Bipolar Disorder – Emphasis on Depression. Diagnosis of BPD

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This is a discussion on Bipolar Disorder – Emphasis on Depression within the General Mental Health forums, part of the Mental Health category; I have been recently diagnosed with Bipolar II. After months of fighting off depression and a few more …

Bipolar Disorder

I have been recently diagnosed with Bipolar II. After months of fighting off depression and a few more symptoms, I recently started to experience some slight mood swings (mood swings from manic to depressed).

Last week, I had one of these “mood swings” which led me to call the doctor, and during the process, I experienced mild symptoms of my “mood swings” (I was manic for about a day). I think that this is one of the times when the symptoms of depression can be more intense than the symptoms of mania, but this didn’t show up until now.

During the past year, I have been fighting the symptoms of depression. My mother, who suffers from depression, constantly tells me that I should treat the depression because, by treating the depression, I will also eventually be able to cure the Bipolar II. I do find that it helps if I take medication, but I was told that medication doesn’t cure depression, but only quells it and also makes it much easier to control.

My question is: is it better for me to keep fighting off the depression, or should I let go of all my past failures and learn to live with the depression (treating it, not hiding it)?

Has anyone out there been diagnosed with Bipolar II? If so, what was the cause of your depression? How long did it take for you to fully recover from it?

I am currently having symptoms of hypomania which also manifests as depression. Last year i had an episode where i was suffering from mild depression (i felt like being a burden on my mom). I would always sleep and felt like i was not living a good life.

The prevalence of bipolar disorder (BPR) during life is 4.5%. This disease is associated with premature death and is one of the leading causes of disability in the developed countries of the world among people aged 15 – 44 years. Thus, the level of completed suicides is about 5% among persons who have never been treated in the hospital, and 25% in patients in the early stages of the disease. BDP is often associated with other conditions, in most cases, anxiety disorders and substance abuse. The M.D. Mark A.Frye article, published in the New England Journal of Medicine (2011; 364 (1): 51 – 59), discusses various approaches to the management of BDP, and also provides a brief overview of the official guidelines.

BPR is characterized by high morbidity and mortality. It is characterized by recurrent episodes of mania or hypomania and depression.

A more pronounced increase in mood and disability associated with it distinguishes mania in patients with BPR I (characterized by psychosis, the need for emergency care or hospitalization, a marked deterioration in mental state) from hypomania with BPR II. Unlike patients with mania, those with hypomania rarely seek medical help, except when the diagnosis of BPD is already established and the patient is concerned about the progression of the disease (for example, the occurrence of an episode of mania). While the old term “manic-depressive psychosis” implied the presence of a depressive episode after each episode of mania, many patients had one or more episodes of depression before the first episode of mania (or hypomania), after the occurrence of which the diagnosis of BPD was established. The diagnostic criteria for a depressive episode with BPD are the same as for unipolar depressive disorder.

Despite the fact that the severity of mania is obvious, disability associated with BPD occurs more often in the depressive phase. According to one study, significantly more working days per year were lost by patients with BPD than with unipolar depression (Kessler et al., 2006). The difference was primarily due to recurrent depression, not mania. Episodes and subclinical symptoms of depression usually last longer than episodes and subclinical symptoms of mania. The National Institute of Mental Health conducted a depression study in people with BPD I that was observed for more than 12 years, and the symptoms were almost 50% of the time. Symptoms of depression were observed during one third of the entire period of the disease, symptoms of mania – 10%, mixed symptoms – about 6%. Subclinical symptoms of depression are also associated with functional disability and subsequent relapse of depression.

Diagnostic criteria for depressive disorder *

1. The episode lasts at least 2 weeks, during which 5 or more symptoms are noted (at least one of the symptoms should be decreased mood, loss of interest or pleasure from almost any activity).

2. Changes in appetite or decrease/increase in body weight, insomnia or hypersomnia, psychomotor agitation or lethargy are observed; reduced energy levels; self-worthlessness or guilt; difficulties of mental activity, reduced concentration of attention or difficulty in making decisions; recurring thoughts of death, planning suicide or his attempts.

3. Symptoms are new or more severe than before the depressive episode, most of the time, almost every day, for at least 2 weeks in a row.

4. The episode is accompanied by clinically significant distress or deterioration of social, professional functioning or functioning in another important area of ​​life.

5. Symptoms are not the result of severe loss (death of relatives) or the mental effect of drugs, somatic illness, or the consequence of substance abuse.

Note: * – when depressed, a person’s mood is described as depressed, sad, hopeless, depressed, or “depressed” (criteria of the American Psychiatric Association).

Diagnosis of BPD

Diagnosis – Borderline personality disorder (BPD) is a psychiatric condition that affects roughly 1% of the U.S. population. While those with BPD experience a wide variety of symptoms (including intense feelings of emptiness, guilt, emptiness and rage), the most characteristic is instability of mood.

What are the symptoms of BPD?

BPD is a psychiatric disorder characterized by three “clusters of symptoms” (a phrase I don’t like).

They are:

Affective dysregulation

  • (a) “unpredictable” mood and mental state – this cluster includes a wide variety of emotional features and changes. This could be as mild as “being upset at someone who has hurt you” or as severe as an episode of depression, mania or hypomania. It’s important to understand that these emotional changes could happen for any reason – a relationship breakup, a death in the family, a major life event, a birthday or an election. This is what I like to call “emotional volatility.” For BPD, emotional volatility often involves intense feelings of emptiness and hopelessness.
  • (b) impulsivity – BPD symptoms include a reckless or even dangerous disregard for the consequences of their behavior. For example, a patient may feel intensely angry or anxious and act on that anger/anxiety. It’s very difficult to predict or understand how she will act once she has acted.
  • (c) “reactive” self-injurious behavior – BPD patients often react to their intense emotions by self-injuring. Patients are not aware of any pleasure they get from this behavior, nor do they realize that it might have any consequences.

Some key terms related to BPD

The word “symptom” comes from Greek roots and means “to show.” Symptoms are like side effects of a medication. For a patient with a psychiatric condition, the idea of medication is foreign. You might hear patients say things like “I hate my life,” or “I’m stuck in my head.” When you’re with patients who say things like these, you might suspect a BPD diagnosis. In a sense, you can say you are doing a “symptom” of BPD – you are showing how the patient presents her behavior – BPD traits.

Sometimes, patients are also accused of being manipulative. In fact, all of the symptoms of BPD can be considered to be manipulative, as you might with a child. You might say that you are “manipulating” the patient to “get her attention,” or “get her to stop the behavior,” or “to do something else.” It is also common for people who have not been trained in the use of psychiatric terminology, to say things like “She’s borderline,” or “She’s acting like a borderline patient,” as a way to explain the patient’s behavior. It is important to understand that patients with BPD usually describe themselves as “symptomatic” and “manipulative,” and it is equally important to consider whether the patient’s behavior is manipulative or not, in order to develop a plan to help.

A person with BPD has difficulties with anger and impulsivity. Many people who suffer from BPD also have a low tolerance for frustration and anger. If the patient becomes angry, she may act on the impulse to “get it out,” even if she really doesn’t need to. BPD sufferers often feel overwhelming anger, which they might express in different ways: through acting aggressively toward themselves, their caregivers, or others. BPD patients who can’t control their anger might lash out physically, as well as verbally, often at themselves. In some cases, the patient will actually hurt her caregivers.

Borderline Personality Disorder is one of several personality disorders. With BPD, the behavior may seem to be caused by a reaction to an emotional or other intense event. But in reality, BPD is a long-term pattern of behavior that the person has developed. BPD patients often have difficulty distinguishing between external and internal events that cause them to behave in certain ways. This is the same dynamic that occurs with other people who experience emotional stress and then act out as though it were the only thing going on in their life. Patients with BPD usually have an inflexible core personality. They often feel uncomfortable with uncertainty or change, and they may have strong negative feelings about themselves and the world in general.

The following behaviors are examples of the kind of behavior often seen in a person with BPD:

  • The person may feel a great deal of anger and rage, yet in public she may exhibit few or no outward signs of that anger. The patient may even deliberately display her feelings in public, such as in an argument or in a flirtatious manner, as a way to win approval or to create the impression that she is confident and strong.
  • The patient may feel and react to her emotions, such as anger or anxiety, with aggression or impulsiveness. In such cases, the patient may take great care to control her emotional state to appear calm and collected.
  • The patient may respond to frustration or rejection with angry outbursts and hostile behavior. Sometimes this is a deliberate strategy to avoid, or at least reduce, potential conflict. Other times, this pattern of behavior can become extremely rigid and habitual, so that the person feels completely unable to alter her emotional response to someone or something that she deems to be threatening or disappointing.
  • The patient may be intensely preoccupied with details of her appearance. She may engage in a strict regime of grooming, including a specific diet and a particular color of clothes to wear, to reinforce her sense of herself as being certain, orderly, and disciplined.
  • The patient may be unusually sensitive to criticism or rejection. While others may see rejection as a normal part of life, for the patient, it can be frightening and overwhelming, even life-threatening. The patient’s emotional response to rejection, especially in the form of criticism, can be so severe that she may engage in self-mutilating, compulsive-obsessive behavior, such as cutting or biting, to ward off the painful feelings of anger and humiliation.
  • The patient may suffer from fears and anxieties, and express them with verbal or nonverbal gestures or other mannerisms. These may be generalized or specific to particular situations. The patient may also have beliefs and fears about relationships and family, or have peculiar or superstitious beliefs about the universe, such as beliefs about the existence of aliens, the supernatural, or some other form of alternate reality.
  • The patient may feel helpless and hopeless about the future. She may feel that she has no control over what will happen to her or how her life will be affected. The patient may suffer from low self-esteem and feel worthless, or she may feel that she has accomplished nothing in her life and is an insignificant part of the universe.
  •  In addition to these emotional responses, the patient may have a cognitive disorder. This may manifest itself in either a thought disorder, such as delusions or hallucinations, or a formal thought disorder, such as compulsive perseveration and perseverative speech.

The initial assessment of a patient with depressed mood should include screening for alcohol and other psychoactive substance abuse, an assessment of suicidal behavior, personal and family psychiatric history, physical examination and laboratory tests to exclude additional health problems that may cause these symptoms. Chatting with relatives or other close people can be helpful for getting more information, especially regarding the severity of the symptoms.