Sanctuary for the Abused
Saturday, August 22, 2020
Misdiagnosing Narcissism (BiPolar I)
Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.
The manic phases of the Bipolar Disorder, however, are limited in time - NPD is not. Furthermore, the mania is followed by - usually protracted - depressive episodes. The narcissist is also frequently dysphoric. But whereas the Bipolar sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - the narcissist, even when depressed, never forgoes his narcissism: his grandiosity, sense of entitlement, haughtiness, and lack of empathy.
Narcissistic dysphorias are much shorter and reactive - they constitute a response to the grandiosity gap. In plain words, the narcissist is dejected when confronted with the abyss between his inflated self-image and grandiose fantasies - and the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. Yet, one dose of narcissistic supply is enough to elevate the narcissists from the depth of misery to the heights of manic euphoria.
Not so with the Bipolar. The source of her or his mood swings is assumed to be brain biochemistry - not the availability of narcissistic supply. Whereas the narcissist is in full control of his faculties, even when maximally agitated, the Bipolar often feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her attention span (distractibility), and his/her motor functions.
The Bipolar is prone to reckless behaviors and substance abuse only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors both when elated and when deflated.
As a rule, the Bipolar's manic phase interferes with his/her social and occupational functioning. Many narcissists, in contrast, reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of narcissistic supply usually put an end to the narcissist's career and social liaisons.
The manic phase of Bipolar sometimes requires hospitalization and - more frequently than admitted - involves psychotic features. Narcissists are never hospitalized as the risk for self-harm is minute. Moreover, psychotic microepisodes in narcissism are decompensatory in nature and appear only under unendurable stress (e.g., in intensive therapy).
The Bipolar's mania provokes discomfort in both strangers and in the patient's nearest and dearest. His/her constant cheer and compulsive insistence on interpersonal, sexual, and occupational, or professional interactions engenders unease and repulsion. Her/his lability of mood - rapid shifts between uncontrollable rage and unnatural good spirits - is downright intimidating. The narcissist's gregariousness, by comparison, is calculated, "cold", controlled, and goal-orientated (the extraction of narcissistic supply). His cycles of mood and affect are far less pronounced and less rapid.
The Bipolar's swollen self-esteem, overstated self-confidence, obvious grandiosity, and delusional fantasies are akin to the narcissist's and are the source of the diagnostic confusion. Both types of patients purport to give advice, carry out an assignment, accomplish a mission, or embark on an enterprise for which they are uniquely unqualified and lack the talents, skills, knowledge, or experience required.
But the Bipolar's bombast is far more delusional than the narcissist's. Ideas of reference and magical thinking are common and, in this sense, the Bipolar is closer to the Schizotypal than to the Narcissistic.
There are other differentiating symptoms:
Sleep disorders - notably acute insomnia - are common in the manic phase of Bipolar and uncommon in narcissism. So is "Manic speech" - pressured, uninterruptible, loud, rapid, dramatic (includes singing and humorous asides), sometimes incomprehensible, incoherent, chaotic, and lasts for hours. It reflects the Bipolar's inner turmoil and his/her inability to control his/her racing and kaleidoscopic thoughts.
As opposed to narcissists, Bipolar in the manic phase are often distracted by the slightest stimuli, are unable to focus on relevant data, or to maintain the thread of conversation. They are "all over the place" - simultaneously initiating numerous business ventures, joining a myriad organization, writing umpteen letters, contacting hundreds of friends and perfect strangers, acting in a domineering, demanding, and intrusive manner, totally disregarding the needs and emotions of the unfortunate recipients of their unwanted attentions. They rarely follow up on their projects.
The transformation is so marked that the Bipolar is often described by his/her closest as "not himself/herself". Indeed, some Bipolars relocate, change name and appearance, and lose contact with their "former life". Antisocial or even criminal behavior is not uncommon and aggression is marked, directed at both others (assault) and oneself (suicide). Some Bipolars describe an acuteness of the senses, akin to experiences recounted by drug users: smells, sounds, and sights are accentuated and attain an unearthly quality.
As opposed to narcissists, Bipolars regret their misdeeds following the manic phase and try to atone for their actions. They realize and accept that "something is wrong with them" and seek help. During the depressive phase they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).
Finally, pathological narcissism is already discernible in early adolescence. The full-fledged Bipolar Disorder - including a manic phase - rarely occurs before the age of 20. The narcissist is consistent in his pathology - not so the Bipolar. The onset of the manic episode is fast and furious and results in a conspicuous metamorphosis of the patient.
More about this topic here:
Stormberg, D., Roningstam, E., Gunderson, J., & Tohen, M. (1998) Pathological Narcissism in Bipolar Disorder Patients. Journal of Personality Disorders, 12, 179-185
Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis I Disorders. Harvard Review of Psychiatry, 3, 326-340
Labels: bipolar, cold, compulsivity, cycling, mental disorder, mood swings, narcissism
Friday, December 16, 2016
Bipolar Disorder: Signs, Symptoms and Treatment
Bipolar Disorder: Signs, Symptoms and Treatment
What is bipolar disorder?
Bipolar disorder (formerly known as manic-depression) is a condition in which a person typically experiences dramatic "mood swings" from periods of extremely elevated moods (mania) to extremely low moods (depression). In most cases, bipolar disorder first appears in young adults, but children and adolescents might also suffer from this disorder.
What are the signs and symptoms of bipolar disorder?Bipolar disorder is characterized by two extremes - the polar opposites that give the condition its name.
Signs and symptoms of the manic phase (Bipolar I):
- euphoria, feeling "high"
- agitation, edginess, irritability, restlessness
- racing thoughts, talkativeness
- increased energy, sleeplessness
- inflated self-esteem; grandiosity; poor judgment
- reckless spending sprees or other activities with high potential for painful consequences
- delusions or hallucinations
- drug or alcohol use
- increased sexual drive
- aggressive behavior
- inability to concentrate well
- Hypomania (Bipolar II) refers to an episode with less extreme symptoms than full-blown mania.
- Although bipolar disorder can be diagnosed from just a manic episode, most persons with this disorder also experience the other extreme, depression.
Signs and symptoms of the depressive state:
- abnormally low mood
- sadness and hopelessness
- excessive feelings of guilt and worthlessness
- difficulty concentrating or making decisions
- changes in appetite or weight (increase or decrease)
- fatigue; changes in sleep patterns (increase or decrease)
- loss of self-esteem
- diminished interest in daily activities
- withdrawal from others
- drug or alcohol use
- suicidal thoughts, plans or attempts.
- A person diagnosed with a Bipolar III condition is identified as "unipolar." He or she experiences recurrent episodes of depression only, but has a family history of mania or hypomania.
What is the typical course of bipolar disorder?There is no standard presentation for bipolar disorder. Some people have relatively few or mild episodes. Others may experience rapid cycling (four or more episodes within a year). People can also experience a mixed state, where symptoms of both mania and depression are present at the same time.
What causes bipolar disorder?
Abnormalities in the brain
The cause of bipolar disorder is under investigation, but there are strong indications that it is a brain-based disorder. It seems that several factors act together to produce the illness. Possibilities include:
- an imbalance of neurotransmitters
- a genetic disorder
- a dysfunction in the mitochondria (see link "Cellular Bipolar Breakdown Lane")
- Other triggers
When an individual is predisposed to bipolar disorder, an episode can be triggered by:
- a major life event
- stress in large doses
- an antidepressant medication
- seasonal fluctuations in light (mania is more prevalent in summer, depression in spring, fall and winter)
- sleep loss
How is bipolar disorder diagnosed?There is no specific diagnostic test for bipolar disorder. It is identified by behaviors often first noticed in adolescence and early adulthood. Symptoms of bipolar disorder may be similar to those of other conditions, such as schizophrenia, other anxiety or depressive disorders, or alcohol or drug abuse.
In children, bipolar disorder may appear similar to temper tantrums, ADHD, or oppositional or conduct disorders. A psychiatrist is the most likely medical doctor to determine the correct diagnosis.
An accurate diagnosis is important because the use of the wrong medication sometimes can lead to more serious symptoms. A medical evaluation should include an assessment of thyroid and kidney function.
How is bipolar disorder treated?
The good news about bipolar disorder is that it is treatable. Proper treatment can help reduce the frequency and severity of episodes and can help people who have the disorder maintain a good quality of life. Without treatment by a psychiatrist experienced with this condition, however, the symptoms can become more severe. But each person is unique. A treatment that works for someone else may not work for you. Although this can lead to heartbreaking rounds of hit-or-miss therapy, there are so many treatments and combinations to choose from that there is bound to be something that is right for you.
Medications may not be the total answer, but they can get you on your feet again and help prevent relapses. It is best to view them as one part of the treatment and wellness equation.
Treatment of bipolar disorder usually includes a combination of approaches, such as:
- medication (mood stabilizers, anti-depressants, and/or anti-anxiety medications)
- cognitive behavioral therapy (to challenge and change negative thought patterns and inappropriate behaviors)
- psychoeducation (learning about the illness and its treatment; recognizing and preventing relapse)
- family therapy (to help family members cope with and manage the stress of bipolar disorder)
- social rhythm therapy (to improve interpersonal relationships and to regularize daily routines, to avoid manic episodes)
- ECT (electro-convulsive therapy, sometimes used when other treatments are unsuccessful, to "re-set" the brain's electrical system)
- nutritional supplements (under investigation to determine if they can help alleviate or prevent bipolar episodes)
One challenge in treating bipolar disorder is that the person often enjoys the excitement of the hypomanic or even the manic state, and does not want to give up those feelings to a medication that will level off moods and may have troublesome side effects. In addition, many people are in denial of the problem, or feel stigmatized about having a "mental illness" and refuse to acknowledge the need for treatment. Education about the cause, consequences, and treatment for bipolar disorder can help these individuals:
- come to terms with the condition
- recognize symptoms when they appear.
- Practical suggestions from families
- Encourage the person with bipolar disorder to maintain a strong support system of family members and friends and to use it whenever he or she needs help.
- Be a loving, caring family member or friend yourself.
- Help the individual find ways to distract or engage him- or herself when the red flags of depression go up, e.g. play a sport, work out, go to a movie, visit a friend.
- Try to convince the individual to stay on medication and point out symptoms as they begin to emerge.
Labels: abusive, aggressive, bipolar, conspiracy, delusions, happy, irritability, mania, neurological, odd beliefs, sad, sleepless
