Tag: bipolar

Popular Psychology

100 Tips for Bipolar Disorder

by Torey C. Richards, LMHCLeave a Comment on 100 Tips for Bipolar Disorder

Introduction

Small things help. When Sir Clive Woodward was asked how England won the Rugby World Cup in 2003 he said “Winning… was not about doing one thing 100% better, but about doing 100 things 1% better”.

Making small changes can really help improve your quality of life as a bipolar sufferer. The cullmative effect of developing a few good habits can help you manage your disorder better and create a more balanced life. Whether you’re just beginning to realise that you have a problem or you’ve been diagnosed for many years, these tips could help you feel just a little bit better everyday.

Some of these ideas will make a lot of sense to you. Some of them you will be doing already. Some will not suit you at all. Start with one or two of these tips that seem achievable, but try to avoid doing it all too quickly as it could trigger an episode.

In a few months hopefully you’ll be doing a number of things 1% better.

N.B. This is a collection of tips gleaned from my own experiences and research. It is not exhaustive or in anyway scientific. You should always consult your doctor regarding your bipolar disorder.

What is Bipolar Disorder?

Bipolar Disorder is a physical disease where one experiences low and high moods. It used to be called manic depression, which is a good title because the disorder is a mixture of mania and depression.

Depression can have the following symptoms:
• Low mood
• Intense sadness
• Lack of motivation
• Crying
• Low self worth
• Low energy
• Disinterest
• Anxiety
• Indifference
• Physical pain

Mania can have the following symptoms:
• Lots of energy
• Rapid speech
• Racing thoughts
• Aggression
• Grandiose ideas
• Self confidence
• Dangerous behaviour
• Irritability
• Anxiety
• Overspending
• Starting over-ambitious projects

A sufferer can also have rapid cycling – cycling through your mania and depression rapidly. This can happen several times a year through to several times a day.

The most dangerous type of Bipolar disorder is the mixed state. It has a very high risk of suicide. Sufferers have the energy and racing thoughts associated with mania alongside the feelings of worthlessness which come with depression.

Sufferers may have periods of feeling fine in between these episodes or it may be a continual cycle.

Go to School

1 Take an online bipolar test.

2 Learn from other people’s experiences.

3 Learn from the experts.

4 Look at websites that offer advice and revisit them from time to time.

5 Get familiar with the symptoms of depression.

6 Get familiar with the symptoms of mania.

7 Get familiar with the symptoms of rapid cycling.

8 Get familiar with the symptoms of the mixed state.

9 Get familiar with what it is like to be fine.

10 Understand that this disorder can make you feel things that are not real.

11 Learn the language of the disorder.

Know Thyself

12 Observe your moods.

13 Record your moods using tracking software, chart or a diary.

14 Identify what feelings are genuine and which are symptoms.

15 Learn your cycles.

16 Get somebody else to give you feedback on your moods.

17 Work out what keeps you calm.

18 Work out what your stressors and triggers are.

Trigger Happy

19 Work out what causes you stress – these factors will be unique to you, don’t worry if they seem petty or weird – you don’t have to tell anybody.

20 Avoid stress as much as you can.

21 Work out what your triggers for going manic are and avoid them.

22 Be aware that your triggers and stressors can change.

23 Allow yourself time to react to things, especially big life events.

24 Avoid stimulants. Smoking, alcohol, caffeine and sugar.

25 If you’re a woman check with your GP that your bipolar is not triggered by your menstrual cycle, if it is then you may be able to reduce your symptoms with medication.

26 Be aware that sexual promiscuity is a symptom of bipolar disorder. Take precautions and stay safe.

27 Avoid recreational drugs and taking over the counter drugs to help with your moods e.g. sleeping pills, St. John’s Wort, antihistamines and painkillers.

28 Try to stay healthy as illness can be a trigger.

29 Avoid going without sleep or sleeping too much.

30 Don’t deliberately make yourself go high.

31 Avoid fighting your depression or trying to avoid it.

32 Be careful when traveling in different time zones. Be aware of the changing seasons and when the clocks go forward/back.

33 Beware that you and those around you may really enjoy your mania and hypomania.

Help!

34 Don’t try to tough it out on your own.

35 Get help as soon as you start getting symptoms.

36 Find a good GP.

37 Get a diagnosis.

38 Communicate with your treatment provider.

39 Take an advocate or loved one with you to appointments.

40 Keep appointments.

41 Don’t skip medication. Take your medication as prescribed.

42 Know the side effects of your medication.

43 Write a list of pros and cons about your medication.

44 Be patient.

45 Get talking therapy.

46 Manage your expectations – there is no magic bullet.

47 Find support support services outside of the medical profession.

48 Be your own advocate.

49 Tell your doctor as soon as you can if you become pregnant and keep in touch with them throughout your term. Some medications are not suitable for pregnant women.

50 Be wary of quick fixes, self help, spiritual and alternative therapies.

Do The Right Thing

51 Try to get the same good amount of sleep every night.

52 Avoid working late or early shifts.

53 Create a good night time routine.

54 Create a good morning routine.

55 Make your bedroom a relaxing place.

56 Give yourself a time out.

57 Create whatever routines you need to get you through the day.

58 Practice meditation or mindfulness.

59 Learn relaxation techniques.

60 If you’re stuck on something don’t force yourself to do it.

61 Don’t hide your feelings.

62 Don’t try to change the way you feel.

63 Have a balanced diet, including Omega 3s and vitamin B rich foods.

64 Go outside at least a couple of times a week.

65 Exercise.

66 Be boring.

67 Take up a hobby.

68 Wash yourself.

69 Relax.

70 Balance work with more enjoyable activities.

71 Find alternatives to self harm.

72 Make your homelife as stable as possible.

73 Don’t avoid people.

74 Cry when you feel like it.

75 Love helps.

76 Breathe.

A Cunning Plan

77 Make a list of symptoms and a plan of action for your family, partner and friends.

78 Plan for mania.

79 Plan for depression.

80 Ask for extra help from family and friends.

81 Make a list of emergency contacts, all medications you are taking, including dosage information and information about any other health problems you have.

82 Make a list of symptoms that you feel would indicate that others need to take responsibility for your care and who those people should be.

83 Decide who is authorised to make decisions on your behalf and inform your doctors.

Straight Talking

84 Find somebody you can talk to about it.

85 Get talking therapy.

86 Tell your story – keep a diary or blog.

87 Join a support group.

88 Connect with people.

89 Ask a loved one to check in with you regularly.

90 Meet new people by taking a class or joining a club.

91 Don’t take it personally if people don’t understand or seem uninterested.

Keep Going

92 You are not alone.

93 Don’t beat yourself up.

94 Don’t apologise for having bipolar.

95 Personal responsibility. Take ownership of your illness.

96 Never think the illness defines you.

97 Don’t underestimate the danger.

98 Remember that it can get better.

99 Remember that one in four people have mental health issues.

100 Don’t give up.

Words and images ©Kate McDonnell 2013.

This article was originally posted on The Bipolar Codex

Popular Psychology

Many Police Shootings Involve The Mentally Ill

by Torey C. Richards, LMHCLeave a Comment on Many Police Shootings Involve The Mentally Ill
Sinuon Pream is pictured in this undated photo. The 37-year-old  mentally ill woman was shot and killed by Long Beach police in January 2017.

Last weekend when I pulled into my driveway I saw an alarming, but not totally unusual sight. My next door neighbor who suffers from a mental illness, was pacing back and forth between my driveway and his, yelling and swearing at the top of his lungs.

I could barely make out what he was yelling about, but I heard a few words that made me think he was venting about some type of unresolved childhood traumas and was clearly off his medications and in a manic state.

He was perspiring profusely and didn’t even acknowledge me when I pulled into the driveway and got out of my car. I didn’t attempt to engage or redirect him because he appeared agitated so I quickly went inside of my house.

For the next hour or so I could hear him yelling. Periodically I looked out of the window and watched him walk back and forth as if he were having an argument with someone who wasn’t there. In the past some of our other neighbors have called the police on him for disturbing the peace and I was hoping that none of them would call the police this time, because as scary and intimidating as this behavior could appear, he was harmless. However, if the police got involved, depending on their approach, I was unsure of how he would react and what the outcome of that interaction would be.

In the best case scenario, the police would come, identify him as a mentally ill individual  and transport him to the mental health hospital which is less than five miles from where we live. Another outcome would be that they would arrest him as they had done numerous times before when he was off of his medication and causing a scene. The worse, and yet what I feared to be a highly likely outcome would be that they would see his manic and agitated behavior as a sign of aggression and use force, perhaps even deadly force on him.

Thankfully, after close to 2 hours of yelling and pacing, he went back in the house and all was quiet again. No one had called the police. No one had gotten hurt.

I woke up the next morning to hear on the news that in the next county over, a mentally ill man was shot and killed by a law enforcement officer after his family called seeking help for him.

Deadly Force and The Mentally Ill

I wrote an article a few years ago about mentally ill individuals and deadly police encounters. Unfortunately, individuals with a mental illness make up a disproportionate number of people stopped, arrested and killed by law enforcement officers.  Research suggests that approximately 25% of the individuals that law enforcement officers encounter have a severe mental illness.

Individuals with a mental illness are 16 times more likely to be killed during encounters with law enforcement compared to the general population.  Some statistics estimate that nearly half of all law enforcement deathly force incidents involve an individual with a severe mental illness.

That is why I was so afraid to call the police to ask for help with my neighbor that night. It’s sad that so many people who need help end up arrested or getting killed by those asked to help them.

Law enforcement officers need to undergo intensive and ongoing training in dealing with mentally ill and unstable individuals and to not always resort to deadly force during these often tense, unpredictable and scary encounters. They could first attempt nonlethal force, verbal de-escalation or calling for more assistance before reaching for their fire arm.

Communities can also increase assess to treatment programs so that individuals are less likely to go untreated and hopefully decrease their chances of having encounters with law enforcement.

When you look into it, the number of mentally ill people involved in deathly police shootings is staggering. No family who calls the police asking for a well-being check on their mentally ill loved one should worry that he or she will be shot and killed by those who are supposed to protect and serve.

Popular Psychology

Micropsychosis: Temporarily Losing Your Mind

by Torey C. Richards, LMHC1 Comment on Micropsychosis: Temporarily Losing Your Mind

loses their minds 

Have you ever heard someone say that they “lost their mind”? Perhaps you’ve even witnessed a seemingly normal person “lose it”, such as the JetBlue pilot in 2012 that had to be subdued by passengers because of sudden, erratic behavior during a flight, or when a flight attendant on an American Airlines flight began speaking erratically over the intercom.

There are multiple medical conditions that can trigger psychotic like episodes such as brain tumors, thyroid conditions, fever, infection and substance abuse. There are also multiple psychiatric conditions that can cause a person to have brief psychosis such as bipolar disorder and major depression.

However, there are times when relatively healthy people can for an incredibly short amount of time, lose touch with reality, becoming paranoid, hearing voices, having a sense of depersonalization (a state in which one’s thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity) or derealization (a feeling that one’s surroundings are not real).

This condition is called micropsychosis and generally last only a few minutes to a few hours and typically occurs during times of heightened anxiety and/or stress. Afterwards, the person goes back to him or her normal self and may never have an episode again. It’s not to be confused with a brief psychotic episode which by definition last longer, typically one day to a month and is not re-occurring.

Micropsychotic episodes are what I think often happens when someone goes into a rage and is seemingly out of control. Afterwards, many of them can’t remember what happened, or feel as if they were watching themselves do things as if it were a movie.

Whenever someone who has never had a psychotic episode suddenly has one, it usually takes them and everyone by surprise, but in retrospect, there is usually some early symptoms that may have gone unnoticed or ignored. Often times it’s the way someone is dealing (or not dealing) with stress.

While having a micropsychotic episode may actually be quite a normal psychological response under some extreme stressful conditions, there is probably some underlying condition that needs to be investigated, even if it’s just talk therapy to help deal with stress or a visit to a medical doctor to rule out a medical condition.

Below is a video of a character with Borderline Personality Disorder and her Micropsychotic hallucination. A funny title for this video would be, “How To Make Your Hallucinations Disappear”.

Popular Psychology

Robin Williams: Depression, Bipolar Disorder, Substance abuse And Suicide

by Torey C. Richards, LMHCLeave a Comment on Robin Williams: Depression, Bipolar Disorder, Substance abuse And Suicide

robin-williams7878It’s hard for many people to understand how someone can be “successful”, and “wealthy” and still be miserable and end up committing suicide, but mental illness and substance abuse doesn’t care about socio-economic status.

There are countless examples of wealthy and famous celebrities who have taken their lives in the face of mental illness and/or addiction. 

Still, many are shocked that someone so funny and loved as Robin Williams, age 63, who’s been battling bipolar disorder, severe depression, drug abuse and alcoholism for a large part of his life, would end up taking his own life. 

For anyone who has ever felt the pain of severe depression knows that once it has a grip on them, it’s almost like being covered in darkness where they can’t see past their failures, no matter how successful they are.

The only thing that they see, hear and think about are their missed opportunities, mistakes and what seems like the bleakness of the future. It doesn’t matter if they are happily married, have accomplished many goals, all they see are their failures. They forget all of their successes and things they should be proud of and just become consumed with feelings of worthlessness, shame and guilt.

When in a deep depression, suicidal thoughts may creep in and become overwhelming to the point where the person feels like they are a burden to the world, especially those close to them. They feel like their spouses, children and friends would be better off without them. Their view of reality becomes severely distorted.

In Robin Williams case, he was married, had children, had a long successful career, was loved by millions, yet he battled addiction, bipolar disorder and depression. At some point in the midst of his depression, the thoughts of being worthless and a burden became overwhelming. 

It also speaks to the point that depression and suicide doesn’t go away at a certain point of wealthiness or happiness. It’s a disease.

Robin Williams is no different than anyone else who suffers from a severe mental illness. About 90% of people who commit suicide have an undiagnosed, untreated or undertreated mental illness. 

Robin Williams was also in the demographic of those highly at risk of suicide which are white, middle aged men with health problems. Robin Williams had been suffering from a heart condition and it’s possible that the thought of losing control of his life, his quality of life or losing his life in general to a physical illness, increased his risk of suicide. 

More than 38,000 Americans commit suicide each year and while depression can last a life time, suicidal thoughts are usually temporary and the act of suicide itself is often impulsive. If we can deter someone from committing suicide they usually will move on from the desire to kill themselves even though the depression continues. 

According to the American Association of Suicidology:

  • 39,518 people died by suicide in the U.S. (2011)
  • 108.3 per day
  • 1 person every 13.3 minutes
  • 3.6 male deaths for each female death by suicide

Comparison to other highly publicized causes of death per year:

  • Homicide 16,238
  • Prostate Cancer 32,050
  • Motor Vehicle Accidents 35,303
  • Suicide 39,518
  • Breast Cancer 39,520

By age:

  • Middle age (45-64 years): 18.6 per 100,000,
  • Elderly: 15.3 per 100,000

*Teens (15-24) is 11 per 100,000*

*The rate for middle aged has been increasing and surpassed the rate for elderly a few years ago*

If you are anyone you know is suffering from suicidal thoughts, the national suicide prevention lifeline can be reached at 1-800-273-8255 or http://www.suicidepreventionlifeline.org

Popular Psychology

Inside The Thoughts of a Cutter: A Poem

by Torey C. Richards, LMHC2 Comments on Inside The Thoughts of a Cutter: A Poem

The other day one of my students who used to cut herself, but hasn’t cut in several months, shared a poem with me she wrote that I thought would be beneficial to share.

I think it gives a quick glimpse into the mind of those who self-injure.

Although she and most of everyone else who was a part of her group I treated for self-injurious behavior have stopped cutting, many of them still fight with the urge to do it when they are faced with certain stressors.

With her permission, I share this poem that has no title.

Depressed and suicidal

Need to escape the misery

Not caring to continue this life

Blood loss has me weary

Scars show my painful past

As the stained blade opens up

Areas of my skin torn and scarred

To be a reminder of a dark past

Mind torn between love and hate

Will I ever be free?

Everyday is a struggle

To be free from this depression

Lost in darkness and misery

Puddles of dried blood stains

From every deep cut that is made

Full of depression and misery

Not worth saving this life of hate.

Abnormal Psychology, Popular Psychology

One Mother’s Experience with Bipolar Disorder and the Importance of Support Groups for Caregivers

by Torey C. Richards, LMHC2 Comments on One Mother’s Experience with Bipolar Disorder and the Importance of Support Groups for Caregivers

The other day I was fortunate to have the opportunity to speak with a former client’s mother about her experiences dealing with her now 19 year old daughter, who was diagnosed with bipolar disorder at the age of 8.

This girl from what I knew of her was extremely unstable, as could be expected from a teenager suffering from bipolar disorder.

Unlike other people suffering from bipolar disorder, teenage girls tend to be even more fickle when you factor in the normal hormones of teenagers as well as social pressures that make even some non-bipolar teens act and feel erratic.

This girl was prone to bouts of depression, mania, impulsivity and explosive anger.

At home her mom had done everything she was supposed to do to support her child including psychotherapy, family therapy and medication, but her daughter was still a hand-full.

When she was in her manic states she tended to have anger directed towards her mother and would at times try to get physical with her and had to be hospitalized several times for suicidal/homicidal ideations.

Her mother tried all she could to pacify her daughter, including painting her room the pretty purple she wanted, only to come home one day and find nearlyevery inch of that wall covered in permanent marker with words directed towards her mother such as “bitch”, “whore” and “I hope you die”.

On top of that she was extremely needy, wanting to be up under her mom 24/7 to the point that she got angry whenever her mom left her and would tear up the house or refuse to go to school.

When she was depressed she would self-mutilate and attempt to kill herself. Her mother would be afraid to leave her alone.

“My biggest fear, even today, is that I will come home and find her dead”, the mother told me.

The biggest thing this mother did that made the most difference was getting educating herself on her daughter’s illness and counseling for herself and joining a support group.

Support groups are invaluable resources that often aren’t utilized enough by those living with or taking care of people with mental illnesses or substance issues.

Through counseling and the support group she learned that she was not alone, that many other parents were on the same roller coaster ride she was on.

She also learned how to change the way she had been dealing with her daughter.

If what you are doing isn’t getting you the results you desire, you have to try something different.

She started accepting that her daughter was going to have good days and bad days, and sometimes within the same day. She also had to understand her role and limitations as the mother of a child with bipolar disorder.

She had to accept that some days she might feel like giving up, or not care when her daughter threatens to hang herself, and that doesn’t make her a bad mother, but it is a sign that she needs to take a break, regroup and seek support herself.

At the end of our reunion I was happy to see that a mother, who just a couple of years ago who was so flustered, angry and exhausted, had turned into a woman not only surviving, but thriving with a daughter suffering from bipolar disorder.

Her and her daughter are doing better, but they are still taking it one day at a time.

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

by Torey C. Richards, LMHC3 Comments on Bipolar Disorder in Children and Adolescents

Often times bipolar disorder is thought of as an illness that effects mostly young adults, and while the average age of bipolar disorder is around the age of 21, younger children and teens can also be effected with the disorder, sometimes referred to as pediatric bipolar disorder.

Working in a high school with students who mostly have anger problems, I hear a lot of them talking about their “mood swings” and some of them even call themselves “bipolar” although they have never been officially diagnosed. But almost everyone has mood swings from time to time, so what exactly is bipolar disorder?

Bipolar Disorder

Bipolar disorder (sometimes called manic-depressive disorder) is a brain illness characterized by episodes of intense mood swings and behaviors known as mania (high energy, elated, impulsive, etc.) and depression that are usually high or low and shift, generally over days or weeks, and sometimes even blend (mixed episodes). It is not the same as the normal ups and down adolescents and teens go through, it is much more severe.

Early onset bipolar disorder happens in adolescence and the early teenage years and may be more severe than bipolar that develops later in life. There was a time in the past when most experts did not believe that bipolar disorder could happen in childhood, but research shows that at least half of bipolar disorder cases start before the age of 25. Children with bipolar disorder often have co-occurring disorders such as attention deficit-hyperactivity disorder and anxiety disorders.

Symptoms

Adolescents and teens exhibiting a manic episode of bipolar disorder may:

  • Feel very happy and act silly in a way that is unusal
  • Talk really fast about a lot of different things
  • Have a short temper
  • Do risky things (i.e. jumping off of things, dashing in front of cars)
  • Have trouble sleeping, yet not feel tired
  • Have trouble staying focused
  • Talk and think about sex more often (if they are sexually active they may actively seek out sexual encounters)
Adolescents and teens exhibiting a depressive episode of bipolar disorder may:
  • Sleep too little or too much
  • Be very sad/depressed
  • Complain about various pains such as stomach and headaches
  • Eat too little or too much
  • Feel very guilty
  • Be overly emotional and/or sensitive
  • Have little energy or interest in doing anything
  • Think/talk about suicide and/or death

Treatments

Treatments for bipolar disorder include medications and psychotherapies including family therapy (it is important that parents taking care of a child with bipolar disorder, just like any other illness, take the time for self-care in order to be healthy and effective caregivers themselves). There is a concern that many children are being over diagnosed with bipolar disorder since in children, bipolar disorder can also look like other disorders such as severe mood dysregulation or temper dysregulation disorder, and some children may not have a disorder at all but be expressing another, normal biopsychological response to life stressors. While there is no way to prevent bipolar disorder, there is ongoing research trying to find a way to delay the onset of symptoms in children with a family history of the disorder.

I currently see 69 adolescents and adults for various reasons and only about three or four I would seriously evaluate for bipoloar disorder and two I have diagnosed with it. One of them is a 15 year old female and her parents are currently in denial of the seriousness of her illness, yet don’t understand why she isn’t getting better although I’ve had to Baker Act (Florida’s statue for involuntary examination of an individual where they are kept up to 72hrs in a hospital for their saftey) due to suicidal thoughts and self-injury. I’ve also referred them repeatedly for medication evaluations, but again, her parents are in denial and think her issue is all behavioral and not a real illness like bipolar disorder. I have another 15 year old girl I diagnosed with bipolar disorder and she is now on medication (Trilecta) and seeing me for cognitive behavioral therapy and is doing a lot better.

Where to go for Help?

As always, your family doctor or mental health professional should be able to direct you to the proper source of help for your child. If not, look up a doctor or mental health facility in your area to have your child evaluated and treated if necessary. If you know someone who is in crisis do not leave them alone, instead get them help, go to an emergency room or call 911 if it is necessary to keep them safe from themselves. If you are in need of help, the same applies and you can also call a free suicide hotline at 1-800-273-TALK (8225). Also, www.thebalancedmind.org . Their “Library” section has terrific information on pediatric bipolar disorder as well as an excellent checklist to help you monitor your child’s behavior.