The Bipolar-ADD/ADHD Connection, Part IV - Questions

Patient Expert

This is the fourth in our conversation on the overlap between bipolar and ADD (or ADHD). In our previous pieces, we looked at the confusion between hypomania and ADD and depression (and fatigue) and ADD. By way of example: If you are dancing on a table during a business meeting, oblivious to those around you, is it hypomania or ADD? What if you are over-absorbed in a project or activity? Or what if you're jumping from one thing to the other? Or what if you fail to rein in your impulses? Or what if you experience getting high on doing something totally crazy or risky?

Is it hypomania or ADD?

What about depression? You can't concentrate, you feel sluggish, as if your neurons are coated in molasses. You lack motivation. The mere thought of performing even a simple task is way too intimidating. It's as if your brain needs a good kickstart. Is it depression or fatigue or ADD?

Crazy thing, my research into this series managed to, in essence, get me confused about me. Confusion is good, mind you - we ask tough questions when we're confused. So, was there any ADD going on with me? Here are some DSM-IV key phrases that apply to me:

"Often fails to give close attention to details," "difficulty sustaining attention in tasks," "difficulty organizing tasks and activities," "often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort," "often loses things necessary for tasks or activities," "easily distracted by extraneous stimuli," "often forgetful in daily activities."

We're not through:

"Often fidgets with hands or feet or squirms in seat," "subjective feelings of restlessness," "often 'on the go' or often acts as if 'driven by a motor'," "often talks excessively," "often interrupts or intrudes on others."

It's not even close with me: According to strict DSM criteria, I am full-on ADD. But what about my lived experience?

Okay, the first hour of my first day of kindergarten. We were seated around tables. The teacher kept talking - and talking. Words, words, words. Blah-blah-blah.There were toys against the wall. The teacher kept talking. I politely waited. But she persisted in talking. Finally - after an eternity of excessive forbearance - I got out of my seat and made for the toys. I was redirected to my seat. More blah-blah-blah. Again, I made for the toys.

My pattern never changed. I was focused, alright, but never in the world I was seemingly abducted into. Okay, occasionally their world would sync with mine. On those occasions, I would blurt out something amazingly insightful or turn in a brilliant assignment. Then I was back on my own planet. If I bewildered my teachers, I drove my father to distraction, but at least he derived a perverse pleasure in endlessly ridiculing me and referring to me as "Nudnik."

Funny thing, though. I wasn't your classic disruptive ADD/ADHD kid. I was always fairly quiet and well-behaved. Even in today's school system, my behavior might have been under the radar. Just your average mild-mannered under-achiever.

Prior to beginning this series, I posed as a Question of the Week a series of queries on your experiences with ADD. A number of you zeroed in on the diagnostic chaos. Kane, who four years ago was diagnosed with bipolar II, commented:

It was a year ago the psychiatrist and I zeroed in on the ADD. Ritalin came into the picture. It worked like a miracle. The obvious benefits were what it primarily functions as, a concentration aide. However, secondarily it helped immensely with energy, and as a major perk, helped elevate moodIn other words it was the missing piece of the mood stabilizer. It lifted the lows to normal. Concentration and focus allowed my natural talents to shine and success followed.

Reports Willa, who was introduced to the dark side of bipolar II after being prescribed an antidepressant:

[My bipolar II] might look like ADD. But ADD, just like bipolar II, is a symptom silo.  Until we start identifying what is going on inside the brain, it's like we're playing gin. You can combine your cards in any variety of ways to justify another diagnosis and another drug to try. Good luck trying to sort this one out.

And from Tabby:

It's not about the symptoms that are felt, that the patient struggles so. It's the behaviors that the patient manifests from the symptoms felt - that all find dysfunctioning and intolerable.

One final point: The DSM keyword that everyone misses is "maladaptive." Somewhere along the line, I learned to adapt. I also learned to adapt to my bipolar symptoms. So - do I have both bipolar and ADD? Or one or the other? Or maybe neither or none? What about you?

Questions, questions ...

Previous bipolar-ADD/ADHD pieces:

The Bipolar-ADD/ADHD Connection, Part I - Paying Attention to Attention

The Bipolar-ADD/ADHD Connection, Part II - Lack of Impulse Control or Hypomania?

The Bipolar-ADD/ADHD Connection, Part III - Lack of Focus or Depression or Fatigue?