagnosed with Bipolar 1 Disorder. The rollercoaster ride lasted for two years with 6 hospital stays.  I have now been in recovery since 2015.  As a Community Service Scholar at DePaul University, I’ve been driven to serve with my skills and talents.  Writing is a passion and something I believe I am skilled and talented in.  So, these words I write come from a place of serving my community.  My hope is: these words serve in a way to help those who are experiencing what I have.

It’s sad.  It’s sad to develop a Mental Illness that has such a stigma in our nation.  I cried most days in the beginning during depressive episodes.  I made up all these wonderful beliefs in mania.  That when back down they fluttered away and I was faced with our shared reality.  I was jobless, unstable, and sad.  Depression skews reality just as much as mania.  But when I was able to think – I’m sad – and grieve that sadness – I was able to rise above it.  I rarely cry by myself over sadness.  I believe it is because I took the time to honor that sadness when I was in it.  Now I can look back and be proud of allowing myself to honor my feelings so I could make room for new ones: pride, acceptance, joy, contentedness.  Honor your feelings so you can move past them, if that’s what you desire.

By Shainna Ali | Mar. 02, 2018

Take a moment to consider all the people in your life: your coworkers, friends, family. At any given time, 1 in 5 of these individuals is living with a mental health condition. You may have noticed them struggling, but if you’re not a trained mental health professional, you may not have known how to help.

However, you can help. You can be supportive and encouraging during their mental health journey. Here are a few tips on supporting the mental health of those you love.
1) Educate Yourself

There are hundreds of mental health concerns; your job is not to become an expert in all of them. When you do notice potentially troublesome symptoms, it’s helpful to determine if those signs may indicate a mental illness. Familiarizing yourself with common symptoms can help you understand and convey your worries. You may also benefit from expanding your knowledge by taking a course or joining a support group of individuals who can relate to the hardships you and your loved one may be facing.
2) Remain Calm

Recognizing that a loved one might need help can be daunting, but try to remain calm—impulsively approaching the individual might make you seem insensitive or aggressive. Try to be mindful and patient. Take time to consider your loved one’s symptoms and your relationship before acting. Writing down how you feel and what you want to say may be useful to help you recognize and understand your thoughts and feelings, and help you slow down while connecting to your good intentions.
3) Be Respectful and Patient

Before talking to someone about their mental health, reflect on your intention to promote healing and keep that in mind. Ask how you can help in their recovery process and be cautious not to come off as controlling. While encouraging a person to seek help is okay, it is not appropriate to demand it of them. Let them know that if they ever wish to talk in the future, you’re available.
4) Listen

Give your loved one the gift of having someone who cares about their unique experience. Don’t bypass their narrative by making connections to others’ experiences. You might recognize a connection to your own experience, however, sharing your story prematurely may undermine their experience. You may be prepared with hotlines, books, or a list of community providers, and although these are excellent sources of support, it’s important to take time to thoroughly listen before giving advice. It’s a privilege to have someone share intimate details of their mental health. Be present and listen before moving forward.
5) Provide Support

One of the best ways to help is to simply ask how. It’s not helpful to try to be someone’s therapist, but you can still help. People don’t like being told what to do—asking how you can help empowers them to take charge of their recovery, while also letting them know you are a source of support.
6) Establish Boundaries

As you support your struggling loved one, it’s important to consider both your boundaries and theirs. When trying to help, you are susceptible to neglecting yourself in the process; boundaries will help you maintain your self-care, while also empowering your loved one. Be sure you’re not working harder than they are at their own healing process.

As a caring person, you may grapple between wanting to encourage and support your loved one while wanting to honor their process and independence. Unfortunately, there are no foolproof guidelines for helping your loved one on their journey towards recovery. However, you can connect to your intentions, convey compassion and maintain your own self-care while empowering your loved one regardless of where they are in their healing journey.

Shainna Ali is a practitioner, educator, and advocate who is dedicated to highlighting the important role of mental health in fostering happiness, fulfillment, and overall wellness. She is a certified counselor and licensed mental health clinician, and the owner of Integrated Counseling Solutions, a clinical and consulting practice in Central Florida. Her areas of focus in research and practice include identity and culture, emotional intelligence, trauma, and creativity in counseling. For more information on Dr. Ali, please visit IntegratedCounselingSolutions.com

Aleene Shirley Morgenthaler

 

In 2013 my life changed forever in a big way.  I was diagnosed with Bipolar 1 Disorder. The rollercoaster ride lasted for two years with 6 hospital stays.  I have now been in recovery since 2015.

 

“Playing the victim” is my first post because it is one of the first concepts I had to shed away for my recovery of Bipolar mania & depression.  When my therapist first talked to me about this, I felt insulted.  I wasn’t playing the victim – I thought.  I lost ‘everything’ because my diagnosis.  I lost my job, mentor, city-life, and best friend.  I lost all connection to them – I thought.  My therapist kept this concept into my mind to the point that I began to understand – I was playing the victim.  Here’s an article that has some examples of victim playing: https://www.lifehack.org/287448/14-signs-someone-always-playing-the-victim.  Most of my energy was feeling sorry for myself.  It wasn’t until I took my diagnosis as a challenge in life – I can overcome with the right medication and talk therapy.  All the while having an attitude: my life is beautiful with lessons I was bound to learn in order to reach a higher state of being.