How well do you know bipolar symptoms? Below are the seven DSM mania symptoms, coupled with one or two symptoms from other DSM diagnoses. Can you identify the correct mania ones?
Symptom one: a) Inflated self-esteem or grandiosity; b) has a grandiose sense of self-importance.
Symptom two: a) Decreased need for sleep; b) Insomnia or hypersomnia every day; c) difficulty initiating or maintaining sleep.
Symptom three: a) More talkative than usual or pressure to keep talking; b) Often talks excessively.
Symptom four: a) Flight of ideas or subjective experience that thoughts are racing b) Restlessness or feeling keyed up or on edge.
Symptom five: a) Distractibility b) Is often easily distracted by extraneous stimuli.
Symptom six: a) Increase in goal-directed activity or psychomotor agitation; b) Psychomotor agitation or retardation.
Symptom seven: a) Excessive involvement in activities that have a high potential for painful consequences; b) Impulsivity or failure to plan ahead; c) Impulsivity in at least two areas that are potentially self-damaging.
If you picked “a” each time, you are technically correct. But by now you have probably grasped the real point of this exercise - namely, that no symptom of mania is unique to bipolar. Not one - zip, zilch, nada. Let’s move down the list:
Symptom one: Grandiose? Aha! you say. A sign of mania. But grandiosity is also a sign of narcissism. Not only that, as we discussed last week - Is It Bipolar? - it’s virtually impossible for a “normal” individual to distinguish grandiose from visionary. Good luck making a diagnostic call.
Symptom two: Decreased need for sleep? That may also be a sign of depression (b) or a sleep disorder such as insomnia (c).
Symptom three: More talkative than usual? Maybe mania, maybe ADD. Or maybe you have something worth talking about, such as your visionary idea.
Symptom four: Racing thoughts? Mania comes to mind, but “keyed up and on edge” sounds very similar, which is a feature of generalized anxiety disorder.
Symptom five: Distractibility? Mania or ADD - take your pick.
Symptom six: Psychomotor agitation? Both mania and depression.
Symptom seven: This involves the impulsivity factor, where we get into trouble. But guess what? People with antisocial and borderline - who have difficulty controlling their impulses - also get into trouble.
In theory, we should find symptoms clustering together in such a way that makes mania an easy call, that separates out this state of mind from narcissism, insomnia, depression, anxiety, ADD, antisocial, borderline, and probably a zillion other conditions.
But here’s the catch: mania only requires three of seven symptoms to meet the diagnostic threshold. Do you see the absurdity in this? Picture this: You talk fast, you get distracted, and you can’t sleep. Is that mania? Or are you from the east coast and in danger of being downsized (which would account for your being distracted and losing sleep).
Oh, and get this: The symptom list for mania is exactly the same as the symptom list for hypomania (mania lite). Good luck trying to sort out the two.
So ridiculously conceived is the DSM mania symptom list that I would submit that any clinician who based a diagnosis on it would be guilty of malpractice. Fortunately, we know mania when we see it - kind of, sort of, maybe, well who knows?
Take home message: We are presented with symptom lists as if they are holy writ, based upon the best science. Websites and books urge us to run down the checklist. Clinicians hold them up as proof and truth. Don’t fall for it. At best, they tell us some key behaviors that we need to be looking for. Too often, they encourage us to take these behaviors out of context, with no regard to how all the pieces may fit together or what may be going on in our lives.
Call me crazy. Actually, “crazy” works for me. How about you?
Published On: April 29, 2012
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