Is bipolar with multiple cycles in a day (ultradian cycling) actually bipolar?

[futureapppsy2]

I've read some lay accounts from people who claim to have a sort of ultra-ultra-ultra rapid cycling (ultradian) version of bipolar I, where they reportedly cycle multiple times in single day, but I've also heard that these types of "cycles" can be better explained by emotional regulation deficits, such as those seen in borderline personality disorder, and thus aren't indicative of true bipolar disorder. A quick pubmed search reveals relatively little literature on ultradian bipolar cycling, and most of it appears to be case studies or small n studies with children.

What is the current consensus, if there is one, on "ultradian bipolar"?

Thanks!

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[SuperSoccer19]

I've read some lay accounts from people who claim to have a sort of ultra-ultra-ultra rapid cycling (ultradian) version of bipolar I, where they reportedly cycle multiple times in single day, but I've also heard that these types of "cycles" can be better explained by emotional regulation deficits, such as those seen in borderline personality disorder, and thus aren't indicative of true bipolar disorder. A quick pubmed search reveals relatively little literature on ultradian bipolar cycling, and most of it appears to be case studies or small n studies with children.

What is the current consensus, if there is one, on "ultradian bipolar"?

Thanks!

My vote is NO! But people who do this really seem to like to tell you they are bipolar...

 

[Shikima]

My vote is NO! But people who do this really seem to like to tell you they are bipolar...

Couldn't have said it any better. Completely Axis II.... I usually explain it that it's not really Bipolar symptoms rather easily explained that's their personality. And I leave it at that.... gives them something to chew on when I send them to their therapist for weekly sessions.

 

[splik]

yes there is absolutely such things as ultradian cycling (switching within the course of <24hrs) and ultra-rapid cycling (week-to-week shifts). however you cannot and should not make a diagnosis of bipolar I disorder without a history of mania. It's not bp I without a classic manic or mixed episode. In these patient younger pts, especially women, those who abuse substances, are on antidepressants or benzos, or have hypothyroidism may experience this. it is different from affect dysregulation of borderline personality or organic personality disorder with emotional lability.

the reliability of bipolar diagnoses just on rapid shifts in mood is very, very low and thus should be avoided. at the same time, do not assume these patients have a character disorder without a full developmental and personality assessment, and collateral.

 

[billypilgrim37]

Many classify these rapid shifts as possibly a mixed episode. They should be distinctly episodic. If there is a week period where these rapid shifts are happening and the week after they're not, that is suspicious for BD. If it's been happening every day for the past 3 years, that's less suspicious. Eric Youngstrom at UNC (one of the "good" pediatric bipolar researchers) talks about the difference between "chocolate milk" mixed episodes" and "fudge ripple" mixed episodes in children, and that seems applicable to adults as well. BD requires a distinct change from baseline with impaired functioning. That's not a slam dunk for differentiating PD from BD, but it's a very good place to start.

 

[gabafan]

I talked to one psychiatrist who thinks that everyone who struggles with angry outbursts (think clientele on the Jerry Springer Show) has Bipolar. I think a lot of this behavior (when not r/t PD, or substance abuse disorders) is more along the lines of IED, which can be helped w/ mood stabilizers.

 

[whopper]

I've haven't seen a case I'd call ultradian cycling. A problem in medicine is never say never. Maybe one day I will, but when I see people that have multiple episodes in a day, it's pretty much always been due to a cluster B personality DO.

A problem with our field is IMHO too many psychiatrists focus on the psychopharmacology and not the personality. Too many docs out there try to medicate a personality disorder with poison-gumbo. Lithium, Depakote, an antispsychotic, an antidepressant, a sleep med, and a benzo, and the patient never got better on anyone of them.

Then someone takes the person off all of the meds and the patient tells everyone "This is the best I've felt in years!"

 

[Shikima]

Just saw a 69 y/o woman last night who said she has rapid mood fluctuations and will use Risperdal 0.125mg on a prn basis and demanded to have her Xanax because it worked better than Klonopin as this was the only medication that worked for her.

She further cites that she can be terrible to interact with (I'm paraphrasing from other choice words used) and claims that her Bipolar disorder.

Additionally, she cites this has always worked for her and no reason to make changes. I informed her that these medications can be filled by her PCP and no longer any need for my clinic to fill these as she was "stable" - she quickle demanded to be changed to another Psychiatrist who only sees children, and took the refills and stormed off in a huff.

 

[Psychobabbling]

LOL reminds of this lady I saw in the ED. She comes in telling me "I'm hypomanic and have been cycling multiple times in a day." No history of a discrete hypomanic/manic episode...but she was a non-psyc nurse and new the criteria for the disorder, which she gladly spouted off. When I had her describe her "symptoms" (a) out-poured some lovely splitting/projection/projective identification and (b) if she dropped her kid off at school and someone gave her a "mean" look in line, she would "instantly get manic." and the best part, (c) "my husband is leaving me because I can be so bipolar"

 

[novopsych]

Just saw a 69 y/o woman last night who said she has rapid mood fluctuations and will use Risperdal 0.125mg on a prn basis and demanded to have her Xanax because it worked better than Klonopin as this was the only medication that worked for her.

She further cites that she can be terrible to interact with (I'm paraphrasing from other choice words used) and claims that her Bipolar disorder.

Additionally, she cites this has always worked for her and no reason to make changes. I informed her that these medications can be filled by her PCP and no longer any need for my clinic to fill these as she was "stable" - she quickle demanded to be changed to another Psychiatrist who only sees children, and took the refills and stormed off in a huff.

I often see on this board a disdain for patients who make best-do with information and routines given to them from previous psychiatrists. Imagine you lived in that world, where up was down. Where every moment could be hell forever. People will cling onto any hope you can give them. A man in the midst of Siberia will hold onto a map of Ireland and not give it up if he's been left alone there too long unless you have something else to offer but scoffs.

 

[Shikima]

LOL reminds of this lady I saw in the ED. She comes in telling me "I'm hypomanic and have been cycling multiple times in a day." No history of a discrete hypomanic/manic episode...but she was a non-psyc nurse and new the criteria for the disorder, which she gladly spouted off. When I had her describe her "symptoms" (a) out-poured some lovely splitting/projection/projective identification and (b) if she dropped her kid off at school and someone gave her a "mean" look in line, she would "instantly get manic." and the best part, (c) "my husband is leaving me because I can be so bipolar"

This is gold. We really need to gather stories like this for a coffee table book.
The title - "I'm manic and so are you!" Enh.... I guess the title needs a little bit of work.

 

[Shikima]

I often see on this board a disdain for patients who make best-do with information and routines given to them from previous psychiatrists. Imagine you lived in that world, where up was down. Where every moment could be hell forever. People will cling onto any hope you can give them. A man in the midst of Siberia will hold onto a map of Ireland and not give it up if he's been left alone there too long unless you have something else to offer but scoffs.

A disdain of the patient? no, you misinterpret. It's the permissiveness and creation of false hope through providers which strokes the fur in the wrong direction. Too much coddling is occuring and no accountibility is held to the patient out steming from an irrational fear that they won't get better. Therapists providing only supportive psychotherapy is another action which rubs me the wrong way - which reminds me of anedotal stories of people attending therapy for the last 17 years and nothing has changed for them.

 

[spemat]

I am finishing an international relations major then plan to pursue a phD in Psychology (Multucultural related) so I may be unqualified to post as a consumer but I started having legit manic episodes as a young child and they start in April and end in Sept/Oct. The first thing that happens once I cross that point where a few days-6 weeks of 1.25 mg/haldol 2mg/klonopin can nip it is, I no longer have bipolar disorder. I am impossible to convince that I am manic until my state goes mixed or paranoid from the tail end lack of sleep and notebooks of tachyon theories of wormholes etc. I also hate to have to tell new providers to make sure if I am dealing with some issue to have definitive proof. I am highly intelligent and my delusions are realistic, hard to tell they are delusions sometimes. My first neurologist who went child psychologist in her eval after tests and more tests had a note. Caution is needed as it is easy to be drawn into the delusions of intelligent paranoids. I have never once thought I was manic and after the fact, it is so humiliating because I have to process what did and didn't happen with certain folks.

I used to know a girl during my undergrad with borderline personality disorder and she used to claim to get psychotically manic and in classes she would flow from sweet, down to earth, get angry and hate people for no reason, she was having family issues and tended to collapse on the way out and would cry and have to leave with three people and come back and let the class know she was okay. She was nice at first but then too much and I gave her feedback about her bias in an anthropology of death course and she called me a psychopath and said she hated me. It was cultural, she's American and it had to do with Haitians and death and they often see ghosts of dead relatives so I didn't understand.

If my feedback as a consumer is not appropriate, I respect that and will stick to my studies and focus more.

 

[myPsychAlt]

I talked to one psychiatrist who thinks that everyone who struggles with angry outbursts (think clientele on the Jerry Springer Show) has Bipolar. I think a lot of this behavior (when not r/t PD, or substance abuse disorders) is more along the lines of IED, which can be helped w/ mood stabilizers.

Oh, I think I know this person. Is he named "every child psychiatrist ever?"

 

[suka0830]

Simply put, under-treated or entirely untreated comorbidity - Bipolar I and Borderline Personality Disorder - would validate such claims of ultradian cycling within bipolar disorder.

 

[whopper]

It's been years and I still haven't met someone with ultradian cycling. I've seen rapid cycling for real, but not ultradian cycling.

 

[smalltownpsych]

Simply put, under-treated or entirely untreated comorbidity - Bipolar I and Borderline Personality Disorder - would validate such claims of ultradian cycling within bipolar disorder.

What is the prevalence of meeting criteria for both disorders? I imagine it can and likely does occur, but I haven't seen it either. Also, it would not validate the claim as emotional dysregulation and manic episode are two different phenomena although there is a dynamic interaction between the two. As stated above, what I see are people with early childhood trauma, emotional dysregulation, chronic suicidality, and self-harm being diagnosed as Bipolar when they don't meet the criteria for a manic episode and never really have. Assessing sleep patterns helps differentiate. The person with borderline wants to sleep but can't and the manic patient loves that they don't have to waste all that time sleeping. It can get confusing though because some patients with borderline PD or a history of borderline PD who tend to be higher functioning can utilize a manic defense as a means of avoiding the intense emotions associated with the disorder.

 

[hamstergang]

Many classify these rapid shifts as possibly a mixed episode. They should be distinctly episodic. If there is a week period where these rapid shifts are happening and the week after they're not, that is suspicious for BD. If it's been happening every day for the past 3 years, that's less suspicious.

This seems like the most reasonable and useful conceptualization to me. Though I base that just on what sounds to make sense and not on me actually concretely applying it in clinical situations.

 

[Shikima]

What is the prevalence of meeting criteria for both disorders? I imagine it can and likely does occur, but I haven't seen it either. Also, it would not validate the claim as emotional dysregulation and manic episode are two different phenomena although there is a dynamic interaction between the two. As stated above, what I see are people with early childhood trauma, emotional dysregulation, chronic suicidality, and self-harm being diagnosed as Bipolar when they don't meet the criteria for a manic episode and never really have. Assessing sleep patterns helps differentiate. The person with borderline wants to sleep but can't and the manic patient loves that they don't have to waste all that time sleeping. It can get confusing though because some patients with borderline PD or a history of borderline PD who tend to be higher functioning can utilize a manic defense as a means of avoiding the intense emotions associated with the disorder.

I've seen both a few times, but more often than not, I do blame laziness in the diagnoses being given.

 

[Ceke2002]

What is the prevalence of meeting criteria for both disorders? I imagine it can and likely does occur, but I haven't seen it either. Also, it would not validate the claim as emotional dysregulation and manic episode are two different phenomena although there is a dynamic interaction between the two. As stated above, what I see are people with early childhood trauma, emotional dysregulation, chronic suicidality, and self-harm being diagnosed as Bipolar when they don't meet the criteria for a manic episode and never really have. Assessing sleep patterns helps differentiate. The person with borderline wants to sleep but can't and the manic patient loves that they don't have to waste all that time sleeping. It can get confusing though because some patients with borderline PD or a history of borderline PD who tend to be higher functioning can utilize a manic defense as a means of avoiding the intense emotions associated with the disorder.

I did know one girl years ago who had a dual diagnosis of BPD and BD. In her case though the difference between her emotional disregulation and a manic episode were pretty obvious (like once you'd actually seen her exhibiting both aspects you couldn't really mistake one for the other).

 

[whopper]

The co-morbidity between bipolar disorder and borderline PD is quite high in some studies but the problem here is the reader must beg the question, just how much did the researcher do to tease the two disorders apart? They may have misdiagnosed.

I still, almost everyday, see people misdiagnosed with bipolar disorder that don't have it but have a cluster B personality disorder and tell me they know they have it because 1-a psychaitrist told them so and 2-"I have highs and lows."

To which I respond....
1-Bipolar Disorder misdiagnosis is actually quite high and some doctors diagnose everyone with it without spending the appropriate time or amount of information to scrutizine and 2- "Everyone has highs and lows, that doesn't mean you have bipolar disorder."

Another problem is some people have a sub-threshold bipolar disorder that's on the spectrum but doesn't meet a DSM-IV or V criteria of it. E.g. cyclothymia.

I've had the hardest time teasing cyclothymia and borderline PD apart.

Teasing apart actual bipolar I or II disorder and borderline isn't hard IMHO if you have enough information and the person is drug-free. Manic episodes don't last 1 hour or less. Depressive episodes don't last 1 hour or less. Average manic episode per Kaplan and Sadock lasts 3 months. (Though I caution that K&S didn't cite the specific reference for that source of information). If someone has bouts of mood problems that occur in a depression cluster, mixed cluster, or manic cluster that has literally lasted several days with no break whatsoever that strongly suggests bipolar disorder.

Someone having high emotional reactivity that lasts on the order of minutes to hours, especially in regards to impulsivity, interpersonal stressors and abandonment is likely a cluster B disorder.

Other softer signs of borderline over bipolar disorder: history of emotional/sexual/physical abuse or neglect as a child, very dysfunctional family structure as a child.

A problem, however, occurs when someone has both and one could have both disorders. In such cases the medication benefit will plateau and could stabilize the bipolar disorder but will likely not do much if anything for the borderline PD.

I mentioned in other threads that psychiatrists shouldn't be too liberal with diagnosing. This is especially true in this area. One study (that I can't find off-hand right now) showed that when psychaitrists used a SCID for diagnosing bipolar disorder it was accurate over 90% of the time but when using a very open format interview it accurately diagnosed it about 60% of the time. The SCID if you don't know uses very clear DSM-IV criteria. They were able to verify this because they followed the patients for about 5 five years (nuts I can't find this study and I have cited it often in court when trying to show the judge the person's prior dx of bipolar disorder is not accurate).

Here's one study though not the one I mentioned above about the problems with dx borderline PD vs bipolar disorder.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849890/

Slightly off on a tangent but while I worked on a forensic unit a colleague of mine had a very large and strong female on her unit that frequently attacked others and was diagnosed with bipolar disorder. The psychiatrist became convinced it was all a combination of antisocial and borderline cause the patient only became enraged and attacked people if she didn't get something she wanted. If she got something she wanted she was very sweet and pleasant. I agreed with my colleague and commended her for having the spine to give the right dx despite a history of several prior dx of bipolar disorder and schizoaffective disorder.

When previous psychiatrists were asked why she was diagnosed with bipolar disorder despite the patient not really meeting a criteria of it the other doctors gave answer to the effect of -well I got to medicate her with something so I had to use this diagnosis even if I didn't believe in it.-

Incredible. What unseen hand forced this psychiatrist to misdiagnose? Why not just say what it is? Where is the evidence that intentional misdiagnosis and medicating a disorder that doesn't benefit from medications will benefit the patient?

 

[MacDonaldTriad]

“The good news is that you don’t have Bipolar disorder. The bad news is that you are a very moody angry person.”

Isn’t it strange that Bipolar disorder is the one illness that patients get angry about not having?

 

[splik]

What is the prevalence of meeting criteria for both disorders?

about 20% of borderline patients have bipolar disorder
see: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.7.1173

 

[smalltownpsych]

about 20% of borderline patients have bipolar disorder
see: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.7.1173

That is higher than what I would expect or what other posters have seen in their experience. I have questions about the utility of combining Bipolar I and II and the concept of Bipolar spectrum and would think that is part of the reason for the higher number. In my outpatient setting, that is not the type of comorbidity that we see and I suppose that someone with both would be more likely to show up in inpatient settings. In my current practice, I probably have about ten patients who meet criteria for Borderline PD and I am fairly certain that none of them have a history of Bipolar I although as whopper's cited study indicated, most have been treated for it. It has been awhile since I worked inpatient so I can't recall any good examples of a patient meeting both, but I am thinking that when a patient was in a clearly manic state (what is the manic equivalent of floridly psychotic?), we probably didn't focus on or maybe even notice the Axis II disorder.

 

[splik]

in my experience comorbidity (especially for bipolar II) is the rule and not the exception.

 

[MacDonaldTriad]

about 20% of borderline patients have bipolar disorder
see: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.7.1173

This depends on the raters and their definition of Bipolar disorder. It could be anywhere from 0 - 100% depending upon the rules they played by.

 

[Shikima]

I wonder what % that show up in the ER say that it is "my Bipolar"?

 

[MacDonaldTriad]

“my bipolar” is so much easier to buy into than “my evil personality in the context of my multiple personality disorder”.

 

[whopper]

A similar phenomenon is bipolar disorder with psychotic features vs schizoaffective.
Per K&S schizoaffective people have a better prognosis than people with schizophrenia. How can that be so? Someone with psychosis bad enough to meet a criteria of schizophrenia but now also has a severe mood disorder and they are better off than just a plain schizophrenic?

IMHO the studies likely didn't tease apart bipolar disorder with psychotic features vs real schizoaffective disorder.

I wouldn't be surprised if the 20% is accurate concerning the bipolar disorder and borderline comorbidity. It is possible to have both and I see a lot of people with both (though I'm also in a biased environment, I work in a jail and there almost all the women have a cluster B personality disorder). But even after reading the study provided above I'm still wondering that perhaps there was some misdiagnosis going on with the borderline vs bipolar vs someone having both.

 

[splik]

This depends on the raters and their definition of Bipolar disorder. It could be anywhere from 0 - 100% depending upon the rules they played by.

they used the SCID and included bipolar I and bipolar II

 

[NickNaylor]

I've actually run into a few of these patients in my ~5 shifts in the psych ED as an intern. The key for us in our diagnosis was that these "rapid" shifts in mood - at least to a depressed mood - were very commonly due to some kind of external stressor, e.g., "my boyfriend and I got into an argument," "I had to talk about my suicide attempt with my psychologist," etc. These patients went from a purportedly euthymic state to suicidal with plan +/- attempt in the course of a day. A few of these patients "felt a lot better" after "talking" about the stressors, to the point that they wanted to go home <24 hours after the onset of their suicidality. After doing just a brief interview it became pretty clear that they had some strong cluster B traits that were likely playing more of a role than any kind of organic mood disorder (and, of course, many of them come in with a diagnosis of BPD).

I have yet to see someone who has entered a "manic" phase as a result of a stressor, though there has been a pretty strong coincidence between people with cluster B traits and people that come in with a complaint of "I'm feeling bipolar." As mentioned above, this seems to have been started by an outside psychiatrist who did some pretty shoddy diagnostic work and the patient now hangs their hat on a medical diagnosis for things that really seem to be more personality in nature. A not insignificant number of these patients come in with a diagnosis of BPD despite not endorsing a true manic episode or even symptoms resembling hypomania at any point in the past. Some seem to have quick and frequent shifts from euthymia to depression and vice versa but no genuine manic symptoms.

 

[splik]

I have yet to see someone who has entered a "manic" phase as a result of a stressor,

why do you think people enter into manic episodes? manic episodes, especially index manic episodes are characteristically preceded by goal striving life events or life-events involving schedule rhythm disruption. in some cases frank loss events precipitate manic episodes though this is less common.

 

[NickNaylor]

why do you think people enter into manic episodes? manic episodes, especially index manic episodes are characteristically preceded by goal striving life events or life-events involving schedule rhythm disruption. in some cases frank loss events precipitate manic episodes though this is less common.

Of course, I just haven't seen it in this setting where people are rapidly cycling. I don't doubt that it exists and know that stressors can precipitate mania.

 

[splik]

well rapid cycling is really just one mood episode

 

[Shikima]

I have yet to see someone who has entered a "manic" phase as a result of a stressor,

Be careful when looking for/at BP d/o and the various phases of depression and mania. People will destabilize in the face of internal/external stressors, much like a schizophrenic will. They most often will develop depression, there are a scant few that will end up as mixed or manic because of that.

 

[splik]

They most often will develop depression, there are a scant few that will end up as mixed or manic because of that.

if you think this is the case you're not asking the right questions. sleep/circadian rhythm disturbance is the final common pathway to manic episodes and sleep disturbance is typically the result of life events

mixed episodes in my experience typically occur when people experience a life event they experience significant ambivalence about. mixed episodes may also be the end-point of a depressive episode, or represent a transition phase between manic and depressive episodes and vice verse

here is the classic paper on the topic: archpsyc.jamanetwork.com/article.aspx?articleid=204116

also see

and also which shows evidence for Karl Abraham's manic defense hypothesis which is gaining popularity in psychology

mania is not the opposite of depression. it is often the end point of depression, or severe form of depression. manic patients often score very highly on depressive scales and respond similarly to depressive patients on the emotional stroop. and in my clinical experience patients do better when you are able to context their bipolar disorder within their life context

 

[Ceke2002]

“The good news is that you don’t have Bipolar disorder. The bad news is that you are a very moody angry person.”

Isn’t it strange that Bipolar disorder is the one illness that patients get angry about not having?

Well naturally, I mean why have a diagnosis where you actually have to attend therapy and work on yourself, when you can get a diagnosis that requires you to just pop a pill. And as a bonus Bipolar disorder gives you maximum attention seeking advantages with a lower rate of attached stigma. All those Hollywood celebrities, why you can regale people for hours about the struggles of creative genius and how you are now a proud member of the same club.

Of course if you happen to decide to join a patient support group you'll very quickly find that actual Bipolar patients utilise the groups as well, which means you're no longer considered a special snowflake. Time to up the ante if that happens - throw in a few psychotic episodes, maybe consider ramping your diagnosis all the way up to Schizophrenia depending on what level of snowflake you're trying to achieve.

 

[smalltownpsych]

@splik. I usually find myself agreeing with much of what you have said in the past, but I don't know if I really think it makes sense to broaden the definition of Bipolar Disorder or to apply it more liberally which is what it sounds like you are saying. Some of that could be semantics. I tend to think of depressed and elevated mood as normal states of being within the normal fluctuations of mood and depressive episodes and manic episodes as being different yet similar constructs. Where do we draw the line between adjustment disorder with anxiety and hypomania? I think that the evidence on depression is beginning to show that there are reasons to clarify between the mild vs severe forms and appropriate treatments. So why begin blurring the lines in Bipolar?

***edited to change mania to Bipolar Disorder***

 

[smalltownpsych]

when have i suggested broadening the definition of mania. i have a very stringent definition of mania. not sure what is confusing?

Fixed it. I guess my concern is the potential for pathologizing normative emotional responding. I know that is not what you are advocating in any way, but the pharmaceutical companies would love to broaden their target market and the public gets much of their info from the ads. Just as an example, seroquel has been really pushing the extended release formula for treatment of the depressed phase of bipolar which might be very effective for some patients, but I believe they also want to sell it to people who don't really meet those criteria.

 

[whopper]

I believe I've seen people turn manic in the face of stressors. E.g. guy is losing his home so he is freaking out and can't sleep and then a few days later he is manic. Of course maybe he was going manic first and that's the real reason why he couldn't sleep but the guy's sleep was disturbed right after he got the bad news.

 

[strangeglove]

I believe I've seen people turn manic in the face of stressors. E.g. guy is losing his home so he is freaking out and can't sleep and then a few days later he is manic. Of course maybe he was going manic first and that's the real reason why he couldn't sleep but the guy's sleep was disturbed right after he got the bad news.

Or maybe it's the reason he lost his house?

 

[lonerider]

My vote is NO! But people who do this really seem to like to tell you they are bipolar...

This is not true , years went by knowing something was very different about my everyday life. friends and family would say "fire and ice" , and when having a doctor say you have a "condition" known as ultra ultra rapid cycling bipolar, and told me it was rare and the few other doctors I went to had only started to learn about it, the last thing I wanna tell anyone that includes myself, "I am Bipolar" or any form of it. please know this is not to disregard any and all thoughts for what is really going on in those of us that have been marked with such a condition. I joined to learn more about what is really happening and maybe believe it really is just who I am. because at 43 years old im getting mighty tired of it. its pure joy, then pure pain, everyday no matter what is done to prevent having an "episode" found the one thing that has helped from a boy at 6 years old to present day, solitude. only real treatment that has helped and of course, most likely hindered my "ultra something whatever up down side to side inorder disorder" sorry . just being me. but one day everyone will begin to understand no one person should ever say no to something such as this. might be named wrong and in wrong catogory but, we are real. with hopes that no one including ourselves will have to go through it. Yeah Right......

 

[lonerider]

anyway, it is something and its hard to read about such a condition is made up or what have you. best thing that i know is that family and friends really help by just not talking about what we have to do or need or should, but to just remember it will be different at any moment with out notice outta the blue . thats what makes it hard in everyday life. again sorry for butting in when i am just , and this one is real. a" ultra cyclist" ultra endurance cycling all over alaska. Thank you all and happy to know some look at things as I do. open eyes, open minds, open to more then one knows ,so lets check it out...

p.s. current meds, bupropion 100g three times a day. dont seam to really help. but what do i know.

 

[smalltownpsych]

This is not true , years went by knowing something was very different about my everyday life. friends and family would say "fire and ice" , and when having a doctor say you have a "condition" known as ultra ultra rapid cycling bipolar, and told me it was rare and the few other doctors I went to had only started to learn about it, the last thing I wanna tell anyone that includes myself, "I am Bipolar" or any form of it. please know this is not to disregard any and all thoughts for what is really going on in those of us that have been marked with such a condition. I joined to learn more about what is really happening and maybe believe it really is just who I am. because at 43 years old im getting mighty tired of it. its pure joy, then pure pain, everyday no matter what is done to prevent having an "episode" found the one thing that has helped from a boy at 6 years old to present day, solitude. only real treatment that has helped and of course, most likely hindered my "ultra something whatever up down side to side inorder disorder" sorry . just being me. but one day everyone will begin to understand no one person should ever say no to something such as this. might be named wrong and in wrong catogory but, we are real. with hopes that no one including ourselves will have to go through it. Yeah Right......

The general public overuses the term Bipolar and we see patients everyday who say they have bipolar and don't really have it. That is who other posters are referring to. Many of us have not seen the rarer forms of bipolar such as more rapid cycling, but the good clinicians retain an open mind about it. Meanwhile, we will continue to assume that many of our patients are referring to emotional regulation problems when they say they are bipolar especially when they have a chronic history of suicidality and NSSI and chaotic relationships along with their mood instability.

 

[Shikima]

Same goes for the over use of ADD/ADHD because they cannot focus and is usually in the context of duress. They looked up symptoms or heard from a friend or a family members says you need to be checked out for it. It's a lack of education and transforming a diagnosis for popularization to create a new fangled american euphemism.

 

[Ceke2002]

@lonerider ^^^ What they said above, also keep in mind that it's actually a really positive, and advisable, thing for Doctors to be able to openly discuss and confer and learn about non typical diagnoses, or non typical presentations of different diagnoses, because it's important when they're working with patients that those patients receive the correct/best treatment for the right diagnosis. For example it's no good someone being treated for Bipolar Disorder when they actually have something like Borderline Personality Disorder or Complex-PTSD, same as it's no good someone being treated for BPD or C-PTSD if they actually have Bipolar Disorder. Doctors don't stop learning when they receive their medical licenses, or at least they shouldn't, so look at this discussion as something positive because it means there's an ongoing seeking of knowledge and better understanding taking place. At least that's how I look at it as one of the patient's on this forum.

 

[SuperSoccer19]

This is not true , years went by knowing something was very different about my everyday life. friends and family would say "fire and ice" , and when having a doctor say you have a "condition" known as ultra ultra rapid cycling bipolar, and told me it was rare and the few other doctors I went to had only started to learn about it, the last thing I wanna tell anyone that includes myself, "I am Bipolar" or any form of it. please know this is not to disregard any and all thoughts for what is really going on in those of us that have been marked with such a condition. I joined to learn more about what is really happening and maybe believe it really is just who I am. because at 43 years old im getting mighty tired of it. its pure joy, then pure pain, everyday no matter what is done to prevent having an "episode" found the one thing that has helped from a boy at 6 years old to present day, solitude. only real treatment that has helped and of course, most likely hindered my "ultra something whatever up down side to side inorder disorder" sorry . just being me. but one day everyone will begin to understand no one person should ever say no to something such as this. might be named wrong and in wrong catogory but, we are real. with hopes that no one including ourselves will have to go through it. Yeah Right......

Further support that "people who do this really seem to like to tell you they are bipolar..." and we're often too tired to fight it.

Agree with above quotes. You are in distress, but its a different "disorder" vs mood dysregulation vs PD.

Good think wellbutrin is not a recommended treatment for "bipolar disorder."

 

[DD214_DOC]

Oh, I think I know this person. Is he named "every child psychiatrist ever?"

Unfortunately, although I'm different. But I get the sense I'm an outlier.

I have reversed many bipolar diagnoses. My usual spiel is, "Any time I see this diagnosis in someone under X age, I'm skeptical. Bipolar disorder is a very specific thing yadda yadda yadda". I honestly have no idea where this comes from. I can't find, "intermittent episodes of reactive anger and aggression without any other associated symptoms that spontaneously resolves with return to baseline in seconds-to-minutes" in the DSM criteria for mania or hypomania. Some child shrinks will give a kid that label so that they can get services through the school to accommodate what is more likely learned behaviors from parental modeling. Or externalizing behaviors from another mood disorder. Or, who knows ?? because kids are weird. My evaluation for impulsive anger/aggression behaviors in kids, after getting collateral from the parent on a description of the behavior, antecedants, and what happens after the behavior, I then look at the parent(s) and clearly ask them, "What do you do when you get angry?" Most will describe themselves as doing the same exact thing. A few make the connection as soon as they start talking. Most don't.

On another note, fudging a diagnosis so a kid can continue to have behavioral problems and forcing a school to take it does a huge disservice to both the patient and the other kids in his class. Child psychiatrists need to start growing backbones and begin challenging parents on these things.

 

[lonerider]

@lonerider ^^^ What they said above, also keep in mind that it's actually a really positive, and advisable, thing for Doctors to be able to openly discuss and confer and learn about non typical diagnoses, or non typical presentations of different diagnoses, because it's important when they're working with patients that those patients receive the correct/best treatment for the right diagnosis. For example it's no good someone being treated for Bipolar Disorder when they actually have something like Borderline Personality Disorder or Complex-PTSD, same as it's no good someone being treated for BPD or C-PTSD if they actually have Bipolar Disorder. Doctors don't stop learning when they receive their medical licenses, or at least they shouldn't, so look at this discussion as something positive because it means there's an ongoing seeking of knowledge and better understanding taking place. At least that's how I look at it as one of the patient's on this forum.

I want to say thank you to all of you, reading what is posted and had been brought to light about bipolar and other conditions is really what a person needs sometimes. Its hard to be told you have a disorder but much harder when after alot of people only ever see you as that. I have one close dear friend that has mentioned I try to see another doctor and not believe I'm bipolar. She grew up around family with mental conditions and like those of you here , say there's much more going on and believes the current meds really don't do much or not alone they don't. Anyway. Its very calming to read this forum and know like myself with the mechanical world, one never stops learning and with that, I'm smiling because those of you here have helped me more in the time it took to read this then what I have learned over years asking, searching and not getting answer's. Why? Cause I was looking only at what had been told my condition was and not other areas with similar but much more detailed and understood. Again I'm very grateful to have found this forum and to have real reply to my post . thank you .

 

[Shikima]

You can blame the Kardashians for throwing it around like holy water to describe any kind of emotions distress and interpersonal conflict. Because, you know, they're... oh... so... eloquent.