Most of us get called moody once in awhile, and the term bipolar gets thrown around an awful lot these days. When we discuss someone’s moods, we need to define our terms very carefully.
Bipolar Disorder is a major psychological disorder, requiring counseling, periodic or long-term regimens of medicine, and in the lifetimes of most bipolars, even hospitalization to treat. The initial diagnosis and medication usually and ideally comes from a psychiatrist. “Bipolar” literally means subject to two extremes, in this case mania and depression. To be diagnosed bipolar, you have to have a history of at least one manic episode, but because most get somewhat depressed afterward, they’re called bipolar.
A manic episode is a period lasting roughly one week or longer marked by excessive amounts of roughly half the following: self-esteem, talking, activity, energy, racing thoughts, distractibility, outbursts of anger or rage, or pleasurable but risky/dangerous behaviors like gambling, spending sprees, and love affairs. Manic episodes can wreak havoc on relationships and bank accounts if not brought under control through treatment.
A major depressive episode is a period of two or more weeks with the exact opposite: excessive lack of energy, self-esteem, activity, and the preoccupation of with thoughts and feelings of worthless, hopeless, useless, doomed, longing for sleep and death, etc., all of which is usually disabling vocationally.
To carry the diagnosis of a bipolar disorder is like being an alcoholic or a diabetic: it just means one was born with some unusual body chemistry and genetics that leaves them vulnerable to too much alcohol, sugar or emotional highs and lows. It is a constitutional weakness some people are born with. None of them have to limit family and vocational responsibility and fulfillment, if the condition is diagnosed and accepted early enough. The wise are those who take responsibility to get educated and to ask others to help them live their lives between the dangerous extremes, to enjoy freedom within limits.
All the disorders above have several things in common. Folks at the emotional extremes of mania or depression are generally the last ones to realize they have a problem, because their feelings aare trusted, indulged and expressed way too much. (If you had sudden surges of happiness and confidence, you’d want to go with them too—it’s like free drugs!) Manic, depressive and bipolar disorders get much better with both counseling and medication than with either one or the other, or neither. A manic or depressive episode wears out not only the patient, but loved ones and coworkers. It is like a temper outburst or an orgasm: if you don’t start soon enough trying to avoid it, you will soon be unable to do so. So early detection is key.
Those prone to manic or depressive episodes need to cooperate with someone they live with (or if they live alone, with the person who sees them most) and draw up lists of behaviors that would serve as warning signs that they are drifting toward mania. Specific, observable, somewhat measurable or verifiable early signs of the behaviors listed in the third and fourth paragraphs of this article need to be spelled out. One list of behavioral boundaries can be monitored by the bipolar person, and the other by one or two loved ones.
Often for a period after a manic episode, the bipolar person and a partner will need to monitor and share about how things look on a regular basis (like a weekly pow-wow). When bipolar behavior gets over the line, there needs to be a prior mutual agreement that lifestyle adjustments will be made (again, by mutual agreement) to ramp the mania back down. If this isn’t agreed to or complied with, the agreement would be that a session would be promptly scheduled with a licensed mental health counselor to get some professional advice about how to guard against further mood swings. This session could be with the bipolar person, a partner, or both, but it should include a prior report from any person that doesn’t come to the counselor’s office. This session would consider adjustments in communication, lifestyle, and medication.
So much for the severe level of emotional problems like bipolar disorder. An intermediate level of disturbance is a personality disorder (PD), a pervasive and stable pattern of emotional and relationship problems that has existed most of one’s adult life. Of the ten kinds of PD, three are most likely to be called moody (correct) or bipolar (incorrect): histrionic (drama kings, crisis queens, exaggerators who need lots of attention), cyclothymic (moods go slowly from up to down without quite hitting the extremes of previous paragraphs), and borderline (relationships and moods are unstable and intense, and though they always know basic reality like who they are, they vacillate suddenly and without much apparent reason between extremes of idealizing and villainizing key people in their lives).
Don’t throw these terms around at home: they are very insulting because diagnosis and treatment of these conditions requires a licensed professional, and a spouse or loved one is way too close to the situation and too involved to be objective, even if they are themselves a licensed mental health professional. Besides, this condition often doesn’t need medication, and those with personality disorders can generally go right on working and fulfilling their responsibilities. They are mostly a pain for other people, and if you think you are living with a person who has a personality disorder, email me and I will give you my article on that, “Coping with Difficult People,” the title of a book I wrote years ago for this same purpose.
The mildest form of emotional disorders is adjustment disorders. These do not have manic periods, but discouragement will alternate with anxiety and/or misbehavior (poor judgment) milder than a manic episode. Adjustment disorders are basically triggered by life events, but involve prolonged reactions, longer than three months (or if losing a loved one, 6 to 12 months, depending on how close was the deceased, and how suddenly or violently they died).
Finally, all of us have moods, emotional reactions which seem excessive to others. Others of us are just moody, inclined to be emotionally sensitive and over-reactive. Neither medication nor counseling is going to change moody people that are born that way, or moody moments that life just deals us from time to time. It’s best for us to give the comfort and help we can afford to give hurting people, and then just accept them, backing off to give them time and space they need to heal. Otherwise we’ll just put ourselves in a bad mood.
Dr. Paul Schmidt is a psychologist life coach you can reach at [email protected], (502) 633-2860.