Bipolar Disorder and Personality Issues: My Real Road to Recovery

Patient Expert

Last week, we talked about separating out "state" from "trait." Although we may be   vulnerable to states of mania, hypomania, and depression, these are not necessarily a part of our personality. The key word is "uncharacteristic." We are not our true selves in these states. Hopefully, once we settle down, we become pleasant and responsible people again.

In a comment to my sharepost on the topic, Narelle referred to a recent hospitalization where her personality "took a holiday inside a mixed state." Hopefully, she is reunited with her old personality again, but suppose, like waking up from a bad dream, she finds herself in a worse reality?

It happens to far too many of us. Our moods get stabilized, but nevertheless we still feel a sense of unease about ourselves and our surroundings. We're not well. Our lives are still a train wreck. Could something else be going on?

Time to examine "trait," which is wedded to personality. Back in 2006, I heard one of the leading personality disorder experts, Joel Paris of the University of Toronto, speak at the American Psychiatric Association annual meeting. Unfortunately, he said, clinicians prefer not to want to hear about personality. It means trouble. They would rather throw more meds at the problem.

The reason I was attending a session on personality disorders was that, based on my experience in support groups, I was coming to the conclusion that a major obstacle to our recovery was unresolved personality issues. I include myself in this category, as well.

Among other things, for most of my life I have been uncomfortable around people, which had a host of cascading effects. For one, getting depressed with not a friend in the world to turn to is not such a terribly bright idea. Thankfully, these days, most of the time, I only have my bipolar to contend with.

"Only my bipolar" - never in a million years did I dream I would put those words into a sentence. A few weeks ago, a crushing depression literally pinned me to my bed for several hours. Left to my "stupid John tricks" I would still be there.

These days, I find myself advising people with my illness to research borderline personality disorder. I'm very quick to add that I am not implying that they have this illness. But we all have personality issues in abundance, and psychiatry is beginning to look at the topic in a new light.

For years, the DSM has separated out "Axis I" disorders from "Axis II." Axis I is where depression, bipolar, anxiety, schizophrenia, and other so-called "biologically-based" illnesses reside. Axis II, which equated to psychiatry's version of Siberia, was where personality disorders were exiled to. The separation fostered the misconception that personality was some kind of sideshow.

The DSM-5 (due out in 2013) would do away with the Axis I/Axis II distinction. Moreover,   it would acknowledge that personality varies in severity, much like blood pressure. Employing this line of reasoning, we needn't have a full-blown personality disorder to merit clinical attention. We simply need to be mindful of our issues that we need to be working on.

The draft DSM-5 has given borderline personality disorder a face lift. At first glance, the revised symptom list resembles a pastiche of symptoms shoplifted from other illnesses, including depression and bipolar, but a second look reveals a pattern of "negative emotionality."

This includes "having emotions that are easily aroused, intense, and/or out of proportion to events and circumstances." Those who live in close proximity to those with borderline describe the experience as akin to "walking on eggshells." Out of nowhere, for no apparent reason - pow - the person next to you literally detonates.

There is also "antagonism", "disinhibition" (impulsivity), and "disassociation" (experiencing disruptions in the conscious process).

The same year I heard Dr Paris speak, I learned about borderline from a patient's perspective at a session at the NAMI convention. "Anne," a very smart and personable woman with a degree in creative writing can only get a job answering phones. When she loses it, she admits, you don't really want to be around her.

She compared her dealings with people to "walking on shifting boards." The world is far from a safe place, and the ground beneath her could collapse any second.

"It's like demons possess me," she related. Something inside of yourself so overwhelms you that you want to change it instantly. Such as slitting your wrists, impulsive sex, alcohol, and acting out.

There is a lot more to borderline personality disorder than I am relating here, as there is to personality issues. The simple point I wish to leave you with is that if you are simply researching bipolar, you are doing only half the job. Diagnostic categories tend to blind us to other things that our holding us back.

Ironically, investigating another diagnostic category - borderline personality disorder - may encourage you to take a more global view of what is going on with yourself. From there, you can extend your investigations. Speaking from a personal point of view, I learned a lot about managing my illness by researching everything I could find on bipolar, but my real breakthroughs occurred when I came to grips with my personality issues.

The fewer "stupid John tricks" I have to contend with, the better. Be well, know thyself ...