Author: Kathryn Davison

Categories
Trauma and Stressor Related Disorders

When Does Change Become Too Much? Adjustment Disorders in College Students

Stress: it’s something all students face when going to college for the first time. While starting college is a positive step for many people, it is a big change. Being in a new environment, taking harder classes, making new friends, and often living away from home are just some of the challenges that new college students face. When this new stress becomes too much, it can develop into an adjustment disorder.

Adjustment disorders typically occur during times of great transition and stress in one’s life. Adjustment disorders can be caused by both single events and ongoing occurrences. Some examples of changes that can lead to adjustment disorders include getting married, breaking up with a significant other, or starting a new job, but can really be any sort of  big life change (American Psychiatric Association, 2013).

While most people experience stress associated with changes in their lives, people who struggle with adjustment disorders experience this stress on a new level. Adjustment disorders are characterized by a person’s stress reaction to an event or change exceeds a manageable level. Their reaction to stress leads to an inability to function normally, which impacts their social, emotional, and occupational wellness. Adjustment disorders can exist with a variety of symptoms, including depressed mood, anxiety, changes in behavior, or a combination of many symptoms (American Psychiatric Association, 2013).

For many people, going to college is a positive opportunity for growth. However, for some it can bring on the debilitating effects of having an adjustment disorder. One study found that a significant number of first-year college students experience adjustment disorders, making it one of the most common mental health issues facing college students. Angelyn Ramos, a student at the University of Utah, felt that having an adjustment disorder changed her entire identity, causing her debilitating anxiety. She struggled to find coping techniques that worked for her intense anxiety at the start of her college career. However, she found comfort in knowing that she is not alone in her struggle. Many college students experience trouble in transitioning leading to adjustment disorders. Despite the wide-spread experience of adjustment disorders amongst first-year college students, there is limited information and research on the subject.

Oftentimes, adjustment disorders go away on their own as the person adjusts. However, this does not mean anyone should suffer in silence. In some cases, adjustment disorders can develop into full-blown anxiety and depression. This can all be avoided with treatment. Like Angelyn, Caitlyn, a student at Penn State, also struggled with anxiety due to an adjustment disorder when she first went away to college. She particularly struggled with the aspect of living in a dorm with a roommate. After receiving help for her adjustment disorder, she has finally started to feel at home at her university. For Caitlyn, therapy was effective at helping her manage symptoms and help her develop coping strategies she can use the rest of her life.

For many, college is the first big adjustment in a person’s life, and is often followed up by other changes like getting a full-time job or moving out. This makes college a good time to learn healthy coping methods needed for further big changes in the future. Every person experiences having an adjustment disorder differently. For many, adjustment disorders are treated by treating the symptoms that they present. For example, if a person is struggling with depressed moods as a result of their adjustment disorder, they may be helped by treatment used for depression like antidepressants or psychotherapy.

Fortunately, many college campuses have mental health resources that can be used to treat and alleviate the symptoms of adjustment disorders. College students struggling with adjustment disorders are never alone. There is likely someone in the same residence hall or lecture room going through the same thing. Adjustment disorders get better with time, and can be made more manageable through treatment. The prevalence of adjustment disorders on college campuses just show how necessary mental health services are for the college community.

References

American Psychiatric Association. (2013). Trauma and Stressor Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

https://doi.org/10.1176/appi.books.9780890425596.dsm05

Frolo, C. (2020). How Freshman Year Played Into My Mental Health Diagnosis. Daily Collegian. https://www.collegian.psu.edu/news/article_dfecc84c-4934-11ea-be58-5bc2256b7a85.html#comments

Ramos, A. (2018). I Suffered From an Adjustment Disorder. Her Campus at Utah. https://www.hercampus.com/school/utah/i-suffered-adjustment-disorder

Rogers, L.S., & Tennison, L.R. (2009). A Preliminary Assessment of Adjustment Disorder Among First-Year College Students. In Archives of Psychiatric Nursing- Volume 23, Issue 3. https://www.sciencedirect.com/science/article/abs/pii/S0883941708001076

Categories
Post Traumatic Stress Disorder

A Guide to PTSD Treatment

Reaching out for help is often thought to be the hardest part of the journey to improvement for mental illness. However, what is often not considered is the complex and overwhelming amount of treatment options . As someone seeking treatment for the first time, finding an option that is accessible, manageable, and effective can be confusing and difficult. When it comes to treatment for PTSD, there are a lot of options; some of which may work, some of which may not. Depending on the root cause of one’s PTSD as well as their symptoms, treatment may vary, and it may take time to find the right one. For many patients, it is not a matter of the treatment not working, it is a matter of finding the right one for them. As one individual with PTSD put it, treatment can be life saving. “I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help” (Philips, 2018).

The most common, and often most effective, treatment for PTSD is psychotherapy, or talk therapy. Although it may sound simple, psychotherapy can exist in a variety of forms. Trauma-focused therapies for PTSD have proved to be effective, as they help work through the specific traumatic event (or events) that has caused the PTSD as well as the memories, emotions, and meaning behind it. Cognitive Behavioral Therapies (CBT) are the basis for most recommended psychotherapies by the American Psychological Association for PTSD. CBT is centered around changing harmful patterns of thoughts, feelings, and behaviors. CBT is effective because it focuses on all aspects of the symptoms of PTSD including thoughts and behaviors. A typical session of CBT may involve talking through a traumatic memory and attempting to adjust the thoughts and feelings surrounding it. This can happen in a variety of ways depending on the approach taken by the mental health professional. For example, Cognitive Processing Therapy (CPT), a type of CBT designed for treating PTSD, focuses on challenging negative thoughts and beliefs about the trauma; essentially creating a new perspective of the traumatic event(s). Another form of CBT, Cognitive Therapy, focuses on relieving negative feelings, like guilt, surrounding the traumatic event(s) as well as coming up with effective ways to challenge recurring thoughts and behaviors.

Perhaps the most intimidating, but also one of the most effective forms of therapy for PTSD is prolonged exposure therapy. Prolonged exposure therapy involves slowly facing the fearful memories, feelings, and situations associated with the trauma with the support of a mental health professional. The end goal of prolonged exposure therapy is to overcome negative feelings and fears of situations associated with the trauma(s).

Often used as a supplement to psychotherapy, medication can be a helpful and important tool in the treatment process. Many people with PTSD are reluctant to explore pharmaceutical options because of common misconceptions about mental health medications and potential side effects. However, drugs like selective serotonin reuptake inhibitors (SSRIs) are the most common and effective medications used to treat PTSD. These include brand names like Zoloft, Paxil, Prozac, and Effexor. They work by increasing the levels and the effect of serotonin, a neurotransmitter (chemical) in the brain that affects sleep, mood, and emotions. Increased levels of serotonin in the brain can alleviate PTSD symptoms including nightmares, poor sleep, and panic attacks among others. Psychiatrist, Dr. David Graham, describes taking medication as a volume knob being turned down. Although it may not entirely eliminate symptoms, things may become a lot more manageable.

With PTSD affecting so many people, there are a lot of questions and studies exploring what future treatment possibilities may be. Some recent suggestions have ranged from acupuncture to reliving a traumatic event through virtual reality, to taking ecstacy. Although some of these options may seem unconventional, there has been some evidence to show they and some others have been effective at treating PTSD. The most promising new treatment for PTSD is the use of an injectable drug known as stellate ganglion block (SGB). SGB has previously been used in the treatment of chronic pain. Some results of SGB treatment have been extremely promising, reducing symptoms like angry outbursts, hyperarousal, and avoidance associated with PTSD (Lynch, 2016). Although it is still in an early stage of research, SGB holds promise for the future treatment of PTSD.

In the overwhelming realm of PTSD symptoms and treatments, there should be one constant: hope. Treatment is a tool. Between various types of psychotherapy, medications, and new and developing treatments, it can be overwhelming. Exploring options for treatment is the first step to feeling better. There is constant stigma and stereotypes surrounding PTSD and PTSD treatment, making it difficult to seek help. There needs to be more conversation about PTSD, connecting and making people aware of the resources they may need.

References

American Psychological Association (2017). PTSD Treatments. https://www.apa.org/ptsd-guideline/treatments/

Lynch, J. H., Mulvaney, S. W., Kim, E. H., de Leeuw, J. B., Schroeder, M. J., & Kane, S. F. (2016). Effect of stellate ganglion block on specific symptom clusters for treatment of post-traumatic stress disorder. Military Medicine, 181(9), 1135–1141. https://doi-org.proxy.library.stonybrook.edu/10.7205/MILMED-D-15-00518

National Health Service (2018). Selective Serotonin Reuptake Inhibitors (SSRIs). https://www.nhs.uk/conditions/ssri-antidepressants/

Philips, P.K. (2018). My Story of Survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd

Tull, M. (2020). How is PTSD Treated? Verywellmind. https://www.verywellmind.com/ptsd-treatment-2797659

U.S. Department of Veterans Affairs. (n.d.) Medications for PTSD. https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp

U.S. Department of Veterans Affairs. (n.d). PTSD Treatment Basics. https://www.ptsd.va.gov/understand_tx/tx_basics.asp

Whitaker, B. (2019). SGB: A Possible Breakthrough Treatment for PTSD. CBS. https://www.cbsnews.com/news/sgb-a-possible-breakthrough-treatment-for-ptsd-60-minutes-2019-06-16/

Categories
Post Traumatic Stress Disorder

Fighting Your Ancestors’ Battles: Intergenerational Trauma

Imagine being traumatized by something that didn’t even happen to you. That is the reality for an unknown number of people whose relatives have experienced trauma. A common misconception is that when a traumatizing event happens to someone, it only impacts the life of that individual. What is often not considered is how this trauma will impact their future children, grandchildren, and generations to come. The effects of trauma can last generations and can be transferred through genetics, verbal communication, and cultural norms of oppressed groups.

Leah Warshawski’s grandmother, Sonia, is a Holocaust survivor. Sonia witnessed her mother being taken to the gas chamber to die. Sonia herself was shot in the chest, but miraculously survived to see the end of the war, and her freedom from the concentration camp. Her devastating yet inspiring experience left her with more than just physical wounds. Sonia struggled to connect with her children, often being too judgemental and filled with anxiety at all times. Leah describes her childhood as generally happy, although something was always off as they never discussed their family’s history with the Holocaust. It wasn’t until her adult life that she began experiencing anxiety, a lack of connection with family members, and intense self-judgement. She began to experience symptoms similar to that of her grandmother’s. Digging a little deeper, she realized that what she was dealing with was trauma. However, this trauma was not her own. She was dealing with intergenerational trauma as a third generation Holocaust survivor.

Intergenerational trauma can exist in a variety of different forms and can be experienced by anyone whose family has gone through trauma. Often, intergenerational trauma is displayed by a higher rate of mental illness in the children of those who have experienced trauma. Those who experience intergenerational trauma tend to struggle with anxiety, depression, and PTSD. Many individuals living with these types of mental illness may not even know that the cause of their mental health issues is intergenerational trauma, as it can happen without them even knowing their ancestors experienced any kind of trauma. However, in some cases individuals that experience intergenerational trauma become fixated on specific trauma that a family member experienced. Sometimes they even relive it as though they experienced it themselves.

In many instances, intergenerational trauma is passed down verbally. For example, if a parent experienced trauma in a hospital, they may have a fear or distrust of doctors and pass this fear onto their child who later develops a similar fear of doctors. For a parent who grew up or lived in a stressful environment, it is in their nature to continue to live in “survival mode.” This then gets passed down to their children, who have learned these fears from their parents. Oftentimes, a parent believes they are doing their child good by protecting them from the trauma that causes them so much stress. However, their actions can lead a child to feel discomfort and anxiety surrounding similar triggers of their own, thus propagating the trauma in future generations.

Some studies have shown that in addition to verbal communication, intergenerational trauma can be passed down genetically. When a person experiences an extremely stressful or traumatic event, their genes and sex cells can be altered. One study from the University of California showed that children of Holocaust survivors had lower levels of methylation, a stress-receptor. This is not the result of a genetic mutation, but rather a specific expression of a gene similarly among the population of children whose parents experienced trauma. The lack of methylation could be the result of the body’s biological adaptation to being in a stressful environment. Other studies have shown that trauma can directly change the RNA of sperm and therefore the genes of the child. Additionally, studies have shown that trauma that occurs while a mother is pregnant can greatly impact the genetics of their unborn child. However, this science is still relatively new and hard to study. As a result very little is known about the genetic component to intergenerational trauma.

Communication and genetic patterns within a family are often perpetuated by large scale historical trauma. Historical trauma, such as slavery and genocide, has impacted families of color and other oppressed groups throughout the world. Historical trauma is similar to intergenerational trauma as it is trauma passed down from generation to generation. However, historical trauma exists on a much larger scale, often the entire populations and communities experience trauma and intergenerational trauma within their families. Historical trauma is particularly prominent within Blacks, Native Americans, and other minority groups who have experienced large-scale oppression and trauma. For better or worse, many of us carry the experiences of our ancestors within us. The events that have shaped them continue to shape us today.

References

Carey, Benedict (2018, December 8). Can We Really Inherit Trauma? The New York Times. https://www.nytimes.com/2018/12/10/health/mind-epigenetics-genes.html

Coyle, Sue (2017, May). Intergenerational Trauma- Legacies of Loss. Social Work Today. https://www.socialworktoday.com/archive/051214p18.shtml

DeAngelis, Tori. (2019, February). The Legacy of Trauma. American Psychological Association. https://www.apa.org/monitor/2019/02/legacy-trauma

TedX Talks [Username]. (2017, May 9) How do you cope with the trauma you didn’t experience? | Leah Warshawski | TEDxTwinFalls [Video]. YouTube. https://www.youtube.com/watch?v=OkAMHQhabkU

Categories
Trauma and Stressor Related Disorders

Beyond The Individual: A Look at Parents With PTSD

Loud noises. Crowded places. Feeling overwhelmed or like things are out of control. All of these things are associated with being a parent, but they can also be triggers for a person living with posttraumatic stress disorder (PTSD). Although raising a child is difficult on its own, the symptoms and emotions surrounding post-traumatic stress can make parenting a struggle. For a child, having a parent with PTSD can be confusing and stressful. With proper communication and treatment, the relationship between parent and child can grow without PTSD getting in the way.

The actions of children can trigger feelings of distress for parents with PTSD. Erin, a mother with PTSD, wondered how her mental illness would affect her ability to raise her two young boys. As a child, she experienced repeated sexual abuse by members of her family, leaving her with the emotional scars of PTSD. She felt constantly torn between her intense love for her children and her fear of her own emotions and how they would impact her children. She would often lock herself away to keep her negative emotions from permeating into the lives of her children. She described having feelings of depression, anger, and anxiety along with repeated nightmares: “PTSD is heartbreaking. Being a parent with PTSD is daunting. It’s heartbreaking because your past robs you and your family of the present and the happiness in it” (Bouvier, n.d.). Having children forced her to confront her past struggles and get help for her PTSD.

PTSD can be complicated and difficult to understand, especially for a child. Despite stigma and general uncomfortability, it is important for there to be open communication between parent and child. When considering opening up to a child about PTSD, it is important to consider the age of the child as well as their experience and prior understanding of the disorder. When a parent openly discusses their experience and symptoms of PTSD, a child may begin to feel relief. Oftentimes, the emotions and behaviors that result from a child triggering a parent can make a child feel guilty, upset, or even afraid. Openly acknowledging that the parent’s reaction to a trigger is not the child’s fault can put a child at ease. It is important to remember that talking about PTSD doesn’t always have to involve talking about the trauma that causes the stress, but instead focus on what the ongoing symptoms are and how that will impact parent and child going forward. The perspective and thoughts of the child during a conversation about PTSD are as important as the parent’s to be able to share their feelings towards the subject going forward.

Brooke, a mother and veteran with PTSD describes how her PTSD has changed the lives of her children. “I worried that I was passing down my combat experience like a mother passes down half of her DNA makeup. My children are different than they would have been if I, their caregiver, nurturer, and life giver, had not served in the Iraq War. Their lives have been shaped by my PTSD triggers and combat experience” (King, 2017).  In some cases, her fears were mirrored in her children in the form of nightmares and general discomfort towards the thing that would trigger her PTSD. In order to keep her children from triggering her, Brooke has a series of rules, including being silent while she is driving, not playing war, and avoiding any discussion of death. In the case of Brooke and her two sons, open conversation and clear guidelines regarding potential triggers for Brooke’s PTSD was a helpful tool.

Having PTSD affects the whole family, not just an individual. The parenting style of an individual with PTSD can differ greatly from a parent without. Parents with PTSD may struggle with anxiety, especially when it comes to allowing their children to gain independence and do things on their own as they grow older, often making the child feel suffocated. In calm moments, it is important for the parent to establish important, rational ground rules. To help differentiate between being a concerned parent and PTSD anxieties, it can be helpful for a parent to get a second opinion in the form of a mental health professional, spouse, or another person of support. There are a number of online forums and support groups for parents with PTSD. Discussion and mindfulness in parenting with PTSD is crucial to avoid passing on trauma. Most of all, it is important for trauma survivors to find a balance between parenting and PTSD symptoms.

The impact of having a parent with PTSD can be traumatizing, strengthening, educational, or all of the above. According to a systematic review of the research and data on children whose parents have PTSD, one of the most common feelings experienced by children who had a parent with PTSD was having to be extremely cautious around them. Although having to exercise caution around a parent may not be traumatic or even negative, it can put stress on the relationship between parent and child. In some cases however, feelings of caution lead to feelings of fear towards the actions of the parent (McGaw, 2019). Additionally, children of parents with PTSD often struggle with feelings of guilt, as though they are the reason for the actions caused by their parents PTSD. The impact a parent’s actions can lead to harmful misconceptions, and that is why open communication and discussion are crucial (McGaw, 2019).

Witnessing a parent experience post-traumatic stress can be stressful and scary for a child. In some cases, children who have parents with PTSD can inherit or take on some of the fears associated with their parent’s PTSD.  For example, one daughter of a father with PTSD experienced issues trusting other people because her father also had the same issues (McGaw, 2019). Witnessing a parent experience extreme distress caused by PTSD can cause a child to be traumatized or develop fears of their parents triggers (McGaw, 2019). Children of parents with untreated PTSD can be withdrawn, aggressive, have issues concentrating, anxiety, and depression.

Oftentimes, it is the stigma surrounding PTSD that causes the most difficulty. It is often believed that people with PTSD, or mental illness in general, can’t be good parents. Stigma can cause a parent to doubt themselves and their own skills and ability to raise their children. There is not one single parent-child relationship, each relationship is different. People with PTSD are perfectly capable of raising happy children, they just have to communicate and know when to reach out for help.

References

Bouvier, E. (n.d.) Mommy’s Hidden Monster: Parenting With PTSD. Her View From Home. https://herviewfromhome.com/mommys-hidden-monster-parenting-with-ptsd/

Brico, E. (2017). Why Kids Trigger Parents with PTSD and What to Do About It. HealthyPlace. https://www.healthyplace.com/blogs/traumaptsdblog/2017/11/kids-trigger-ptsd

King, B. (2017). A Veteran Wonders: How Will My PTSD Affect My Kids? The Atlantic. https://www.theatlantic.com/health/archive/2017/11/a-vet-wonders-how-will-my-ptsd-affect-my-kids/547034/

McGaw, V. E., Reupert, A. E., & Maybery, D. (2019). Military Posttraumatic Stress Disorder: A Qualitative Systematic Review of the Experience of Families, Parents and Children. Journal of Child & Family Studies, 28(11), 2942–2952. https://doi-org.proxy.library.stonybrook.edu/10.1007/s10826-019-01469-7

The Oaks at La Palma. (n.d.) How a Parent’s PTSD Affects Children. https://theoakstreatment.com/ptsd/how-a-parents-ptsd-affects-children/

Powell, T. (2019). Parenting While Living with Complex PTSD. HealthyPlace. https://www.healthyplace.com/blogs/traumaptsdblog/2019/3/parenting-while-living-with-complex-ptsd

Sherman, M.D., Straits-Troster, K., Larsen, J., Gress-Smith, J. (2015). A Veteran’s Guide to Talking About PTSD With Kids. South Central Mental Illness Research, Educational, and Clinical Center. https://www.mirecc.va.gov/VISN16/docs/Talking_with_Kids_about_PTSD.pdf

Categories
Bipolar Disorder

It’s All in the Genes: Increased Creativity and Bipolar Disorder

Winston Churchill, Nietchze, Mariah Carey, Vincent Van Gogh, and Kurt Cobain. What do they all have in common? Although they may have lived in different times, and done different things with their lives, they all made a lasting impact. They all had strong, talented, and creative minds able to make a large and lasting impact. While creativity is one thing that connects them, bipolar disorder is another. For years, scientists have been studying a possible connection between bipolar disorder and higher creativity. Although bipolar disorder, as well as other mental illnesses, are often viewed in a negative light, the people who have them shouldn’t necessarily be portrayed the same way. People who have bipolar disorder are more than their diagnosis, they are their impact.

Over the years, it has been speculated that there is a correlation between bipolar disorder and increased creativity, due to the high number of people with bipolar disorder who have made creative advances. Studies have found that there is a correlation between bipolar disorder and high creativity, but the question is why. Some speculated that the intense emotions associated with bipolar disorder resulted in this increased creativity, but in recent years, it has been found that there is a significant genetic component as well. Those who are predisposed to bipolar disorder are more likely to exhibit creative features. Creativity and bipolar disorder are determined by our DNA. These changes in DNA for people with bipolar disorder display themselves in many ways, including the way the brain is structured. Brain scans of people with bipolar disorder show that they have “diminished frontal regulation of subcortical affective systems involving the amygdala and striatum, which may increase their affective instability as well as their compulsiveness” (Collingwood, 2018). This specific brain structure allows for many of the boundaries in a “typical” brain to not exist in the brain of a person with bipolar disorder. Researchers have found that creative individuals are up to 25% more likely than non-creative people to carry genes that are associated with bipolar disorder. Studies have shown that in relatives of people with bipolar disorder who do not share the same diagnosis, this same creativity is often still passed on. This proves that although creativity and bipolar disorder might not be always be necessarily connected, they are associated genetically.

The creativity exhibited by people with bipolar disorder can exist in a variety of different forms. One study found that children with higher IQ’s were more likely to exhibit the manic symptoms of bipolar disorder later in life. In using IQ as a test of intelligence, people with bipolar disorder or who exhibit bipolar features are essentially smarter than those who do not have bipolar disorder or features. Another study found that those who have higher than average grades in high school were four times more likely to develop bipolar disorder than those who had average grades. One study looking at business people found that those who had symptoms of bipolar disorder were more likely to be successful entrepreneurs. Overall, it seems that some of the world’s smartest and greatest minds have bipolar disorder. Many people who have high creativity, such as those that work and participate in creative fields, may carry genes associated with bipolar disorder, even if they are not aware of it. Fields and talents such as acting, music, and dancing are more likely to have people with bipolar disorder or bipolar features. One study found that poets are 30% more likely to have bipolar disorder in comparison to the rest of the population.

The intense emotions associated with bipolar disorder can trigger episodes of creativity. Periods of hypomania and mania are associated with high energy, irritability, and outgoing mood. Particularly, the high energy of hypomania can bring on creative episodes. Many artists and other creative individuals describe their episodes of hypomania and mania as their most creative times. Hypomania in particular is associated with heightened periods of creativity, cognitive thinking, and mental speed. Andrew, a rapper with bipolar disorder, says that although he can write new lyrics when he is depressed or stable, he is able to write faster while experiencing hypomania. When experiencing a hypomanic episode, a person might feel inclined to create, whether it be for a reason, or simply just for a release. The feelings of mania and hypomania can easily become overwhelming for the person experiencing them. Engaging in creative activities can relieve some of the pent up energy associated with hypomania and mania. Even for people without bipolar disorder, engaging in creative arts can be therapeutic. It is important to note that sometimes mania in particular can be so intense that it actually inhibits creativity. This is where treatment can help stabilize a lot of the intense emotions experienced by people with bipolar disorder.

When considering the relationship between bipolar disorder and high levels of creativity it is important to remember a few things. Not everyone who has bipolar disorder experiences increased creativity or enjoys engaging in creative tasks. Additionally, the struggles of bipolar disorder still exist even if the people who have it are able to create beautiful art. Mental illness is not something that should be romanticized. That being said, the association of high creativity and bipolar disorder just shows that people with mental illness are so much more than a label.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Cirino, E. (2018) Bipolar Disorder and Creativity. Retrieved from https://www.healthline.com/health/bipolar-disorder/famous-creative-people

Collingwood, J. (2018) The Link Between Bipolar Disorder and Creativity. Retrieved from https://psychcentral.com/lib/the-link-between-bipolar-disorder-and-creativity/

Jackel, D. (2019) The Truth About The Connection Between Bipolar Mania and Creativity. Retrieved from https://www.bphope.com/bipolar-mania-creativity/

Categories
Bipolar Disorder

A Barrier of Parental Love: The Relationships of Parents With Bipolar Disorder

Just as bipolar disorder is unique to each individual that experiences it, the relationships to those with bipolar disorder are unique as well. For a child, being raised by a parent with bipolar disorder can be stressful, confusing and sometimes traumatic. For parents with bipolar disorder, raising children can be exhausting, intimidating, and shameful. Familial relationships are complicated as it is; the ups and downs of bipolar disorder can make matters more complex and difficult for everyone involved. Self-care and open discussion are crucial for those impacted by bipolar disorder in families.

Being raised by a parent struggling with bipolar disorder can be extremely difficult. The experience of a child being raised by a parent with this disorder can vary. Some children may never even know that their parent has a mental illness, while for others it is very apparent. It all depends on how the parent is coping with the disorder. If left undiagnosed or untreated, the actions of parents with bipolar disorder can have lasting impacts on their children because of the inner turmoil they’re experiencing. Seeing a parent go through the roller coaster ride that is bipolar disorder can be extremely confusing for a child. Some children, like Satya, try to bury and avoid the struggles of growing up with a parent suffering from this disorder. When Satya was young, she recalls running to her room and hiding during her father’s intense manic episodes. Similarly, she would simply avoid her father during his episodes of depression. Other children try to help and confront the struggles head on. Michelle took an active role in trying to help her mother who struggled with bipolar disorder. She would stay home from school when her mother was too depressed to leave bed. Having such a large responsibility and stress at a young age had a great impact on her going forward. The issues that can arise from being raised by a parent struggling with bipolar disorder can be lifelong. Children of parents with bipolar disorder are more likely to attempt suicide, abuse substances, engage in risky sexual behavior, and behave aggressively. Additionally, children may have issues establishing relationships, experience financial stress, and experience severe emotional distress. Many of these symptoms are linked to trauma from childhood. This trauma can happen from abuse and negative environments brought on by a parent with bipolar disorder. The experience of a child growing up with a parent who has bipolar disorder can be quite contradictory. Satya recalls the confusion she experienced as a child, “Despite the love my father had for me, he would mimic a school bully at times, as if an impersonator devoid of compassion took his place” (Khare, 2016). Although a parent may deeply love their child, bipolar disorder can change the way they behave and raise their child. Looking beyond the diagnosis and struggles of bipolar disorder is extremely important for children to do once they grow old enough to understand. Bipolar disorder can be a boundary between a parent’s love and their child.

There is this idea that just because a parent has a mental illness, their child automatically has a mental illness as well. Not only is this false, but it can also be harmful to both the child and parent. Being raised or born by a person with bipolar disorder does not specifically indicate that the offspring will have the same disorder. However, there is a genetic component to bipolar disorder. A child who has one parent diagnosed with bipolar disorder has between a 15% and 30% likelihood of being diagnosed. A child who has two parents with bipolar disorder has between a 50% and 75% chance of being diagnosed. Although bipolar disorder is fairly hereditary, there can be other causes as well, including brain structure and environmental factors. When raising a child with a strong connection to bipolar disorder, it is a good idea to complete a screening to recognize the disorder earlier. Bipolar disorder has a high hereditary component so it is important to share family history with a doctor, as the diagnosis often comes sooner and easier.

Parenting with bipolar disorder can be very difficult. The fatigue and lack of motivation associated with depressive episodes can make it hard to do anything, especially care for a child. The presence of intense, high energy manic episodes can make it difficult for a middle schooler to concentrate on his work at home. Growing up with a parent who has bipolar disorder can be difficult for a child to understand. Having open conversations about bipolar disorder between the parent and child can be extremely beneficial regarding the child’s understanding of his or her parent’s actions or feelings. Establishing that the parent is mentally ill and not acting or feeling a certain way because they want to or because they don’t love the child is crucial. Children have a lot of questions and so communication is very important. The best way to keep bipolar disorder from getting in the way of a relationship is to seek treatment. Similar to any other illness, alleviating symptoms can make things better for everyone involved. People with bipolar disorder can be amazing parents, they just have to treat their symptoms. Having a child is a strong motivation to stick with treatment and try to establish a better quality of life. Lynn, a mother of a 12 year old boy, began struggling with bipolar disorder shortly after having her son. She describes having extremely intense episodes and being unable to control her actions. She struggled for years to find the right treatment for her. Once she did, she was able to establish a better relationship with her son. “Since 2012, I have had no issues with my disorder interfering with my ability to be a great parent. The key to being a great parent is to make sure you’re healthy first. Make sure you take your medication regularly and as prescribed, get plenty of sleep, eat healthy, and try to exercise” (Ulrich, 2016). When you’re healthy, your relationships will be healthy, especially relationships with your children. Importantly, parents with bipolar disorder need to be able to trust in themselves that they are capable and doing a good job. It is important to recognize that people with bipolar disorder are not automatically putting the child in a negative situation, simply by making the decision to have children knowing of their disorder.

Reaching out and getting help is important. It is important not only for the person who has the disorder, but for their family and friends who have been impacted as well. Getting help can manifest itself in many different ways including going to therapy, talking to a friend, or talking things through with family members. Michelle struggled to heal from her childhood trauma, which was living with her mother who suffered from bipolar disorder. She has overcome the difficulties of her upbringing and recognizes the importance of getting help and talking about the issue. “There’s been too much silence around this issue, too much hush-hush, too much stigma. I want to cause conversations to happen, so people realize that having a mental illness is just like having heart disease or any other health condition—it’s not anything to be ashamed of. The more we talk about it, the more people will get the help they need for loved ones or themselves” (Dickinson-Moravek, n.d.). Overall, good communication and treatment would strongly benefit any family that has a parent with bipolar disorder.

 

References

Amatenstein, S. (2019). I Have a Parent With Bipolar Disorder and It’s Ruining My Life. Retrieved from https://www.psycom.net/bipolar-disorder-parent

American Psychiatric Association. (2013). Bipolar and Related Disorders.. In Diagnostic and statistical manual of mental disorders (5th ed.). https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm03

Dickinson-Moravek, M. (n.d.) Growing Up With a Parent Experiencing Bipolar Disorder. Retrieved from https://www.nami.org/Personal-Stories/Growing-Up-with-a-Parent-Experiencing-Bipolar-Diso

Duggal, N. (2018). Is Bipolar Disorder Hereditary? Retrieved from https://www.healthline.com/health/is-bipolar-disorder-hereditary

Gibbons-Gwynn, M. (2011). Parenting With Bipolar Disorder. Retrieved from https://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-and-parenting.aspx

Khare, S.R. (2016). Bipolar Disorder: A Daughter’s Experience. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394376/

Pointer K. (2018). What Does It Mean To Have a Parent With Bipolar Disorder? Retrieved from https://www.healthline.com/health/bipolar-disorder/how-to-deal-with-a-bipolar-parent

Purse, M. (2019). The Chances of Having Hereditary Bipolar Disorder. Retrieved from https://www.verywellmind.com/will-my-child-inherit-my-bipolar-disorder-380477

Ulrich, L. (2016). Parenting With Bipolar. Retrieved from https://ibpf.org/blog/parenting-bipolar

When a Parent Has Bipolar Disorder (2019). Retrieved from https://www.camh.ca/en/health-info/guides-and-publications/when-a-parent-has-bipolar-disorder

Categories
Bipolar Disorder

Dating With Bipolar Disorder

When dating anyone it is important to see that person for who they are, not for their label. The drastic ups and downs of having bipolar disorder can make maintaining a relationship difficult. Perhaps the largest obstacle to conquer is the stigma surrounding the disorder. Although dating someone with bipolar disorder can be intimidating and difficult at times, it is important to consider the person for who they are, not their diagnosis. There is hope for those struggling with bipolar disorder to find love.

Twenty-eight year old mental health advocate Hannah Blum has openly discussed her struggle with dating as a woman with bipolar disorder. Her main issue with dating in the past was not the struggles of the disorder itself, but rather the stigma surrounding dating someone with bipolar disorder. Finding someone who is willing to look past her diagnosis can be wearisome. Hannah views her bipolar disorder as a way to eliminate anyone who wouldn’t make a potentially good partner. “Bipolar disorder does the dirty work for me and filters out individuals who tiptoe through life. The fact is, we all have issues, whether you live with bipolar disorder or not. And if someone won’t give you a chance because of a label, consider yourself lucky” (Blum, 2019). She looks at anyone who generalizes or makes assumptions about her based on the mere fact that she has bipolar disorder, as not worth her time anyway. Anyone who doesn’t want to be with someone based on a diagnosis, without truly getting to know them is not going to be a decent person to date anyway. As a result of her mindset, she recognizes the importance of disclosing the fact that she has bipolar disorder fairly early on in a relationship. However, she also recognizes the importance of allowing the person to get to know her a bit before sharing that fact about herself because everyone has assumptions. By waiting a bit to share that aspect of her identity, she is able to allow the person to get to know her before they know her diagnosis.

For those struggling with bipolar disorder, or any other mental illness, having the support of a relationship can be helpful. Studies show the importance of being in a positive and healthy relationship for those with bipolar disorder. While generally being in a relationship does not alleviate the symptoms of the disorder, being in a healthy, mutual, quality relationship can help a person living with bipolar disorder (Dunne, 2019). As with any relationship, having a partner who is understanding and supportive is crucial. The concern around dating while having bipolar disorder is that the stress of a relationship will cause more harm than good. However, most of those close to people who have bipolar disorder agree that a relationship would be beneficial to them, even for people who struggle with severe bipolar disorder (Purse, 2019). The idea that those with mental illness are incapable of loving or maintaining a relationship is simply false.

Entering a relationship with someone who has bipolar disorder can be a difficult and daunting situation. When entering any relationship it is important to understand different aspects of your partner. In order to have a successful relationship with someone that has bipolar disorder, it is crucial to understand the disorder itself, as it is a part of them. Although a partner who is not bipolar themselves cannot truly understand the extent of what it is like to be bipolar, they can try to sympathize with their partner. In order to do this, it is important for the partner to understand the effect bipolar disorder can have on someone. The extreme ups and downs of bipolar disorder can be difficult for someone on the outside to handle. Another important factor when considering dating someone who has bipolar disorder is self care. Being in any relationship can be difficult, but dating someone with a significant mental illness such as bipolar disorder can be extremely stressful and difficult. When dating someone with bipolar disorder, taking care of yourself needs to be a priority over taking care of your partner. Mary is married to a man with bipolar disorder. She recognizes that the positive attributes of her husband and her love for him far outweigh the struggles he has due to his bipolar disorder. She states that the social pressure and judgement that she faces from being in a relationship with an individual with this disorder far outweighs the struggles they have internally within their relationship. She advises to recognize the difference between the person and the disorder they are dealing with as “…the physical body is a slave to nerve endings and neurons and blood chemicals. The spirit, however, is completely separate” (J, 2018). All in all, a mental illness doesn’t make it impossible to date and should not stand in the way of a relationship because, when a healthy relationship is established, it can have a positive effect on the individual with bipolar disorder.

References

Blum, Hannah. (2019). Gaslighted By My Boyfriend: What Dating With Bipolar Disorder Really Feels Like. Retrieved from https://www.psycom.net/what-dating-with-bipolar-really-feels-like/

Dunne, L., Perich, T., & Meade, T. (2019). The relationship between social support and personal recovery in bipolar disorder. Psychiatric Rehabilitation Journal, 42(1), 100–103. https://doi-org.proxy.library.stonybrook.edu/10.1037/prj0000319

J, M. The Love of My Life Has Bipolar Disorder. Retrieved from https://psychcentral.com/lib/the-love-of-my-life-has-bipolar-disorder/

Kumar, P., Sharma, N., Ghai, S., & Grover, S. (2019). Perception about marriage among caregivers of patients with schizophrenia and bipolar disorder. Indian Journal of Psychological Medicine, 41(5), 440–447. https://doi-org.proxy.library.stonybrook.edu/10.4103/IJPSYM.IJPSYM_18_19

Purse, M. (2019). Dating Someone With Bipolar Disorder. Retrieved from https://www.verywellmind.com/love-roses-and-real-support-380584

Categories
Bipolar Disorder

Mixed Features: The Fight Between Emotions

Imagine being happy, yet sad at the same time. Overjoyed but devastated. Arrogant and insecure. Having a bipolar episode with mixed features is like simultaneously experiencing opposing emotions. Emma, a 20 year old with bipolar II, describes her bipolar episodes with mixed features as confusing. “‘How can you be manic and depressed at the same time? [It feels like] your brain isn’t equipped to handle that,”’(Andriakos, 2018). Bipolar disorder is often thought of as a cycling between episodes of mania and depression. Although periods of mania and depression are what determine bipolar disorder, they are not always experienced separately. For many people, the periods of mania or depression are not so clear-cut, there can be overlap. It can be hard to understand how two feelings that are complete opposites could potentially intersect and cause such distress, especially for the person experiencing it. 

Prior to 2013, bipolar episodes that had features of the opposing episode were referred to as a mixed episode. With the release of the DSM-V, the term “mixed episode” was replaced with a specifier of “mixed features.” The specifier is used to include the symptoms of the mixed features into the diagnosis of the episode. Before the change to the term mixed features, it was much more difficult to diagnose impure bipolar episodes. In addition, the change in terminology from mixed episode to mixed features allows more people to get an accurate and specific diagnosis. In order to diagnose a mixed episode, the entire criteria for both mania/hypomania and depression would need to be met. Although this happens for some people, in most cases only a few symptoms from the non-dominant emotion are expressed. In a bipolar episode with mixed features however, the criteria for the primary episode, manic or depressive, is met along with at least three symptoms of the opposing episode. Experiencing a bipolar episode with mixed features can be extremely challenging to understand and manage because the emotions are fighting with each other to be experienced and expressed. 

In a manic or hypomanic episode with mixed features, the full criteria for mania or hypomania are met. This includes elevated mood, irritability, and inflated self-esteem. In addition to manic symptoms there are symptoms of depression like depressed mood, disinterest, and feelings of hopelessness. Manic episodes with depressive features in particular can be extremely alarming and dangerous leaving individuals “feeling helpless and miserable and they have the energy to act on that” (Andriakos, 2018). In depressive episodes with mixed features, there is a similar protocol for diagnosis. The full criteria for a depressive episode must be met, with at least three features of mania or hypomania. The feelings of depression can be so intense, that hypomania can be a relieving break from intense depression. Joey describes his experience with mixed depressive episodes as “a relief.” While experiencing hypomania during a depressive episode, he is able to get a moment of clarity. 

Treating people who have bipolar episodes with mixed features is a complicated and difficult process. Up to 34% of people diagnosed with bipolar disorder experience episodes with mixed features. Each of these people experience it differently, and require personalized treatment. Sometimes the feelings they are experiencing simultaneously can be direct opposites of one another. Other times, the opposing moods can happen back to back in rapid succession. Joey, who experiences bipolar episodes with mixed features, describes them as having one emotion driving the other in a chaotic and debilitating way. Gracie, who also experiences mixed episodes, describes them more like intense and confusing mood swings without much reason. The differences in individual experiences makes bipolar disorder with mixed features difficult to treat. Additionally, while one treatment may improve one portion of the symptoms, it may exacerbate other symptoms, making them worse. For example, taking a typical antidepressant (like a selective serotonin uptake inhibitor), can improve feelings of sadness and depression but make manic symptoms worse. Oftentimes more than one form of treatment is needed for people that experience bipolar episodes with mixed features, like a mood stabilizer in addition to an antidepressant. There is currently limited knowledge regarding bipolar episodes with mixed features, particularly surrounding why mixed features happen to some people and not others. This makes bipolar episodes with mixed features harder to treat and for people experiencing it to understand what is going on. 

In addition to having bipolar disorder, having episodes with mixed features is a challenging additional issue being faced by people with bipolar disorder. It can make things more confusing and complicated to understand. By improving awareness and knowledge of bipolar episodes with mixed features, there is hope for better experiences for those struggling with it. 

 

References 

American Psychiatric Association. (2013). Bipolar and Related Disorders. in Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Retrieved from https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm03#x38498.2610324

Andriakos, J. (2018). This Is What a Mixed Episode Feels Like. Retrieved from https://www.self.com/story/mixed-bipolar-episodes

Hu, J., Mansur, R., & McIntyre, M.S. (2014). Mixed Specifier for Bipolar Mania and Depression: Highlights of DSM-5Changes and Implications for Diagnosis and Treatment in Primary Care. The Primary Care Companion For CNS Disorders, Volume 16 (2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116292/

McIntyre, R.S., Soczynska J.K., Cha D.S., Woldeyohannes H.O., Dale R.S., Alsuwaidan M.T., . . . Kennedy S.H.. (2015) The prevalence and illness characteristics of DSM-5-defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project. Journal of Affective Disorders, Volume 172 Pages 259-264. Retrieved from https://www.sciencedirect.com/science/article/pii/S0165032714005801

Muneer, A.. (2017). Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment. Chonnam Medical Journal. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125/

Categories
Bipolar Disorder

Beyond Mania and Depression: The Bipolar Spectrum

When we go to a doctor, we expect a diagnosis. We expect expertise. We expect them to recognize our symptoms and diagnose us accurately. We expect proper treatment based on the diagnosis we receive. What we do not expect, is an incomplete diagnosis. When it comes to mental illness, going to the doctor for help can be difficult. To go through the whole process of accepting that you need help, and then reaching out, is extremely difficult. When the doctor’s appointment that was supposed to provide relief to the endless questions you have about yourself ends with an inconclusive diagnosis, it can be extremely confusing, and discouraging.

 

For people diagnosed with bipolar disorder–not otherwise specified (BP–NOS), the feelings of uncertainty and confusion can be significant. Bipolar disorder itself exists on a complex spectrum. Bipolar disorder is generally described as “periodic changes in mood, alternating between periods of elevated mood (mania or hypomania) and periods of depression” (Cagliostro, 2019). This disorder has many different symptoms ranging from near-total mania to depression with infrequent episodes of hypomania. The current definition of BP–NOS is quite broad, including any disorders that have “bipolar features.” The criteria for BP-NOS includes distinct periods of abnormally elevated or irritable mood that lasts a significant part of the day or more, at least two manic symptoms associated with bipolar disorder, and a change in functioning. Oftentimes, BP-NOS is described as having the same symptoms as bipolar disorder, just not as severe. Hearingthis can be disheartening, especially when the symptoms can be debilitating for the person experiencing them. 

 

The symptoms and treatments of bipolar disorder, and specifically BP-NOS, can be completely different from person to person. One person with BP-NOS can be experiencing the exact opposite of what someone else diagnosed with the same disorder is experiencing. Because of this, it is hard to come up with a uniform criteria to diagnose it. Without the proper diagnosis, people cannot begin to receive the proper treatment. As a result, many people who have BP-NOS are not diagnosed and do not receive proper treatment. Currently around 4% of the population is diagnosed with some form of bipolar disorder. It is estimated that an additional 2% of the population could be suffering from bipolar disorder undiagnosed (Bader and Dunner, 2007). Up to 155 million people could have a form of bipolar disorder and not even know it, bringing the total number of people with bipolar disorder to an estimated 450 million (Bader and Dunner, 2007). 

 

Bipolar I and II are described as “the main types of bipolar disorder,” when in reality, they are the more extreme cases, while the spectrum is much larger. By including people with BP-NOS in the statistics as part of the number of people struggling with this disorder, more attention and awareness can be brought to this issue. Although this disorder impacts so many people, there is still a stigma surrounding bipolar disorder and a general lack of knowledge about it. Despite the variety of symptoms people with this disorder experience, there is still only four official types of bipolar disorder and corresponding treatment plans. There is not much known about the bipolar spectrum, even by the medical community and mental health professionals. 

 

Oftentimes when people struggling with BP-NOS receive a diagnosis, it is not for bipolar disorder at all, but for depression (Ozcan, Sheikh, and Suppes, 2003). This is because many people fail to report or don’t experience manic or hypomanic symptoms right away. Getting the wrong diagnosis can be dangerous and have strong negative effects on the person because treatment for depression is different from the treatment for bipolar disorder. Bipolar disorder is serious, and often requires serious treatment. Recent studies have shown 17% of people diagnosed with BP-NOS have attempted suicide (Bader and Dunner, 2007). Although it is commonly regarded as less severe than other forms of mental illness, BP-NOS can be devastating for an individual. 

 

Many of those diagnosed with BP-NOS, are children. The diagnosis is often given to children just beginning to show symptoms of bipolar disorder. A third of children between the ages of eight and twelve with BP-NOS are later diagnosed with bipolar I or II (Martinez and Fristad, 2012). With the consideration of family history, the diagnosis and proper treatment for bipolar disorder tends to come earlier (Bader and Dunner, 2007). The family’s medical history often confirms the diagnosis of BP-NOS as opposed to depression (Martinez and Fristad, 2012). In the case of BP-NOS in children, the earlier the diagnosis, the better. With an earlier diagnosis, treatment can be implemented earlier and ise more effective. Learning to cope with the symptoms of mental illness and establishing a routine and treatment plan earlier, can change the course of a person’s life. 

 

For Sabrina, a 34 year old living with BP-NOS, receiving treatment helps to establish her version of “normal” and “have a better handle on her emotions.” Prior to taking effective medication, she experienced unpredictable moods and felt as though she had access to every possible emotion. Although she still experiences many of the struggles of having BP-NOS, she is doing better due to medication. She often feels alone in her struggle with bipolar disorder, and doesn’t have many friends or family. Sabrina is an example of how bipolar disorder can manifest itself in many different ways depending on the individual and how the proper treatment can help alleviate some of the symptoms associated with the disorder. 

 

Each and every kind of bipolar disorder is impactful and deserves appropriate awareness. The effects of bipolar disorder stem beyond just mania and depression, but truly impact each individual differently. Sabrina is an example of why we need to listen to the individuals struggling with all forms of bipolar disorder, as they all need the proper attention. Sabrina says she wants “‘people to know that bipolar isn’t as ‘big’ as it appears on TV. Manic episodes don’t necessarily mean hopping around the house or harassing people or going ‘crazy.’ And depression associated with bipolar doesn’t necessarily manifest as sadness. For many people, myself included, it’s an unrelenting and insidious apathy.’” (Miller, 2017). 

 

References

Bader, C. D., & Dunner, D. L. (2007). Bipolar disorder not otherwise specified in relation to the bipolar spectrum. Bipolar Disorders, 9(8), 860–867. Retrieved from http://search.ebscohost.com.proxy.library.stonybrook.edu/login.aspx?direct=true&db=mnh&AN=18076535&site=ehost-live&scope=site

Cagliostro, D. (2019) Bipolar Disorder. Retrieved from https://www.psycom.net/depression.central.bipolar.html

Gregory, C. (2019) Bipolar Spectrum Disorder. Retrieved from https://www.psycom.net/depression.central.lieber.html

Martinez, M., & Fristad, M.A. (2012) Conversion from bipolar disorder not otherwise specified (BP-NOS) to bipolar I or II in youth with family history as a predictor of conversion. Journal of Affective Disorders, Volume 148, Issue 2, Pages 431-434. Retrieved from http://resolver.ebscohost.com.proxy.library.stonybrook.edu/openurl?sid=EBSCO%3arzh&genre=article&issn=01650327&ISBN=&volume=148&issue=2%2f3&date=20130601&spage=431&pages=431-434&title=Journal+of+Affective+Disorders&atitle=Conversion+from+bipolar+disorder+not+otherwise+specified+(BP-NOS)+to+bipolar+I+or+II+in+youth+with+family+history+as+a+predictor+of+conversion.&aulast=Martinez%2c+Molly+S&id=DOI%3a10.1016%2fj.jad.2012.06.018&site=ftf-live

Miller, T. (2017) This is What It’s Actually Like to Live With Bipolar Disorder. Retrieved from https://www.self.com/story/this-is-what-its-actually-like-to-live-with-bipolar-disorder

Towbin, K., Axelson D., Leibenluft E., & Birmaher B. (2014) Differentiating Bipolar Disorder-Not Otherwise Specified and Severe Mood Disregulation. Journal of The American Academy of Child and Adolescent Psychiatry, Volume 52 Issue 5. 466-48. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697010/#R8

Ozcan, M. E., Shiekh, M., & Suppes, T. (2003). How rare is bipolar disorder not otherwise specified? Bipolar Disorders, 5(3), 226–227. Retrieved from http://search.ebscohost.com.proxy.library.stonybrook.edu/login.aspx?direct=true&db=mnh&AN=12780876&site=ehost-live&scope=site