The post about drugs earlier prompted me to write about a common question I’ve gotten from people about my co-morbid bipolar disorder and addiction. How was I diagnosed if I was using drugs? How could anyone know if it was truly bipolar disorder?
I’m going to break down my diagnosis and early disease course to illustrate how the professionals I’ve worked have known it’s bipolar disorder and not drugs.
First, I had a history of depression and very impulsive behavior as an adolescent. I wasn’t diagnosed with bipolar disorder as an adolescent, but my behaviors were extreme without using drugs with any regularity. My first manic episode occurred when I was 18, and I had been clean from drugs for months. I then experienced at least two more manic episodes before returning to using drugs.
A thorough history is the most important part of diagnosing someone with bipolar disorder. I’m suspicious of clinicians who diagnose people (especially children) with bipolar disorder without doing a good history and observing behavior.
I was seeing a therapist who insisted I see the clinic psychiatrist after observing my behavior for a few months. I spent two long sessions with the doctor and he diagnosed me. I went to a doctor a year later and was diagnosed again based on my behavior. I was using drugs at the time, but he trusted my diagnosis from a year prior was accurate.
A few months later, I was hospitalized for the first time at Connecticut Mental Health Center in New Haven. It’s affiliated with Yale, and their treatment was excellent despite it being a state hospital. They observed my behavior, did a thorough history, completed a ridiculous amount of psychological testing, interviewed my mom about my history, and eventually diagnosed me with bipolar disorder.
I used drugs on and off. I had periods of sobriety. I was tested again and again to ensure I had bipolar disorder, including at the Menninger Clinic. Even after I was on Social Security Disability.
This is speculation, but I believe it’s the observation of true manic episodes that took away the doubt of bipolar disorder. I have my psych records from two hospitalizations and a therapist. I’ve had other records in my possession which I’ve lost over the years.
It’s been several years since I’ve had a full-blown manic episode. I’ve taken my medication regularly without using drugs. I have a stable life. I avoid stress as much as possible. But I’ve had some serious depressive episodes. I’ve had hypomanic episodes, some problematic and some that had no negative impact on my functioning.
The diagnosis of bipolar disorder is trickier than one would think with all the quizzes you can take on the Internet. Asking about racing thoughts and the like. I appreciate that these tools can help someone who is experiencing these symptoms and needs help. I’m concerned about the power of suggestion. There is nothing simple about this illness. It alters your life so completely you can’t get away from it.
Mania is pretty unmistakable. Especially when it’s severe and you get psychotic. I frequently had delusions of grandeur when I was manic. It was common for me. I experienced auditory hallucinations at times in manic, mixed, and depressive episodes.
It sucks. I have a terrible fear of hearing voices. Sometimes I think I might have heard something in my head and it scares the shit out of me. I stop cold and wait to see what happens. Luckily it hasn’t actually been voices in a long time.
This is serious stuff.
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Chris, i’d like to see more on the different types of bi-polar disorder. there are so many! it took years to get a bi-polar II diagnosis, probably because the high-functioning mania looks like professional success…if not for frequent, severe depression and a catatonic episode i’d still be under the mistaken impression that i’m just this total loser who can’t maintain any semblance of normal life for very long. sadly, i think that’s pretty common.
I will work on such a post because I think there’s a lot of confusion there. I agree that it’s common to believe that when you have those symptoms you tend to start thinking there’s something innately wrong with you as a person. It’s easy to lose sight that it’s an actual illness causing the problems. I know I felt that way for a long time…