Three Threads from the Bipolar Fabric of Life

For those living with bipolar disorder, the first few years post-diagnosis can be some of the most difficult in terms of one's relationship to the disorder. Beyond the necessity of initial symptom management, the process of accepting and coming to terms with the reality of one’s bipolar disorder is among the more difficult tasks to be faced.

For most this is a gradual process. Two years post-diagnosis individuals are usually more accepting than they were on day one. At five years, there's generally a stronger degree of positive adaptation, and so it goes throughout one’s future with the illness; though certainly, there are those whose struggles to find acceptance can be ongoing.

For those who do strive to live well with bipolar disorder, there are significant challenges that lie beyond issues of acceptance. A salient one involves learning to identify the unique symptom pattern of one’s own illness.

If I were to ask the newly diagnosed person, "What do your bipolar symptoms look like?" he or she may not yet know the answer. However, several years into the illness, that same individual will have a much more textured sense of how mood instability is experienced across the mood continuum.

If you look at the American Psychiatric Association's Diagnostic and Statistical Manual 5, you’ll find a broad list of symptoms that typically present during major depression, hypomania, and manic mood episodes. But these aren’t person-specific. Elevated energy doesn’t describe what “your” elevated energy is like. The same applies to symptoms such as racing thoughts, distractibility, increased goal-directed activity, impulsivity, irritability, etc. These are very general terms. Only you will be able to identify your unique and specific bipolar symptom set.

Why is it so important to be able to identify one’s own bipolar symptoms? If signs of symptom onset are noted early enough, individuals are more able to take necessary steps towards addressing emerging symptoms that may herald mood destabilization. Once early symptoms progress beyond mild to moderate acuity it becomes more difficult to get back to baseline. If increased energy, strong optimism and lessened need for sleep are early signs of one’s emerging hypomania, then their presence should serve as an alert — "a call to action," so that one can take steps to limit the impact of a mood shift.

A very different reason for improving one’s awareness of mood symptoms involves the importance of distinguishing that which reflects one's bipolarity vs that which reflects mood and thought processes that are separate and distinct from one’s bipolarity.

For those who are relatively new to the bipolar landscape, a predictable response to this last statement may be something like... “you mean, my bipolar illness isn’t the cause of most of my difficulties?” The answer here, for many, is … probably not. It’s just one of three different threads that combine to make up the fabric of a bipolar life.

Bipolar disorder creates shifts in mood, energy, emotions, thought processes and behaviors. Sometimes these shifts occur without any situational precipitants. They just seem to come out of nowhere. It's difficult to see any clear causal relationships between what's happening on the outside vs what's happening internally. In fact, this is one of the key features that differentiates bipolarity from several other disorders. Simply put, the bipolar brain sometimes has difficulty maintaining continuous stable mood. This is the first, and the most essential, of the three threads associated with bipolarity.

A second thread involves the strong influence of personality, an area I perceive as receiving inadequate attention throughout much of the bipolar literature.

Think of the broad range of individuals that don’t necessarily carry a psychiatric diagnosis. For some, their mood can remain relatively stable over time. They don’t struggle with strong emotions that create uncomfortable mood intensity. I suppose most would view this as desirable, unless of course, you’re someone who perceives quality of life as entailing a high degree of mood intensity.

But I think we’d also agree there are a fair amount of people who do live with strong mood intensity, much of which is not necessarily experienced as “desirable.” People are angry, irritable, needy, gloomy, anxious, worried, driven to achieve, preoccupied with physical appearance, strongly emotive, impulsive, arrogant, etc. At least as pertains to Western culture, our population is not an aggregate of people that live with a high degree of peace and contentment. My point is that personality, or the aggregate of one’s psychological processes, is complex, often intense, and ubiquitous in its impact upon “how we are” in the world.

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Indeed, personality has an integral role in its contribution to an individual’s evolving mood states. And ... there’s some really good news here: While we don’t have a cure for bipolarity, basic aspects of personality are changeable over time, particularly for those with strong motivation towards change. In fact, personality can and often does change and evolve as a function of maturation, which can continue across the entirety of one’s life cycle. But beyond maturation, substantive shifts in “how we are” can occur through strong commitment to self-awareness, personal growth and even psychotherapy. We’re not just stuck with our enduring patterns. We all represent “works in progress.”

And the third thread? It’s actually the most obvious: It’s the environment.

Those who live with bipolarity typically have a low reactivity threshold in relation to situational stress. With enough sustained stress, healthy patterns of living become disrupted and mood stability slips away. Instead of mood changes without situational precipitants, we see mood shifts that are absolutely brought about by environmental stresses. Reality is that bipolar disorder usually represents a mixture of mood shifts that are understood as reflecting situational influences as well as those that occur in the absence of situational or environmental factors.

To summarize, at any given point in time, individuals living with bipolarity may be affected by 1) endogenous neurochemical changes, 2) exacerbations of mood and emotion brought on by the role of personality, or 3) strong degrees of stress upon the mind and body as a function of the surrounding environment.

Now, it’s important to recognize that we rarely get to observe experience that’s sufficiently unidimensional as to reflect the isolated factors identified in the previous paragraph. Indeed, those different threads are synergistically interacting much of the time. They don’t exist in isolation and the broad picture, reflecting their interactive outcome, is what those with bipolarity are dealing with much of the time.

So, what's the point? Why conceptually delineate things that don't have impact in isolation from other factors?

The answer is that by better understanding the separate components of experience, one can gradually become more skilled at disentangling the threads that comprise the fabric of a bipolar life. The more one has clarity about the origins of what's happening, the more one can develop strategies for stabilization, which are essential for living well with bipolarity.