[Karen1933]

My 19 yo daughter diagnosed with bipolar, seems to get physically ill...vomiting mostly...frequently. She is unmedicated, so it's not the meds. It happens every rew weeks I think, and out of the blue, mostly in the morning after waking up, she just gets nauseated and has to vomit.

She stresses very, very easily and am wondering if this is what sets it off. She used to get this way alot before having to go to school, so she missed alot of school before eventually dropping out.

There are no other symptoms, her eating habits are poor...she eats some, gets full quickly (by the way, she is severely overweight, most likely due to hypothyroidism). It's quite a horrible pattern and for a while I thought she was pregnant, which she wasn't, but this does not seem to go away....any thoughts/advice?

[Baaku]

Good morning Karen,

What you describe is not a common symptom of Bipolar Disorder, unless she was on meds such as Lithium in which lithium toxicity can cause vomiting and nausea.

My 1st sense was that this was a Psychosomatic condition: distress, fear, great anxiety and high emotionality can bring on this vomiting-- this is very common, so your instincts are probably right. You say she is overweight and has poor eating habits, this too can cause vomiting, especially if she's overeating on a regular basis (but I didn't get this sense from your description).

I would 1st look in the home environment to see if there are any stressors that create tremendous anxiety, worries, or nervous tension. It's well known, for example, that families that have a lot of "expressed" emotion where members are overly-intrusive, highly emotional about the illness and how it affects the family, any hostilities, extremely expressive and overly concerned, or stressed-out themselves, can bring this about. I'm not suggesting this is what's happening here at all, but it is very common and also a significant cause of relapse and rehospitalizations for many. Expressed emotion shows up a lot in the literature on schizophrenia, Bipolar Disorder, Borderline Personality Disorder and some other conditions-- especially most childhood ones. Here is an excellent and well detailed reading of it: Expressed Emotion and Relapse

If she works or has outside responsibilities, they can cause a great deal of distress, as can even the shear act of getting up in the morning and having to face the world, even if it is just the family. The fact that she had anxiety going to school and did the same strongly suggests this.

I'm not hearing a significant pattern here, such as daily vomiting or even vomiting 2-3 times per week, so it doesn't sound as if she has a medical condition; however, to be on the safe side, it might not be a bad idea for her to see a gastroenterologist as she could have any number of other conditions.

Karen, this must be very difficult for you, especially if she is nit on meds. I was wondering if you could talk about the no meds piece a little?

Good luck Karen I truly hope this helps.

Compassionately,
Baaku

[Karen1933]

Well...I guess a bit of background is probably in order..so I'll detail it as much as I can without writing a novel

Something went severely wrong when she entered high school, 5 years ago. Although she was always overweight (doctors kept checking her for diabetes, never for thyroid issues), she did very well in school, had very, very good attendance, etc. Yes, I know her weight played a part in self-esteem, but nothing manifested in that regard until 3 weeks after she entered high school.

Within that 3 weeks, I saw her do a complete 360. She began cutting herself (only did this once), if she wasn't out somewhere, she was sleeping, she started cutting school, and using marijuana. Needless to say, it just spiraled down from there. Although, at one point in Jr. year, I believe she had a period of remission where she actually made the Honor Roll one semester. Eventually, due to truancy and failure, she dropped out. I had to sign her out and I did only because they threatened to jail me for her refusal to go to school.

She dropped out after the first semester of Sr. year.

She enrolled in Job Corp...only lasted about 2 months, went awol, and when she returned, they would work with the awol, but she tested positive for weed (she had tested positive from the get go, but was in their drug program to get clean). Although the two tests showed quite a significant level change, she still tested positive and they terminated her.

The vomiting really started in high school. I look back and really can't find a pattern perse, but it did increase in frequency as time went on...hence the truancy issues. I got to the point where I refused to write the excuse note because she wasn't well enough to go to school, but that did not hinder her social life in anyway.

I can't quite pinpoint it to stress, becauseshe doesn't really talk to me if she is stressed, but I can see signs of mania when it comes on. I had to put her out of my house about a month ago because she was stealing and severely disrupting the household (I have another daughter who is 17 and in school, plus I am the breadwinner and have to work everyday). She would come and go at all hours of the night, up and down if she was here, on the phone fighting with someone...it was just too much and the stealing (for the ?th time) just put me in a spot where I had no choice. I could not live with the constant feeling of being violated within my own home. Plus, she was stealing from her sister as well.

Last Fall, she attempted suicide, as I said. She did not cooperate, but through blood tests, they found hypothyroidism and gave her medicine for that, which she only took intermittently for a few months, then quit also. She would not cooperate so they did not diagnose bipolar. By February when I was able to get her on state insurance (she was still 18), I got a referral from a family physician for a psychiatrist. He diagnosed her bipolar and gave her Abilify.

She took the Abilify (only if I gave it to her everyday) for about 2 weeks, couldn't stand the side effect of sleepiness, and just stopped. Hasn't seen anyone or taken anything since...not even the thyroid medication.

Her untreated bipolar is getting worse, I believe. She rapid cycles, has zero tolerance for stress, cannot do a multi-step task (even one that involves only 2 steps) and basically drifts. I have seen her go from one mood to the other within minutes sometimes. The worst comes when she needs something for an impulsive desire and won't get the cooperation, kind of like a spoiled child, but the desire is usually one that is pretty dangerous to herself or risky in general.

The lying is so intense that if I ask her the color of the sky, I have to check myself to make sure. It's horrible. When I ask her things...she gets irritated and even belligerent.

No meds in general is a bad thing...no meds AND no therapy in any form is worse.

You have helped me in answering the physical part of it, and I believe it is correct. Because her stress level is 0, I imagine that with no outlet, it takes on the physical form of vomiting, upset stomach, etc.

[allme]

Hey

It wouldnt be a symptom of bipolar as such but I know that I get physically sick when under distress... maybe an arguement with hubby or something or when really upset.

*hugs*

[Karen1933]

I'm thinking that it's indirectly related only because someone with bipolar usually has absolutely no tolerance for stress, anxiety, etc. I know when I get really nervous, my stomach becomes very upset, even nauseated sometimes.

I read the link on the "Expressed Emotion" I'm almost going to go as far as saying my presence to her is upsetting and creates problems...let alone any type of engagement with her. We're fine as long as we are distracted...for example shopping together...but after that...major explosion in the works.

I guess I have to limit my exposure to her...but that's hard considering I'm the one she calls when something is going on.

[BlackPup]

I would question the diagnosis of BP based on your descriptions. I would suggest that a diagnosis of BPD (borderline personality disorder) is more acurate. In reality - it doesn't make that much difference, meds for BP can help BPD and therapy for BPD can help BP, and the features are really similar (at least on paper....)

It's just the major focus for BPD is on therapy, so much of what causes her problems is about her ability to deal with stress, to deal with life and her self image and this would be best addressed by therapy.

Of course, she would have to make the decision to want to get better, and only she can do the hard yards to make it work.

Agree with the anxiety -> vomiting thing, my mum and grandma both had that.

Best of luck to both of you. (btw - some times you have to be cruel to be kind, good on you for making her leave when she was misbehaving, you deserve to be respected in your own house.)

[Keillah36]

I get the same way! I'm VERY VERY easily stressed out by things i shouldn't even care about. I'm 14 && unmedicated. If I get too stressed out I get really sick.. then I just puke. It's always at night though.. I'm never stressed in the mornings. It's always at ngiht after i've had to deal with crap during the day.

[Baaku]

Good morning Karen,

This will be brief but I hope to get some info to you nonetheless. Medication noncompliance is classic for patients with Bipolar Disorder, and the problem with this is that minus the meds, the condition worsens over the years until one develops what's called the "kindling effect" which is a condition in which the illness becomes self perpetuating and may even worsen to rapid cycling, to ultra-rapid, to ultradian cycling when left untreated over the years. We see this also in seizure disorders. For a good and easy read, you can look here:"Kindling" effect.

Secondly, while you can't control her or her behavior, I second the idea of managing your home by keeping her out if her behavior destroys family life. In this case, we recommend to families that they set up 3-5 basic house rules or boundaries (NO CURSING OR THREATS, NO DRUGS IN THE HOUSE, NO STEALING, NO COMING HOME HIGH, RESPECT OTHERS PROPERTY, ETC.) that can be done jointly with her so as to get her buy in. If she breaks one of the house rules, she has to leave for 2-4 days-- this becomes your behavioral contract and if aplied consistently with absolutely no emotion, fanfare, agitation, etc., it becomes an effective tool for teaching her how to respec the home. This will reduce much of the stress and actually may change the course of your relationship with her. Once she is on meds, if she gets on them, social skills training would be very useful. Overall, her treatment, as Blackpup wisely suggests, would be very different than that of someone with Borderline Personality Disorder, although there would be some similarities, such as learning mindfulness and acceptance.

I know this will be most painful for you and my heart goes out to you, but it may be what saves your relationship and your family as a whole. The roles must be enforced by you strictly since they teach responsible behavior and self regulation, which are requisites for learning to live with others and taking self responsibility.

With respect to whether or not she has BPD or Bipolar, while it never hurts to get a 2nd opinion (I always recommend this for some conditions) as implied by Blackpup, they're very distinct conditions. I do evals every day and these are 2 conditions that can be easily isolated by most descent clinicians, much more so than some of the personality disorders.

Sorry this is so short, please write back if you have any questions or need more info. Good luck to you Karen.

With great compassion,
David

[Karen1933]

Thank you all for the great, informative responses.

Because this is not the first time I have put her out, and the stealing has been going on for a very long time, and the fact that the information you provided me, David, about the family dynamic and expressed emotion is so so relevant here, letting her back is not an option, even with the rules. We have been round and round about rules and conditions, and now, my boundary is very clear: she must get treatment and be on tract for at least 6 months with it before I would even consider letting her back.

Ironically, or maybe not, she does not behave in these ways in other people's homes. Maybe their rules are different, so there is no confrontation there, I don't know.

She has a psych appt on July 29 with another doctor, not the one who diagnosed her. She is working with a social service agency in obtaining help, but like always, she has to want it bad enough...no one can want it for her.

I'm not surprised that the condition will worsen without attention and treatment...after all, isn't that the way all illnesses work? Just because you ignore it, doesn't mean it goes away....sigh

[Baaku]

I think this is an excellent plan and I know that as painful as this is, it has taken great courage. What I also like about it is that the door is always there, so she is not left to feel abandoned.

Good luck Karen and please feel to keep writing in for support and encouragement, even if it is about your own core issues with this.

Ciao,
Baaku

[Baaku]

Originally Posted by Keillah36

I get the same way! I'm VERY VERY easily stressed out by things i shouldn't even care about. I'm 14 && unmedicated. If I get too stressed out I get really sick.. then I just puke. It's always at night though.. I'm never stressed in the mornings. It's always at ngiht after i've had to deal with crap during the day.

My daughter would often get stressed out and come to hate school with all the cliques and meanness that goes on. Some days she would be so ill we kept her home just for her sanity... and she has no mental illness, so this is much, much worse if you already have a propensity towards a condition.

Keillah, have you also been diagnosed with Bipolar or is this simply that you really understand what she's going thru as a teen?

[Karen1933]

I can see where Keillah is coming from...maybe holding it in all day. With my daughter, it was all prior to whatever it may be...she would be sick only in the morning.

Because....in the evening, or right after school she would be out socializing and probably abusing marijuana. If she cut school, I'm pretty sure she abused then too. Looking back, I could tell you now when she used it and I know now when she uses it...it does medicate...she is different...but completely going about it the wrong way.