The Psychiatry Blog by John Deri, M.D.

Do you experience major mood swings?  In this blog posting, you will gain new perspectives on your condition.  As well, you will learn about treatment approaches and coping strategies.

I will share some thoughts with you regarding bipolar disorder from four vantage points:  biological, psychological, social and spiritual.

I. Biological

Heredity plays a major role in the transmission of bipolar disorder.  Although there is much speculation, the biological basis for this condition is not known.  Extensive genetic research is being pursued, in an attempt to identify the mechanisms that render an individual vulnerable to this disorder.

Lithium remains the first line medication for classic bipolar disorder, also known as Bipolar I.  This condition is characterized by full blown manic episodes, with or without alternating major depressive episodes.  Other forms of bipolar disorder, including Bipolar II (major depressive episodes, alternating with period of hypomania), and rapid cycling bipolar disorder are best treated with an anticonvulsant mood stabilizer, such as Lamictal (lamotrigine). Hypomania is a less severe form of mania.

Bipolar depression usually requires the addition of an antidepressant medication.  Extreme mood states can trigger psychotic symptoms, a break with reality.  In this case, an antipsychotic medication, e.g. Abilify (aripiprazole), may be necessary.

II.  Psychological

From a psychological point of view, bipolar disorder may be viewed as a decreased capacity to regulate emotional states.  Affective self regulation is impaired in people with certain personality structures.  Narcissism is characterized by unstable oscillations between grandiosity and insecurity.  Borderline personalities experience and manifest rapidly shifting, intense affective states.

These personality traits may often be traced back to early childhood experience.  Phyllis Greenacre, a child psychoanalyst, wrote that “the infant is seen in the beam of the maternal pathology.”  Some mothers are prone to have a split perception of their children.  Such mothers (often themselves borderline personalities) will alternately idealize and devalue their children.  These children, in turn, will tend to internalize a correspondingly split view of themselves. With the idealization, euphoria and grandiosity may ensue.  Devaluation of the self will likely manifest as depression.

In a depth psychologically oriented therapy, the therapist takes on the role of a symbolic parent, whose function is to serve as an accurate mirror of the patient’s personality. Tensions and contradictory aspects of the patient’s psyche can be accurately reflected and articulated, without splitting.  This process promotes the integration of the personality, and the stabilization of mood states.

A cognitive behavioral therapeutic approach would help the patient to monitor closely her own thoughts, or self-talk. The patient learns to catch and to correct those thoughts that are either excessively idealizing or devaluing of the self.  Since thoughts are triggers for feeling states, thought correction will tend to minimize excessive mood swings.

III.  Social

Unstable, labile mood states make it extremely difficult to function at work, or to maintain relationships.

Getting help with mood stabilization in a social context is vitally important.  Try seeking feedback from a significant person in your life regarding your behavior, as well as their perceptions of your mood states.  This kind of objective feedback from a trusted friend or family member can greatly help you to become more self aware.

Support groups, and group psychotherapy, can serve a similar function.  A good resource for finding such groups in your area is the Depression and Bipolar Alliance (http://dbsalliance.org).

IV.  Spiritual

There is a Buddhist image of viewing yourself as the host, and your emotions as your guests.  Achieving this perspective will powerfully help you to stay grounded, even in the face of intense oscillating mood states.

Drawing strength from all of these internal and external resources will help you to achieve a level of integration and self awareness that you may never have attained, in the absence of a mood disorder.