Is It Bipolar? Or Is It Something Else?

John McManamy Health Guide
  • You may have noticed an "Ask" feature here at BipolarConnect. A recent sampling:

    "Do all bipolar people lie or is it just my husband?"

    "My boyfriend is bipolar and is coping with heroin."

    "Is this an episode loving another man not my husband?"

    "My husband is bipolar and every time we talk he always tells me I'm attacking him."

    Are you beginning to spot a pattern?

    First, let me say that these people and others are asking in good faith. They are going through hell. They are at the end of their rope. They are desperate for answers.

    But I am also reading into their questions the type of answer they wish to hear, namely:

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    "Yes, bipolar is the cause of [your husband's lying, your boyfriend's drug habit, your own infidelity, your husband's inability to discuss issues with you, and on and on]. Bipolar is a highly treatable illness, and with the right treatment these problems will all go away."

    If only.

    These days, bipolar is copping a bad rap for no end of inappropriate behaviors, by patients and non-patients alike. No wonder the public is scared of us. No wonder the stigma persists.

    Inevitably, when responding to these questions, I point out that a mood disorder is very different from a personality issue. Yes, there may be a connection. Yes, a mood episode obviously influences behavior. But first, it pays to make a separation.

    To start, a mood disorder is morally neutral. Fluctuations in mood have nothing to do with one's personal character or values. Hitler may have had bipolar, but he was going to invade Poland, anyway.

    On the other hand, there are complications. Hitler imprudently invaded Russia with winter coming on. Were it not for his unbalanced mental state, it is possible to imagine a far different outcome to World War II.

    Further, psychiatry makes a very clear distinction between various mood (and other) disorders and personality disorders. The distinction tends to be inexact and even artificial, but it is extremely useful for getting one's bearings:

    Bipolar occupies that class of mental illnesses defined as Axis I. As well as bipolar, these include depression, anxiety, schizophrenia, and ADHD. It is very easy to picture a brain malfunction as the source of these illnesses. The fact that patients with Axis I illnesses tend to respond to psychiatric meds reinforces the belief that these illnesses are biology-based.

    Axis II illnesses - personality disorders - on the other hand, are far more problematic. These include: borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, and others, all which overlap to a large degree. As opposed to the Axis I illnesses, it is far easier to assign personal choice as the culprit. The fact that patients with these illnesses don't suddenly become more manageable on psychiatric meds reinforces this belief.

    Nevertheless, as we are learning more about the brain, it becoming increasingly clear that there is a biological basis to Axis II illnesses, as well.

    Moving right along, we can have personality issues without necessarily having a full-fledged Axis II diagnosis. This is normal. The key question, then, is not whether we have personality issues, but HOW MUCH personality issues we may have. Enough to alarm our associates and loved ones?

  • Let's bring bipolar back into the equation. Yes, an episode may result in behavior that we will later regret - and regret is the key word, as I see it. Once we have cycled back to our default setting, we know we have a lot to answer for. We show remorse. The behavior stops.

    To a certain extent, because bipolar is considered to have a biological basis, because destructive cycles tend to be spaced far apart, there is room for forgiveness and even absolution.

    Those branded with personality disorders are not nearly so lucky. In the case of antisocial personality disorder, the DSM gives the impression of individuals trapped in their default settings, incapable of displaying remorse, with no cycle to bail them out.

    Or, alternatively, in the case of borderline personality disorder, we get the impression of a threatening and unpredictable world closing in on its victims, overwhelming them, with no cycle to slow down events. There is room for remorse, but because those close to them are forever ducking for cover, forgiveness is often lacking. The "sinner" is seen as having a flawed character rather than a flawed biology. Talk about stigma.

    Once I recovered from the initial shock of my bipolar diagnosis ten years ago, I felt an overwhelming sense of relief. For all of my life up until that point, I had bought into the view that I lacked the fortitude and moral character to "just snap out of it." Instead, I had a "no-fault" diagnosis. I wasn't a "bad" person, after all.

    But my work was only just beginning. My mood stabilizer did what it was supposed to do and no more - it slowed down my brain just enough to keep my moods from spinning out of control. As a result, I was able to get a handle on my mood-related behaviors. But there remained a whole host of personal issues that had nothing to do with my mood. Some of them involved a few minor course corrections to resolve. Others I'm still working on. The point is we can change.

    No doubt, there are many of us walking about with undiagnosed personality disorders. Certainly, we all have personality issues in abundance. Educating yourself on the former sheds invaluable light on the latter. It is tempting to blame all that is wrong with us (and our loved ones) on bipolar. Indeed, a lot of us are guilty of trotting out "the bipolar excuse," as if our diagnosis constituted some kind of free pass.

    Take a good long hard look at yourself. Is it your bipolar that is truly holding you back or is it something else? Congratulations. You are on your way ...


    For more on personality issues, please check out these two articles on my website:

    Borderline Personality Disorder

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Published On: November 20, 2008