Author: Elizabeth Liuzzi

My interest in the medical field and, in turn, psychology was only discovered relatively recently, through EMT training. After gaining a year of experience learning and providing patient care, I was inspired to return to school to pursue a career in medicine. My unique experiences have taught me that I really enjoy hearing people’s stories and getting to know them on a personal level – their struggles and their triumphs, the stories that are hardest to tell and the stories that are their favorites. I think understanding people on a deeper and more holistic level makes us better empathizers, better professionals, and better people, and I hope that my own career in the medical field one day reflects this understanding.

My interest in mental health comes not only from my own struggles with anxiety but from seeing firsthand the effects untreated mental disorders have on other people. My hope is that through the Humanology Project people will realize just how common these issues are, and that would equate to less silent suffering and more empathetic understanding.

When I am not studying or waiting tables on the weekends, I like spontaneous road trips, anything to do with the beach and the outdoors, and the occasional ostrich ride when I’m at the Curacao Ostrich Farm (which actually only happened once).

Categories
Bipolar Disorder

Use and Abuse: Overlap in Bipolar and Substance Use Disorder

While there is a high rate of comorbidity among mental illnesses in general, there is perhaps no other combination of disorders more dangerous to the individual and those around them than mental illness paired with substance use disorder (SUD). Together, these two illnesses can work in powerful combination, exacerbating the vulnerability and instability already experienced by individuals with poor mental health.  Those with bipolar disorder are particularly at high risk for a comorbid diagnosis of SUD. These two disorders occur together so often that some even believe it should be common practice to screen bipolar individuals (specifically young adults) for drug use as soon as a diagnosis is made.

Why is it, then, that these two illnesses, seemingly distinct and unrelated to each other, are so often linked together?  A recent article on the common prevalence of comorbidity between bipolar and substance use proposes that this phenomenon is due to one or a combination of three different reasons: genetic factors underlying aspects of both diseases occurring in the brain, overlapping neurobiological pathways in the brain, or one disorder fostering another.

It is commonly known that many mental illnesses are comorbid — a single diagnosis of any mental illness puts one at much higher risk for encountering another at some point in life. At any given point during a 12-month period, 50% of adults clinically diagnosed with a psychiatric disorder also had at least one other accompanying mental disorder. Anxiety and depression, for example, are two mental illnesses that have extremely high rates of comorbidity (upwards of 60%).  Similar to the current understanding of how many other mental illnesses develop in conjunction with one another, one theory for understanding the particularly high comorbidity of bipolar and SUD is that they have similar genetic causes. Biological factors that lead to genetic vulnerability toward one disorder also predisposes the person to greater vulnerability toward another disorder.

Along this same trend, some scientists point toward overlapping neurobiological pathways in the brain as the root cause for high rates of SUD and bipolar occurring in conjunction with one another. As both mental illness and substance abuse progress, both disorders display a similar pattern. In bipolar, manic and depressive episodes become more frequent with shorter symptom-free periods as the untreated disease progresses; in substance abuse, addiction becomes more all-consuming as time goes on, causing the drug user to crave the high of the drug more frequently in the case of longer duration of drug use. The theory of overlapping pathways, then, points toward greater “sensitization” from an untreated disorder in the brain as a sort of “kindling,” or fuel, for the other disorder to track down the same destructive pathway when left untreated.

Although this theory explains some of the science of what causes co-occurring disorders, it does not capture the whole picture. Current psychological research describes the development of mental illness in terms of genetic and environmental influences. The environmental contributions to bipolar disorder and SUD can be best understood if SUD is conceptualized as resulting from the bipolar disorder. In an effort to deal with the intense ups and downs and extreme mood swings, people with untreated bipolar will sometimes resort to “self-medicating” with addictive substances such as alcohol, marijuana, or other drugs. Some people rely on these substances so heavily that they can even trigger manic or depressive episodes due to their use. Cocaine, for example, has been shown to potentially send people with mood disorders into a manic or hypomanic episode because of its effect on the body and complex neurotransmitter chemistry in the brain. The person, however, may view the drug as a way to remedy intense depressive episodes experienced from a bipolar “low,” unaware that the resulting hypomanic or manic episode can be just as harmful.

Due to these complex interaction effects from both disorders, it is generally recommended that people receive treatment for bipolar and SUD together and not separately, as was common practice up until recently. The very fact that these two illnesses are linked together so frequently reiterates the importance of understanding their combined effects.  Even further, though, understanding the comorbidity and underlying causes between bipolar and SUD also empowers us with the even greater understanding that each individual and their needs are extremely unique and amazingly varied, making us more compassionate and empathetic practitioners, students, friends, and partners.

References:

Mcgregor, S. Substance Abuse and Bipolar Disorder. Retrieved on February 18, 2018, from https://psychcentral.com/lib/substance-abuse-and-bipolar-disorder/

Quello, S. B., Brady, K. T., Sonne, S. C., Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Retrieved on February 18, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/

Cameron, O. G. Understanding Comorbid Depression and Anxiety. Retrieved on February 18, 2018, from http://www.psychiatrictimes.com/anxiety/understanding-comorbid-depression-and-anxiety

Dual Diagnosis. Bipolar Disorder and Addiction. Retrieved on February 18, 2018, from https://www.dualdiagnosis.org/bipolar-disorder-and-addiction/

 

Categories
Bipolar Disorder

Mental Health and the Judicial System: Why We Should Care for the Most Vulnerable

In the judicial system, the interaction between the mentally ill and established tradition in caring for them and meeting their needs is something that has raised increasing concern in recent years. Politicians, judges, and others involved in the prison system are realizing that the care of the mentally ill has not kept pace with changing attitudes toward the lack of resources available to this subset of the inmate population. With sixty-four percent of local jail inmates afflicted with some sort of mental illness, there has been a push for greater access to programs designed specifically with the mentally ill in mind.  

Some places, like California, have increased their budgets substantially to account for more treatment beds and mental health programs inside prison walls. According to the Los Angeles Times, Governor Jerry Brown has recently budgeted a shocking $117 million to provide better resources and treatment for those unfit to stand trial due to their mental illness. New York City governor Bill DeBlasio has also recently budgeted money specifically dedicated to female inmates dealing with mental illness, financing much-needed services to rehabilitate them, provide them with career counseling, and supply other types of treatment specific to their needs.

Other places, however, are providing unique access to care that is focused more on prevention and rehabilitation. Rebecca Rossmeisl, 32, was the first participant to graduate from the Whatcom County Mental Court’s program, a relatively new program dedicated specifically to women with mental illness who are convicted of misdemeanors. It was designed as a jail alternative to rehabilitate those whose offenses are clearly due to their state of mental health, helping integrate them into society having overcome some of the deficits that their mental health has left them with, whether social, behavioral, or cognitive.

Many times, people with such illnesses do not have access to the care and facilities that they need in order to cope with their illness and its potential ramifications. This program, started just recently in 2015, makes an effort to acknowledge this gap in not only the judicial system, but also the mental health community as a whole. Throughout the course of the program, participants work through everything from building social skills to creating and maintaining healthy personal habits to participating in volunteer work.

This issue of mental health in the prison/judicial system should be important to those of us championing the mental health campaign and trying to increase awareness for how these types of illnesses affect people every day.  Certain types of mental illness make patients more vulnerable and prone to violent behavior, and this can affect their daily life and their road to recovery. Those with bipolar disorder, for instance, are particularly vulnerable to both violent behavior and suicidal ideation due to the intense mood swings they can experience.  During a manic episode, people with bipolar disorder experience inflated feelings of self-esteem and self-importance, leading them to do things that they would otherwise recognize as dangerous, risky, or inappropriate behavior. According to the Psychology of Law and Criminal Behavior Blog, criminal behavior may present itself in those with bipolar when it is accompanied by drug or alcohol abuse. According to the Blog, the risk of criminal behavior seems to show a positive correlation with the duration and frequency of the manic episodes experienced in bipolar.  

Bipolar sufferers are certainly a small subset of the population, and mental illness does not equate violent or criminal behavior. However, the need for facilities that take into account the needs of the mentally ill in the judicial system are still certainly needed. Programs like the one in Whatcom County, Washington, are a necessary step toward more comprehensive treatment for the mentally ill. As opposed to scrambling to keep up with the needs of a burgeoning population of mentally ill inmates, perhaps in the future we can be a part of perpetuating a new, healthy cycle of mental health awareness and aid, one where the mentally ill are granted access to programs that create healthy habits, encourage positive behavior, and take positive steps toward maintaining a productive, self-sustaining lifestyle.

References:

National Alliance on Mental Illness. Department of Justice Study: Mental Illness of Prison Inmates Worse Than Past Estimates. Retrieved on February 14, 2018, from https://www.nami.org/Press-Media/Press-Releases/2006/Department-of-Justice-Study-Mental-Illness-of-Pris

Ulloa, J. California’s mentally ill inmate population keeps growing. And state money isn’t enough to meet needs, lawmaker says. Retrieved on February 4, 2018, from http://www.latimes.com/politics/la-pol-ca-mental-health-incompetent-trial-costs-20180202-story.html

Toussaint, K. NYC To Invest $6M to help break cycle of incarceration for women. Retrieved on February 4, 2018, from https://www.metro.us/news/local-news/new-york/nyc-6m-break-cycle-incarceration-women

Pratt, D. These women were facing mental illness and jail time, and this program helped them heal. Retrieved on February 4, 2018, from http://www.bellinghamherald.com/news/local/article196984014.html

National Institute of Mental Health. Bipolar Disorder. Retrieved on February 4, 2018, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Paldowitz, K. Bipolar Disorder: The Highs and the Lows. Retrieved on February 4, 2018, fromhttp://www.psychology-criminalbehavior-law.com/2015/01/bipolar-disorder/  

Categories
Bipolar Disorder

The “Blessing” of Bipolar?

“I’ve been blessed haven’t I? … because I’m able to experience life in sort of what some people describe as kind of extremes, it just gives me an opportunity to feel things and experience things that I wouldn’t otherwise do, simple as that.”  If someone you just met were to tell you they were diagnosed with bipolar disorder, most likely the first thoughts that would come to your mind would not be to make a remark congratulating them on their diagnosis; you would probably say something along the lines of, “I’m sorry, that must be difficult to deal with.” While the 2.6% of the population diagnosed with bipolar disorder would almost certainly have their share of devastating stories to tell recounting depressive episodes or suicidal ideation, many people with bipolar also learn to view their illness as an asset to them. The unique perspective their illness gives them allows many people to not only accept the illness as a part of their individual identity but to embrace it for what it contributes to their life as a whole, struggles and setbacks included.  

While it is now a well-circulated fact that there is a link between bipolar and creativity, as there also seems to be with other mental illnesses, the reasons bipolar can be an important part of a patient’s identity extend well beyond creative advantages. Bipolar patients claim their illness allows them greater empathy for others going through similar situations, gives them a tenacity lacking in others who do not have to experience the same struggles and gives them the motivation to focus on all parts of their overall health and well-being, including their physical health. One patient who wrote an article on her experience with bipolar as a mother of three implied that her bipolar has actually provided her with several advantages as a parent. Though she used to feel guilt over how her children would perceive her as they grew older and became more aware of her depressive episodes, she worked to change her own perspective of her illness and used her bipolar and her openness in discussing it with her children as a way to encourage them to examine their own emotional health and freely express how they feel.

The experts also have things to say about why a bipolar diagnosis does not need to be viewed as something that will only cause harm and suffering to the individual. Dr. Nassir Ghaemi, MD and author of the book A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness, claims that the traits inherent in those with bipolar diagnoses could also be linked to greater leadership capabilities. According to Dr. Ghaemi, “Depression enhances empathy and realism and the mania enhances creativity and resilience … so when people have bipolar disorder, they have the full gamut of benefits.” Distinguished historical figures, like Winston Churchill and Florence Nightingale, both known for their tenacity, their wit, and their leadership capabilities, were also plagued by both depressive episodes and periods of enhanced drive and motivation that were rumored to be signs of bipolar disorder. “A lot of the reason we can do what we do is not necessarily in spite of [having bipolar], it’s because of,” explains one bipolar patient.

While bipolar disorder is certainly a difficult diagnosis to deal with and the illness does not come without a very challenging set of trials and setbacks, bipolar does not need to be thought of as a life-ending diagnosis. Many patients learn to view bipolar as an important part of their identity and their personage, learning to cope with the illness by embracing all the parts that come with it, the wild manic episodes, the devastating depression, and the periods in between. And just as patients learn to cope with their bipolar symptoms by viewing them as more than simply a disadvantage or a disability, the same can be said for people with a whole range of mental illnesses, from anxiety to personality disorders to depression, that are just as stigmatized as bipolar.  Learning to embrace this mindset can be helpful in dealing with their diagnosis, and in managing their mental and physical symptoms.

References:

Parry, W. Bipolar Disorder Has Its Upside, Patients Say. Retrieved on November 26, 2017, from https://www.livescience.com/20185-bipolar-disorder-positive-effects.html

National Institute of Mental Health. Bipolar Disorder Among Adults. Retrieved on November 26, 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-adults.shtml

Wootton, T. Advantages in Bipolar Disorder: No Longer If, But Why and How. Retrieved on November 26, 2017, from https://www.psychologytoday.com/blog/bipolar-advantage/201306/advantages-in-bipolar-no-longer-if-why-and-how

International Bipolar Foundation. 5 Positives of Living With Bipolar Disorder (Besides Creativity). Retrieved on November 26, 2017, from http://ibpf.org/article/5-positives-living-bipolar-disorder-besides-creativity

Adams, Y. 5 Things to Remember When Being A Parent With Bipolar Disorder. Retrieved on November 26, 2017, from https://www.bphope.com/blog/5-things-to-remember-when-being-a-parent-diagnosed-with-bipolar-disorder/

Forbes, E. Finding the Positive Side of Bipolar Disorder. Retrieved on November 26, 2017, from https://www.bphope.com/accentuate-the-positive/

Categories
Bipolar Disorder

“The Feeling Will Pass”: Misdiagnoses In Mood Disorders

In a world where mental health is still highly stigmatized, another struggle also plagues the mental health community—a lack of accurate diagnoses. Patients struggling with their mental health, even after taking their first initial step toward seeking treatment from someone with experience in the broad spectrum of psychiatric disorders, still struggle in getting a proper diagnosis for their symptoms. Sometimes this is due to a simple lack of awareness by general practitioners, and other times, it is because symptoms overlap to such an extent that it becomes difficult to distinguish one disorder from another. One example of that is in the misdiagnoses seen in bipolar disorder and other similar depressive and personality disorders, particularly borderline personality disorder, or BPD.

Dealing with any mental health disorder and getting a proper diagnosis is challenging, but it can become even harder to get a clear diagnosis when the disorder you are dealing with is highly related to shifts in mood. Tilly Grove, for example, a 24-year-old journalist in the U.K., shared part of her story with BPD in a recent article from The Guardian. “I battled to get a diagnosis for two years,” she says, recounting her struggle in trying to get a mental health professional to take her chaotic mood swings seriously. To make matters more complicated, BPD is oftentimes highly confused with bipolar and a number of other disorders, as in the case of Maggy van Eijk, a journalist who had been misdiagnosed with unipolar depression, bipolar, and even PTSD, all before clinicians landed on a proper diagnosis of BPD. Both bipolar and BPD are presumed to be caused by a combination of genetics and environment, both involve mood fluctuations, and both can be harmful to the individual and the people around them. So how does one tell the two disorders apart when they are so similar?

A main distinguishing factor is the frequency of the mood swings and their intensity, and the individual’s sleep patterns throughout the mood swings. Whereas patients with BPD can experience mood changes quite rapidly, bipolar patients, especially those with Bipolar I, tend to have extended periods of depression followed by periods of mania, where the symptoms are quite pronounced and can lead to dangerous behaviors. BPD mood swings also appear to be triggered situationally, by experiences, as opposed to bipolar, where there may or may not be a situational trigger that sends one into a manic or depressive phase. Because of this, BPD sufferers are more likely to see the effects of their disorder in their unstable personal relationships.

How do these factors impact diagnosis, and why is it important to take this into account? In many cases, a proper diagnosis can mean the difference between returning to a normal routine of life or receiving improper medication that potentially makes the condition worse. Bipolar patients for example, when mislabeled with depression and given antidepressants for treatment, can actually be triggered into a manic episode as a side effect of the medication.

Even still, however, lack of awareness on a clinician’s part cannot account for all of the error in pinning down specific mood disorders. This diagnostic issue is also a reflection on the mental health community and the stigma mood disorders, in particular, can carry, and a lack of urgency for treatment. Perhaps the common link shared by bipolar and BPD, sudden shifts in mood, is viewed by patients and their families as something less detrimental than, for example, schizophrenia or another mental illness related to psychosis and hallucinations. After all, when are you more likely to go to the doctor, or when is a loved one more likely to push you to seek medical help—when you are feeling upset and hopeless, something that is arguably “easier” to cover up with a smile or a forced laugh, or when you are hearing voices in your head and having psychotic hallucinations? While mental disorders related to psychosis are seen as mental illnesses in their “purest form,” perhaps mood disorders are viewed both by the patients themselves and their family members as something less serious, or at least not serious enough to seek help for. After all, controlling one’s mood is seen as something much more accessible to most people than quieting voices in their head, or “unseeing” frightening images from a hallucination. Not only is it important for clinicians to be more aware and alert for early stages of depression, bipolar, or BPD, but it is also important for the patients themselves, and their family members, to realize that something detrimental and life-altering does not need to occur before medical help is sought. It is true that not all mental illnesses are created equal, but they all have the potential to be equally dangerous and equally life-altering. It is our responsibility to be just as vigilant aware of our own mental health, and that of others, as we expect our clinicians to be.

References:

Reynolds, E. Borderline personality disorder: ‘One GP told me I wasn’t ill, just a bad person.’ Retrieved on November 12, 2017, from https://www.theguardian.com/healthcare-network/2017/oct/27/borderline-personality-disorder-stigmatised-misunderstood-misdiagnosed

Van Eijk, M. What it’s really like to have Borderline Personality Disorder in the workplace. Retrieved on November 12, 2017, from https://inews.co.uk/opinion/really-like-go-work-borderline-personality-disorder/

Duckworth, K. Borderline Personality Disorder And Bipolar Disorder: What’s The Difference? Retrieved on November 12, 2017, from https://www.nami.org/Blogs/NAMI-Blog/June-2017/Borderline-Personality-Disorder-and-Bipolar-Disord

NHS Choices. Borderline Personality Disorder. Retrieved on November 12, 2017, from https://www.nhs.uk/conditions/borderline-personality-disorder/

Bushak, L. Bipolar vs. Borderline Personality Disorder: The Differences Between The Two And How To Avoid Misdiagnosis. Retrieved on November 12, 2017, from http://www.ibtimes.com/bipolar-vs-borderline-personality-disorder-differences-between-two-how-avoid-2610556

Categories
Bipolar Disorder

Sleeplessness, the Manic Trigger?

What does the word “mania” sound like to you? Does it sound like a high that some people spend large sums of money, energy, and sanity to attain? Does it sound like an adrenaline rush? The peak of a roller coaster, or a sort of euphoria perhaps? While our mind’s eye pictures “highs” in this sort of way, a bipolar manic high can be completely devastating to the person experiencing it. Its effects may include “elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, difficulty maintaining attention, increase in goal-directed activity, and excessive involvement in pleasurable activities.” While a manic episode may sound a little like an amped up version of your morning caffeine rush, its effects may greatly impact not only the individual diagnosed with bipolar but also have lasting effects on the family members and friends who may be affected by actions taken during this time when one exhibits little control over their actions and their related consequences. While manic episodes are an unfortunate reality for most bipolar patients, new research suggests that these extended euphoric episodes could actually be naturally triggered by extended periods of sleeplessness.

It is commonly known today that sleep deprivation affects many aspects of our physical health and our cognition. Insufficient sleep can make it difficult to concentrate, remember, and retain information and even to regulate your emotions. It also contributes to obesity and cardiovascular problems and has also been linked to a much faster rate of developing dementia as one ages. One University of California professor, Matthew Walker, who has spent the last 20+ years of his life researching sleep and its effects on people and their cognition, even goes as far as to suggest that sleep should be thought of like work or any other mandatory responsibility because of its importance to how we function and our longevity. “[Sleep] needs to be prioritized, even incentivized,” he says, in order to break the cycle of what he calls the “catastrophic sleep-loss epidemic.”  

While Walker points to startling physical and mental effects that sleep loss has on our bodies over time, preventative care is not the only reason to get your eight hours of shut-eye per night. Those with pre-existing mental health disorders are also greatly affected by lack of sleep. Bipolar, for instance, had previously been connected with sleep disturbances such as insomnia, but these sleep disturbances were most often thought of as an effect of the manic episodes and not necessarily the trigger. It turns out that lack of sleep can actually precede the patient’s decline into mania. The previously-mentioned study, just recently published by Cardiff University researchers led by Ph.D. student Katie Lewis, shows a clear connection between sleep loss and manic episodes in bipolar disorder. According to her findings, “20% of people with bipolar disorder reported that sleep loss had triggered episodes of high mood, whereas 12% reported that sleep loss had triggered episodes of low mood.” Though she did find that women and those with bipolar I were more likely to experience this sleeplessness-mania correlation, Katie and her researchers still discovered the same general patterns across her study population even when accounting for age differences, intensity of illness, and other similar variables.

This is a significant finding because a link like this between sleep and manic episodes can prompt new research studies and possible avenues for new treatment options. While this link between bipolar and sleep is relatively unexplored as of yet, research has already been done on the effects of sleeplessness as it relates to depression. Extended periods of wakefulness has actually been shown to be effective in kickstarting treatment for depression, believed by researchers to be due to the fact that lack of sleep prompts your body into a deeper sleep cycle the next time it has a chance to rest. The fact that a deeper sleep cycle can help with mood regulation is an unsurprising result when compared to the Cardiff University study on bipolar. However, much more research still needs to be done on the topic in order to understand its correlation to mental health even more clearly. Perhaps in the future, as Matthew Walker states, the importance of sleep will fully be recognized, and people will begin to think of sleep as a prescription for mental health, and not an unnecessary burden cutting into their social time and leisure activities.

References:

Bressert, S. (2017). Manic Episode Symptoms. Psych Central. Retrieved on October 17, 2017, from https://psychcentral.com/disorders/manic-episode/

Lewis, K. S. et al. Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender, The British Journal of Psychiatry (2017). DOI: 10.1192/bjp.bp.117.202259

Meltzer, L. The power of sleep: How shut-eye helps the body as you age.  Retrieved on October 19, 2017, from https://www.cbsnews.com/news/sleep-healthy-retirement-gsk/

Cooke, R. ‘Sleep should be prescribed’: what those late nights out could be costing you. Retrieved October 19, 2017, from https://www.theguardian.com/lifeandstyle/2017/sep/24/why-lack-of-sleep-health-worst-enemy-matthew-walker-why-we-sleep

Firger, J. World Mental Health Day: How Bad Sleep Can Literally Make You Go Crazy. Retrieved October 19, 2017, from http://www.newsweek.com/not-sleeping-enough-go-crazy-mental-health-681203

Klausner, A. Sleep Deprivation Might Be the Antidote for Depression. Retrieved October 17, 2017, from http://nypost.com/2017/09/20/sleep-deprivation-might-be-the-antidote-for-depression/

Categories
Uncategorized

DSM, Diagnoses, and Debate: The Many Dimensions of Mental Health

One of the biggest debates surrounding the field of psychology and its practitioners today is the debate concerning how exactly mental health diagnoses should be made. What defines a mental illness? Who determines what constitutes each specific illness and what gives them the credentials to do so?  In the early years of psychology, this very issue contributed to the struggle psychologists faced in legitimizing their field as a science.  Poor diagnostic techniques and lack of standardization of diagnoses made early psychological ventures appear more philosophically-based than factual and scientific.  Today, however, we have the Diagnostic and Statistical Manual of Mental disorders (DSM for short), first created in 1952 as a collective effort by the American Psychiatric Association to standardize psychological diagnoses and further legitimize the field of psychological study.  While the original DSM was a breakthrough in psychological study and treatment for the mentally ill, specifics on the diagnoses are still fiercely debated, and definitions are continually being revised and reworded to include and exclude certain elements of specific disorders.  These specific diagnostic criteria affect not only the psychologists doing the diagnosing — they also greatly impact the people themselves who are being diagnosed.

The debate over how exactly to diagnose patients and what constitutes each individual illness has become particularly relevant again recently, as the fifth version of the DSM was released just a few short years ago in 2013.  It was released to many mixed emotions over the changes that had been made from the previous version. Many psychologists are concerned with the fact that the DSM-V still emphasizes categorical diagnosis, maintaining the need for patients to meet specific criteria for disease diagnosis, which critics believe is outdated and less clinically relevant. Some have even begun working on an entirely new classification system that relies solely on dimensional diagnosis or diagnosing patients according to a spectrum of impairment or disability.  Proponents of this method argue that someone should not have to merely meet a certain “list” of symptoms, but that the severity of their symptoms should also be weighed heavily in their diagnosis.  

Not all of the updates should be criticized, however; the category for bipolar disorders, for example, has also been changed, expanded to include “an emphasis on changes in activity and energy — not just mood.” The phrase “mixed episode specifiers” has also been included in describing manic, hypomanic, and depressive episodes, allowing for more freedom in how patients describe the highs and lows related to their bipolar disorder.  Categories have also been added that describe episodes of short duration and anxiety-related specifications of bipolar disorder.  Thus, as it relates to bipolar disorder, the changes brought about in the DSM-V actually make diagnosis easier for patients struggling with a wide variety of symptoms, for the most part, and include categories and intricacies of the disease that may have been ignored by previous versions of the DSM.

While the clinical relevance of the DSM diagnostic criteria cannot be ignored, the changes in the definition of these diagnoses and the debate surrounding them impact more than just the list of signs and symptoms needed for a specific diagnosis. What about the patients behind the disorders?  How are these changes in diagnostic criteria affecting patients of specific diseases?  When categories are expanded or done away with, it can have a significant influence of the patients, whose diagnoses often become an integral part of their identity.  Melissa Miles McCarter, an author, academic, and publisher, reflects on her experience with bipolar and how it relates to her career and her everyday life, even becoming intertwined in the two.  She says, “Without medication, I deteriorate and become dysfunctional or am thrust into a deep depression followed by manic psychosis. However, if I had never had these challenges, even the bouts with severe mental illness, would I still be the same person — and would I want to be?” Another example of the effects diagnostic criteria can have on mental health patients is in the removal of Asperger’s Syndrome, placing patients that previously met that criteria into a new broadened category renamed “Autism Spectrum Disorder,” which sparked much debate among the Asperger’s community.  

While criteria specific to bipolar disorder and those diagnosed with this disease may have been benefitted from the DSM-V, many categories of illnesses are still under continuous debate.  Re-wording, rewriting, and recombining signs and symptoms of disorders affect not only the psychologists who must be familiar with diagnostic criteria — they also affect the patients whose identities are oftentimes tied quite closely with a disorder they have come to embrace as their “own.”  Unfortunately, no system is without its flaws, and this fact speaks to the current debates facing psychological diagnoses.  While psychologists continue to strive to make improvements to classifications of mental disorders, the interests of the ones who are actually suffering from the mental disorders must be balanced with the need for better classification systems and criteria.

References:

McLeod, S. A. (2011). What is psychology?. Retrieved October 9, 2017, from www.simplypsychology.org/whatispsychology.html

American Psychiatric Association (2017). DSM History. Retrieved October 1, 2017, from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm

Whitbourne, S. K. (2013, May 4). What the DSM-5 Changes Mean for You. Retrieved October 1, 2017, from https://www.psychologytoday.com/blog/fulfillment-any-age/201305/what-the-dsm-5-changes-mean-you

Nauert, R. (2017). New Evidence-Based Diagnostic System Sees Shades of Gray. Psych Central. Retrieved on October 1, 2017, from https://psychcentral.com/news/2017/03/27/new-evidence-based-diagnostic-system-sees-shades-of-gray/118235.html

Grohol, J. (2013). DSM-5 Changes: Bipolar & Related Disorders. Psych Central. Retrieved on October 9, 2017, from https://pro.psychcentral.com/dsm-5-changes-bipolar-related-disorders/004312.html

Ketter, T.A. Solving clinical challenges in bipolar disorder. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.

McCarter, M.M. (2015, April 30). Mental Illness And Identity: Would I Shed My Bipolar Disorder Skin? Retrieved on October 9, 2017, from http://www.huffingtonpost.com/melissa-miles-mccarter/mental-illness-and-identi_b_7176674.html

Berrington, L. (2011, May 21). Asperger’s Removed from the DSM: How Will It Affect Autism Patients? Retrieved on October 1, 2017, from https://www.thedailybeast.com/aspergers-removed-from-the-dsm-how-will-it-affect-autism-patients

Categories
Anxiety and Anxiety Disorders Bipolar Disorder

Bipolar Vs. Anxiety: The Unlikely Relatives

Imagine being on a euphoric mental high so powerful, it makes you dangerous to yourself and others. It makes quickly spending your life savings and engaging in risky sexual behaviors seem like a natural course of action for the intense euphoria you’re experiencing.  After this “high,” your mental state quickly takes a downturn. You crash, you hit the proverbial wall. It becomes hard to function, even though everything was so effortless just days before.  As one patient, comparing her mental state during highs and lows to a sprinting race, puts it, “Life, everyone and everything in life, me included, are exquisitely and fabulously beautiful. But then the sprint and marathon race inside my brain finishes. My brain becomes completely exhausted — depleted of everything it had.” By definition, you are experiencing the manic and depressive episodes shared by all sufferers of this disorder, commonly known as bipolar.  

Now, imagine you are fearfully anticipating an upcoming event. Your anticipation is so pervasive it makes it hard to think about anything else or to focus on things that need to be accomplished for school or for work. In fact, it’s even affecting you physically, in the form of muscle tension and lightheadedness. “It feels like a constant heaviness in your mind; like something isn’t quite right, although oftentimes you don’t know exactly what that something is.” You would be experiencing generalized anxiety.  

Now put the two together, the manic highs and depressive lows, the heavy thoughts and the fearful anticipation. This combination of bipolar and anxiety disorders, something psychologists refer to as comorbidity, is in fact what many bipolar patients experience regularly.  According to a study performed on bipolar patients who were part of the National Epidemiologic Survey on Alcohol and Related Conditions, an estimated 60% of people diagnosed with bipolar have also suffered from an accompanying anxiety disorder. This is in contrast to the 2.9% of the population of American adults that suffer from anxiety disorders who may or may not have an accompanying mental illness. Although anxiety may be hard to distinguish from the highly aroused mental state that comes with bipolar manic highs, Dr. Naiomi M. Simon, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, says that several key factors can help in making a diagnosis. The presence of anxious mood, general worry, panic attacks, or related anxiety symptoms, extended periods of sleeplessness when not in a manic state, and even the time frame during which anxiety symptoms develop, all aid in making a proper diagnosis for an accompanying anxiety disorder.

The fact that these two diseases are so closely tied together is problematic for several reasons. First, some studies show that individuals diagnosed with both disorders were twice as likely to be hospitalized during a depressive episode than those strictly diagnosed with bipolar. The study also correlated stronger bipolar symptoms, such as more manic and depressive episodes and a higher likelihood of suicidal behavior, with a co-occurrence of an anxiety-related diagnosis. Second, just as bipolar is tied to a higher likelihood of experiencing anxiety, the reverse is true as well; those experiencing symptoms solely related to an anxiety diagnosis are nine times more likely to develop bipolar disorder at some point in their lifetime.  Third, treatment for comorbid anxiety and bipolar may be more difficult, as some of the medications prescribed for anxiety may trigger manic episodes even when the patient is taking medicine to control the effects of their bipolar. In addition, antidepressants are sometimes addictive, which may be especially problematic for those more prone to substance abuse as a result of their bipolar.

Despite the potential complications in treatment, there is still hope for decreased symptoms for those struggling with both bipolar and anxiety. According to the Anxiety and Depression Association of America, therapy, in addition to taking prescribed medication, may play a crucial role in mitigating patients’ anxiety symptoms. Research is still being done to investigate the effectiveness of these techniques as they relate to anxiety and bipolar comorbidity.

Though bipolar and anxiety treatment together is still proving to be a challenge for healthcare providers, the combination of both disorders is certainly not uncommon or unique by any means. The comorbidity of these two disorders affects over half of the those diagnosed with bipolar, an important and startling statistic. According to this statistic, patients of both illnesses would actually be in the majority.  Dealing with this sort of mental illness is a complex battle, but with continued research and developments in this field of psychology, perhaps bipolar may one day feel a little less like an exhaustive marathon race and anxiety may feel a little less all-consuming. In the meantime, perhaps increased awareness for the complications of both these disorders can give those of us who do not have to suffer under the grip of manic and depressive episodes and generalized anxiety a better understanding of what sufferers of these disorders experience regularly, perhaps every day.

References:

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

Walz, S. (2017, September 19). How Having Bipolar Disorder Is Like Running a Marathon. Retrieved September 20, 2017, from https://themighty.com/2017/09/what-bipolar-disorder-is-like-running-marathon-sprint/

Hall, A. (2015, June 3). This Is What Anxiety Feels Like. Retrieved September 20, 2017, from http://www.huffingtonpost.com/alivia-hall/what-anxiety-feels-like_b_7495122.html

Pedersen, T. (2015). Bipolar Symptoms Stronger When Anxiety Disorder is Present. Psych Central. Retrieved on September 20, 2017, from https://psychcentral.com/news/2012/05/14/bipolar-symptoms-stronger-when-anxiety-disorder-is-present/38634.html

Anxiety and Depression Association of America (ADAA) – Anxiety and Depression Association of America. (2016). Bipolar Disorder. Retrieved September 22, 2017 from https://adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder-3

LaBouff, L. (2016). Two Anxiety Disorders Tied to Bipolar Disorder. Psych Central. Retrieved on September 20, 2017, from https://blogs.psychcentral.com/bipolar-laid-bare/2016/06/two-anxiety-disorders-tied-to-bipolar-disorder/

Walters, L. (2016). Co-Occurring Anxiety Disorder and Bipolar Disorder. Psych Central. Retrieved on September 22, 2017, from https://blogs.psychcentral.com/coping-depression/2016/11/co-occurring-anxiety-disorder-and-bipolar-disorder/