View Single Post
 
Old Jan 07, 2022, 05:35 AM
FluffyDinosaur FluffyDinosaur is offline
Grand Member
 
Member Since: Nov 2019
Location: In my head, mostly
Posts: 754
OP mentioned "my depressions are just like the deep depressions that are seen in bipolar disorder." I expect OP isn't around to answer this, but could you or anyone else elaborate on how bipolar depression presents differently from unipolar depression? I would find that extremely interesting. Is it just the possibility of mixed features, or are there actual differences in the symptoms? For example insomnia versus hypersomnia? If bipolar could be distinguished from unipolar depression based solely on how a depressive episode presents, that would be extremely useful for diagnosis. I always thought that was not possible, but it sounds like OP's treatment team thinks that it is?

Like Soupe, I'm also a proponent of the bipolar spectrum model. Research suggests that "bipolar 1" and "bipolar 2" are likely the same illness, just with different labels based on the history of (hypo)mania. Those labels are purely artificial. "Bipolar 2" is something that the people who make the DSM came up with when they realized that some people's mania is less severe than the classic form. Nobody has shown any physical difference or significant difference in effective treatment compared to "bipolar 1." They appear to stem from the same genetic basis. That's why it's far more useful to consider bipolar as a single illness on a spectrum, with some people tending more to the manic side and others to the depressive side, and everything in between. This seems to be the view towards which psychiatry is leaning more and more. I think that's a good thing.

That said, if there's no history at all of (hypo)manic episodes, or if you're "always hypomanic" or "always depressed," I personally don't think it makes sense to call that bipolar. The whole thing about bipolar is that you have distinct episodes that tend to last for a while (at least days), not just mood lability. Sometimes those episodes can perhaps last years, but even then they are clearly different than your baseline personality. Bipolar is an illness that can afflict you regardless of your personality. It's not a personality disorder.

If mood shifts chaotically every day and there's never a period of "normalcy," then in my opinion, that should not qualify as a form of bipolar. At that point the definitions just become way too blurry and it sounds to me more like borderline or something else. Something that is caused, for example, by an adaptation to trauma and has become your personality, for lack of a better word, your way of coping with the world. That's not bipolar, because bipolar episodes by definition are deviations from your "normal" self.

For the same reason, I'm rather skeptical about things like "ultradian" cycling. Whenever I read stories from people that are supposedly bipolar with ultradian cycling, it always sounds to me like borderline, and like someone was hesitant to use that label because of the associated stigma. Sure, sometimes you have mixed episodes where manic symptoms and depressive symptoms are both present, and when the depressive symptoms abate for a moment then the mania gets a chance to shine through and you may go from dysphoric to euphoric for a few hours. But even then, that mood lability is episodic, not chronic.

Long story short, I'm all for considering bipolar to be on a spectrum, but let's not stretch the limits so far as to make the concept meaningless. There's already way too much confusion among the public about what bipolar is and I really don't need people to conflate bipolar with things like borderline any more than they already do. When people hear I'm bipolar I would like them to have an accurate understanding about what that means, and that understanding is already lacking enough as it is.

I often hear people mentioning that borderline can be easy to confuse with bipolar. Personally, I don't really see that. There are plenty of symptoms in borderline that are not characteristic of bipolar. The chronic, non-episodic nature of borderline (being a personality disorder), intense fear of abandonment, the tendency to "split" people into good and bad, rapid mood changes, usually measured in hours and often caused by interpersonal stressors, impulsive personality (not just impulsiveness in the context of a manic episode), and more. There's plenty to go on, in my opinion. In contrast, bipolar people (barring comorbidities) can have a perfectly well-balanced personality and mainly get disregulated due to their episodes.

Apologies for the long post, but I had to get this off my chest.

Last edited by FluffyDinosaur; Jan 07, 2022 at 09:01 AM.