Bipolar Disorder Notes
by Michael Nuccitelli, Psy.D.
by Michael Nuccitelli, Psy.D. [April, 2004]
“Bipolar Disorder | Offline & Online Environmental Considerations” is an educational article for families, loved ones and healthcare providers seeking information about those suffering from Bipolar Disorder and related psychiatric disabilities. Authored by Michael Nuccitelli, Psy.D., a NYS licensed psychologist, forensic consultant and author of the Information Age forensic construct iPredator, the article provides helpful information addressing Bipolar Disorder in both offline & online environments.
Disability: Disability is defined as a physiological and/or psychological impairment that negatively limits one or more major life activities in a person’s life, there is an established record of these limitations and a general consensus that the person exhibits impairment.
For those who suffer from Bipolar Disorder or any form of psychopathology, the challenges presented in adaptive functioning and employment environments can be complex, daunting and anxiety provoking. Related to employment, a recent survey compiled by the Depression and Support Alliance estimate that 9 out of 10 Bipolar Disordered adults reported their illness directly impacted work performance and employment relationships. Not to say that medication, exercise, proper diet, therapy, spirituality and a healthy lifestyle cannot reduce these negative consequences, but the cyclical & unpredictable nature of Bipolar Disorder can become a full time job in of itself.
Mirroring the signs and symptoms of Bipolar Disorder, many sufferers often seek out employment opportunities that tend to be intense, project based and short in duration. Even when employed in what would be considered a structured and predictable job, the Bipolar Disordered person tends to manage their task requirements with intensity and hyper focus. Although a structured work environment, with predictable task assignments, have been shown to be most conducive, the idea of a daily routine can easily lead the Bipolar Disordered person to feelings of boredom and disenfranchisement.
For the Bipolar Disordered person, a structured work environment that provides organization, stability and predictability is by far the best employment plan. The byproduct of a structured schedule and predictable work environment reduces the probability of the prime trigger for all Bipolar Disordered persons, which is over stimulation. For the Bipolar Disordered person, environmental employment factors that are stimulation focused are problematic.
As stated, a healthy lifestyle combining organization, stability and predictability is paramount for reducing the negative consequences of Bipolar Disorder. Although Bipolar Disorder has its own unique quality and conditions, compared to other types of psychological dysfunction, a healthy lifestyle that prioritizes organization, stability and predictability is preferred.
A large part of a healthy lifestyle is recognizing the vital importance of medication management and healthcare provider support. It cannot be stressed enough that a consistent dedication to medication management is crucial to behavioral stability. Just as someone who suffers from Type I Diabetes that requires regular insulin shots throughout the day to maintain proper functioning, so too does the Bipolar Disordered person has to prioritize their medication regimen.
What are Mood Disorders
Bipolar Disorder:Bipolar Disorder is a severe and disabling cyclical psychopathology characterized by manic, hypomanic and depressive states. Affecting 2.2 million Americans, Bipolar Disorder begins in adolescence or early adulthood and continues throughout life. Just as all mental illnesses, Bipolar Disorder falls upon a spectrum of severity and chronicity. Clinical studies report that 80% of Bipolar Disordered adults experience multiple manic episodes throughout their lifespan and 15% end their lives in suicide. Bipolar Disorder is distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. Bipolar Disorder is a spectrum of disorders and included in the Diagnostic and Statistical Manual of Mental Disorders [DSM-5] category of Mood Disorders .
Mood Disorders: Mood Disorders are a large, broad spectrum group of clinical syndromes that feature mild to severe mood disturbances, which interfere with a person’s well-being and life functioning. Currently, Mood Disorders are segmented into two separate groups. These two categories include Unipolar Depressive Disorders [absence of hypomanic or manic episodes] and Bipolar Disorders characterized by experiencing episodic Depression, Hypomania & Mania. Secondary mood disorders are a class of psychiatric mood dysfunctions that occurs due to medical illness or mood/mind altering substances ingestion. Depressive disorders range from major depressive episodes to the mild depression manifestation called Dysthymia.
Bipolar Disorders, sometimes referred to as “Manic Depression”, are combinations of manic, hypomanic, major depressive and mixed episodes. These disorders include Bipolar Disorder I, Bipolar Disorder II, Bipolar Disorder NOS and Cyclothymic Disorder. Bipolar I Disorder is characterized by a history of at least one manic episode and one depressive episode. Bipolar II Disorder is characterized by hypomanic episodes alternating with depressive episodes. Cyclothymic Disorder is a mood disorder that is not as severe or chronic as Bipolar Disorder I or II. Bipolar NOS [Not Otherwise Specified] is a combination of manic, hypomanic and depressive themed episodes that do not meet criteria for the other three mood disorders.
What is Bipolar Disorder
Bipolar Disorder [Bipolar Disorder]: Bipolar Disorder [aka, Manic Depression] is a psychiatric disability that typically involves affective states of Depression, Mania & Hypomania. Although not clinically confirmed, research suggests that Bipolar Disorder is inherited and possibly passed down by the maternal second allele recessive gene [aka, mother] as opposed to the paternal primary allele dominate gene [aka, father]. Given the extreme complexity involving the human genome and dominant/recessive genetic markers, the genetic links related to Bipolar Disorder have yet to be accurately mapped.
Using a broad description, Bipolar Disorder is defined as a mood disorder involving cyclical affective shifts ranging from euphoric feelings, expansive thinking and irritability [aka, Mania] to sadness, hopelessness, helplessness and fatalistic thinking [aka, Depression]. The frequency, severity and behavioral manifestation caused by these mood shifts are indicative of gauging the Bipolar Disorder severity and chronicity. These mood shifts occur over discrete periods of time and vacillate in impact to daily functioning [aka, Rapid Cycling]. A list of Mood Disorder signs and symptoms is as follows:
Manic, Hypomanic, and Depression Phase Symptoms List
Bipolar Disorder Manic Phase Signs & Symptoms
- 1. Increased energy, activity, restlessness, racing thoughts and pressured speech.
- 2. Periods of feeling “high”, euphoric and an unrealistic positive mood.
- 3. Extreme irritability, short tempered and distractibility [aka, Hypomania].
- 4. A decreased need for sleep without feeling tired.
- 5. Unrealistic beliefs in one’s abilities and powers [aka, Grandiosity]
- 6. A pattern of uncharacteristic poor judgment.
- 7. Periods of behavioral change that is different from baseline behavior.
- 8. Periods of hypersexual thoughts, fantasies and/or actions.
- 9. Increased use, abuse or experimentation of mood/mind altering chemicals [aka, cocaine, alcohol, prescription medications].
- 10. Provocative, agitated, intrusive, aggressive or obsessive compulsive themed behaviors.
- 11. Denial of experiencing a manic state.
- 12. Periods of heightened work/academic performance and creativity.
- 13. Loss of appetite and/or weight loss.
- 14. Increased physical activity that may or may not be health driven.
- 15. Easily distracted by non-relevant environmental events.
- 16. Increased involvement in high risk or impulsive offline and online activities.
- 17. Periods of increased online/offline spending sprees & poor financial choices.
- 18. Increased focus on “pleasure-seeking” offline and online activities.
- 19. Increased drive to achieve offline and online goals & creative endeavors.
Bipolar Disorder Depression Phase Signs & Symptoms
- 1. Persistently feeling sad, anxious or empty.
- 2. Feeling helpless, hopeless or pessimistic.
- 3. Feelings of guilt, shame and worthlessness.
- 4. A loss of interest or pleasure in ordinary offline and online activities.
- 5. A sense of decreased energy marked by feelings of being “slowed down” or fatigued.
- 6. Difficulty concentrating, remembering or making decisions.
- 7. Periods of feelings restless, irritable and uncomfortable.
- 8. Periods of patterned sleep disturbances [Hypersomnia, Hyposomnia].
- 9. Loss of appetite and weight or increase in appetite [aka, binge eating] and weight gain.
- 10. Reporting chronic pain or other persistent bodily symptoms.
- 11. Thoughts of death or suicide, including suicide attempts.
- 12. Persistently feeling anxiety, worried and nervous.
- 13. Increased frequency and longevity of weeping.
- 14. Decreased sexual appetite and/or sexual thoughts, fantasies and/or actions.
- 15. Increasingly isolative and social activity withdrawal.
- 16. Marked reduction in physical activity and/or physical coordination.
- 17. Increase in slowed, jumbled or slurred speech.
- 18. An Increase in ignoring or avoiding important daily employment/academic tasks.
- 19. Poor performance at school or work.
What is Rapid Cycling?
Rapid Cycling:Rapid cycling is defined as a pattern of four or more manic, hypomanic or depressive episodes during the course of one year. If these four episodes occur within a months period, it has been termed Ultradian Cycling. As the term suggests, rapid cycling is an accelerated shift in mood swings that shift from mild to intense. Once Rapid Cycling begin, the episode can last from a few hours to several days. The duration for those who have suffered Rapid Cycling report feeling as if they are trapped on an emotional “roller coaster” that they cannot stop or control. Rapid cycling primarily involves experiencing a series of behaving impulsive, engaging in uncontrollable outbursts and feeling extremely irritable and angry.
In addition to being intense and frightening, Rapid Cycling episodes occur randomly having no predictable pattern. Rapid Cycling differs from other forms of Mood Disorders. People suffering from Rapid Cycling are unique in how they respond to conventional and experimental treatments compared to other people with Bipolar Disorder. With its sudden, random and unpredictable mood changes, Rapid Cycling is more complex and difficult to manage than other types of Bipolar Disorder.
Cyclothymic Disorder: Cyclothymia is a mood disorder that causes people to experience mild to moderate hypomanic and depressive episodes. Using a broad description, Cyclothymia is a mood disorder involving cyclical affective shifts ranging from euphoric feelings, expansive thinking and irritability to sadness, hopelessness, helplessness and fatalistic thinking. The frequency, severity and behavioral manifestation caused by these mood shifts are less severe and chronic than Bipolar Disorder. Cyclothymic mood shifts occur over discrete periods of time and vacillate in life impact.
As stated, Cyclothymia is a milder form of Bipolar Disorder involving recurrent mood disturbances that vacillate between Hypomania and Dysthymic Mood. From a diagnostic standpoint, a person only has to experience one hypomanic episode in order to meet DSM-5 criteria for Cyclothymic Disorder. Although only one hypomanic episode is required for diagnosis, most individuals also experience dysthymic episodes. Cyclothymia is similar to the less severe form of Bipolar II Disorder, whereby mood disturbances manifest most frequently as hypomanic episodes. Given that Cyclothymics experience mostly hypomanic episodes, feeling creative and highly efficient, they rarely seek therapeutic assistance. It is only when they experience states of Dysthymia that behavioral healthcare help is sought.
What is Hypomania
Hypomania: Hypomania falls within the Bipolar Disorder spectrum describing the less severe and extreme manifestations of a full blown Bipolar Disorder manic phase. Hypomanic states do not include periods of psychotic and grandiose thinking and do not cause life and work functioning dysfunction. Hypomania can occur during the Bipolar Disordered person’s progression into full mania or happen in lieu of a full blown manic state. It is during hypomanic states that a Bipolar Disordered person experiences a sense of heightened creativity and performance.
Individuals in a hypomanic state have a decreased need for sleep, are more outgoing, extroverted and competitive combined with having a great deal of energy. Although part of a psychiatric spectrum disturbance, many people who become hypomanic enjoy the experience and feel elated about life. In fact, it also during the hypomanic phase when a Bipolar Disordered person may cease taking their medication and/or engaging in treatment.
Unlike full mania, those in a hypomanic state can function appropriately at work, school and in interpersonal relationships. Related to Bipolar Disorder, hypomania often becomes the precursor to a full blown manic episode and used as a preparation alert by a Bipolar Disordered person’s support system.
A second negative consequence of hypomania involves a Bipolar Disordered person’s loved ones, family and co-workers. Given the Bipolar Disordered person, in a hypomanic state, is not acting psychotic, grandiose, bizarre or abnormal, it is very easy for loved ones to conclude they are “cured”, rehabilitated or far more functional than they really are. Unfortunately, hypomania is a temporary affective state and not a permanent condition.
Following Hypomania, the Bipolar Disordered person progresses into a full blown manic state or returns to their baseline experience generically known as a “normal” state. Just as some experts define hypomania as a stable non-pathological temperament rather than a psychiatric episode, they also differ in their definitions of a Bipolar Disordered person’s “normal” state.
Bipolar & Work Function
The effects of Bipolar Disorder upon a person’s work function can vary widely ranging from exceptional work performance and creative genius to habitual absences, gross negligence and provocative customer relations. Depending on the severity of their episode [aka, manic, hypomanic, depressive], an employee may initiate a sick leave that can span a couple days to several weeks. If their episodic states are mild, an employer may not even recognize their employee is experiencing a low grade mood disturbance. In fact, the vast majority of Bipolar mood shifts an employee experiences are rarely observed by an employer, supervisor or business owner. Most mood disturbances a Bipolar person experiences is intrapsychic and rarely noticed unless intensely observing the person.
Suffering from a mental illness should not prevent or hinder anyone form endeavoring to climb the proverbial corporate ladder. Behavioral healthcare providers, vocational professionals and occupational therapists recommend being mindful of ones strengths, weaknesses and psychiatric limitations. A psychiatric and/or developmental disability does not have to be the defining reason for not applying for an employment position of interest. The key to employment success is taking the time to assess if the skills, aptitudes and work functions are manageable. Just as important is confirming whether or not the employment opportunity includes job functions that may trigger or agitate a person’s dormant Bipolar state.
Within the vast majority of known employment realms lies those opportunities when functioning as an administrator or manager are available. A strong manager and administrator is essential to the success of any business. They need to have strong planning and organizational skills, while avoiding impulsive behavior and decision making. Having impulsive and intense managers and administrators may come with a price and there are several disadvantages to having such leadership at the helm. Although impulsivity is not chronically pervasive among all mentally ill adults, these counterproductive management traits are central to Bipolar Disorder I, and at a lesser degree, for those who are Bipolar II or Cyclothymic.
Administrators who practice rational, deliberated business management behaviors tend to be more successful in the long run. The key terms describing a manager at risk for not being successful administrating subordinates are impulsive and intense. Impulsive and/or intense management behaviors are at much higher rates of triggering destabilization in the workplace. Impulsive managers change expectations constantly and offer employees minimal levels of consistency regarding what is expected. Instead, employees are left to guess how and when they should respond in employment situations because they are unsure about how his/her manager or management team will respond to their actions.
In relationship to employee relations, an absence of known expectations for employees can make the manager-employee relationship stressful and one that ultimately leaves employees fearful of their own place within the business. For example, impulsive managers who tend to fire employees on a whim may command the fear of their employees, but only out of a sense of necessity and survival. Employees in these situations do not perform their jobs because of loyalty to the manager, but out of fear of losing their job or some other unknown punitive consequences.
Managers, administrators and business owners who act impulsively also tend to lack focus. They jump from one task to the next vacillating between various tasks. In addition to impulsive task attention shifts, the rate of vacillation is directly affected by how the course of their work day is proceeding. These types of managers have no real sense of organization and do not prioritize their activities. This lack of focus is contagious and can affect the entire employee population under the charge of the impulsive manager.
A manager who does not himself focus on the most important tasks does not know how to properly prioritize and delegate responsibility among employees. Employees will too lack this focus and not know which tasks should be the most important because those tasks have not been delegated as such by the manager.
Impulsive managers often have difficulty motivating employees to consistently meet their employment objectives. If employees do not have the focus or know what their expectations are, their ability to meet employment objectives will be severely hampered as a result. Business goals may be occasionally achieved, but usually by the hard work of employees who meet goals despite the impulsive behavior of their manager. Impulsive managers provide employees with little guidance in terms of providing a model for behavior. This leaves employees to figure out their own path to meeting their goals.
Impulsive management behaviors are one of several traits that a supervisor or administrator cannot possess when attempting to mobilize subordinates to successfully complete their employment functions. It is for this reason that when an owner or administrator is considering putting a Bipolar person at the helm of a business operation involving subordinate employees, impulsive management behaviors be confirmed as not being exhibited.
Bipolar Disorder and the “Normal State”
Just all psychopathology, Bipolar Disorder falls upon a spectrum of disability. For those who fall along the mild to moderate side of the Bipolar Disorder spectrum, feeling “normal” can be experienced between affective shifts. Longitudinal research on Bipolar Disorder suggests that these periods of feeling “normal” can be extended if the person prioritizes a consistent healthy lifestyle, as well as, working closely with his/her healthcare providers.
Although generally accepted that Bipolar Disorder and many other psychiatric disabilities have been part of the fabric making human civilization, no known cure, procedure or methodology has successfully cured Bipolar Disorder. The healthcare industry continues to close in on the causes and correlates of Bipolar Disorder, but no proven cure behavioral and/or medical to date has been successful in developing a cure or means of arresting the illness into a state of dormancy. In fact, opposing philosophical camps of medical and healthcare experts continue to debate the causes, treatments and even the interpretative experiences of the Bipolar Disorder.
To illustrate the complexity and lack of professional consensus understanding Bipolar Disorder, there are experts who passionately debate what it means for a Bipolar Disordered person to feel “normal” between affective shifts. For some healthcare experts & professionals, they subscribe to the hypothesis that a Bipolar Disordered diagnosed person can live, feel and experience “normality” who is not suffering from a psychiatric illness. They believe that they can be held within an indefinite dormant state provided the patient prioritizes his/her recovery. Under this premise, recovery is defined as a persistent commitment to medication monitoring, therapeutic treated and behavioral observation.
Within the realm of Bipolar Disorder, the “normal” state is described as a period of time when the Bipolar Disordered person is not experiencing a manic, depressive or hypomanic episode. It is during this “normal” state that experts differ in their definition and prognosis.
For some healthcare providers, the “normal” state is defined as how the person would function if they never suffered from Bipolar Disorder. During this “normal” state, the Bipolar Disordered person is non-pathological and can behave at full functioning levels. Even if the Bipolar Disordered person is being helped by psychopharmaceuticals to enter and remain in a “normal” state, these healthcare providers and scientists subscribe to the notion that the “normal state” is who they would be if they never suffered from Bipolar Disorder.
If the Bipolar Disordered person is assessed or reports being in a “normal” state and he/she acts irrational, impulsive, sullen or narcissistic, it is not caused by the Bipolar Disorder, but due to their own personality constructs, which include both constructive and destructive components.
Similar in philosophy are healthcare providers and pharmaceutical advocates who believe that psychopharmacology treatment can help a Bipolar Disordered person lead a productive life without ever again experiencing states of mania, depression or hypomania. In essence, they believe that medication, therapy and family support are capable of metaphorically “curing” the person of his/her Bipolar Disorder.
Psychiatrists, western trained physicians and pharmaceutical advocates are the predominant segments of professionals who subscribe to this philosophy. It is not out of the ordinary for a western trained physician to tell family members of a Bipolar Disordered person patient that their loved one will be “fine” so as long as he/she takes the recommended medications.
The opposing segment of healthcare providers and scientists do not view the “normal state” of Bipolar Disorder as a full recovery, cure or permanent cessation of psychopathology. To them, the “normal state” is a temporary period of time whereby the Bipolar Disordered person is not experiencing a manic, hypomanic or depressive episode. Although not experiencing these states, they are still at risk for environmental stimulation events triggering a manic, hypomanic or depressive episode. Given the energy and persistence required to habitually prioritize their medication and therapeutic treatments and behavioral plans, being fully compliant 100% of the time cannot be assumed.
Psychologists, holistic and eastern trained physicians and holistic rooted psychiatrists are the predominant segments of professionals who subscribe to this philosophy. For these healthcare providers, they view Bipolar Disorder as a life long illness that must always be prioritized. These professional segments do not subscribe to the notion that psychopharmacology treatment can essentially eliminate future episodes. In fact, it is when Bipolar Disordered persons enter a hypomanic state or conclude that they are cured that medication cessation thoughts become evident.
Combined with loved ones, healthcare providers and a support system that supports the concept of a “Normal State” often encourage or do not dissuade the Bipolar Disordered person from ceasing their medication regimen. For the Bipolar Disordered person’s loved ones, it is natural for them to be receptive when a medication and/or treatment holiday is considered. Family members and loved ones are encouraged to educate themselves on their loved ones psychiatric dysfunction from an educated consumerism standpoint.
It is important to feel comfortable with the Bipolar Disordered person’s treating healthcare provider. To encourage this relationship, family members and loved ones are recommended to actively educate themselves on new medications, medication management topics, mood disorder spectrum topics and community services.
- American College of Physicians www.doctorsforadults.com
- American Academy of Child and Adolescent Psychiatry www.aacap.org
- American Psychiatric Association www.psych.org
- American Psychological Association www.apa.org
- Bipolar Life Insurance http://www.hinermangroup.com/blog/category/bipolar/
- Depression and Bipolar Support Alliance www.dbsalliance.org
- Mental Health America www.nmha.org
- National Alliance for the Mentally Ill www.nami.org
- National Institute of Mental Health | Bipolar Disorder http://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
- Extensive Estate Planning Q & A http://www.eblawgroup.com/Page/faq
- iPredator: https://www.ipredator.co/
- Dark Psychology: https://darkpsychology.co/
- Dr. Internet Safety: https://drinternetsafety.com/
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