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Treating The Correct Disorder When You Have Bipolar and PTSD

by Kristina Randle, Ph.D., LCSW

My therapists help me to identify long-standing bipolar I but is it possible to have that without having never been treated and never suffered any negative consequences. My manias fueled a high-pressure career and I’ve been able to self-monitor and control my tendencies to overwhelm people with my activity and talkative levels. I haven’t had a depression since 1991 and even though I know that one of my first depressive episodes nearly ended in a psychotic break, I was still able to get through it without intervention. My family says they’ve never had a problem with my behavior. Fast forward I also have a serious PSTD problem from living with violent people for 53 of my 58 years. I’ve had inappropriate adrenaline surges for the past 6 years which have been treated with increasing levels of Paxil (up to 60 mg/day now). I cannot get my therapists to focus of the PSTD problems (flashbacks and nigtmares and severe anxiety) and they want me on an anti-psychotic even though there’s never been any hint of a problem with the Paxil setting off the bipolar. Help — what do I do? I want them to trust me to self-report if I see any bipolar symptoms and not start an expensive drug when I don’t need it right now.

I cannot answer your first question: Is it possible to have bipolar disorder despite not having suffered any negative consequences? I would need more information. It would depend on what you consider to be negative consequences. Without knowing that information, I can only speculate.

It seems as though you perceive your symptoms as being advantageous. You are not alone with your beliefs. You may find the article, “Just Manic Enough: Seeking Perfect Entrepreneurs” (in The New York Times business section), to be interesting. It discusses a very similar point to the one that you are making. It essentially argues that in order to succeed as an entrepreneur, a certain amount of hypermania is necessary.

Many mental health professionals would disagree with the premise of that article. Many of them believe that mania, in all cases, is dangerous and would recommend psychological intervention. I can’t say with certainty but I believe that may be the opinion of your treatment team.

It is common for people with bipolar disorder to report that they like the feeling of mania. Tara Parker-Pope, who maintains the Well blog at The New York Times, featured a number of individuals who were willing to share their experiences with mania. One insightful quote came from Carter Goodwin, a 42-year-old artist with bipolar disorder, who said “I miss the mania…I love the mania. It feels so good to feel like I can do anything and like there is something really special about me. But it’s all chemical. It’s not true.”

Goodwin’s point is an important one. The mania makes him feel as though he has special powers and abilities but it’s a delusion. It’s not real and therefore has the potential to be harmful. To live in a world that is not based in reality is delusional.

Another complication of this situation is that you might have become accustomed to living with your symptoms and now they “seem” normal to you. You may now lack the ability to be objective about your symptoms. Thoughts and behaviors that seem normal to you may not seem normal to your treatment team.

You mentioned two additional issues regarding your treatment team. They do not focus on what you believe to be post-traumatic stress disorder symptoms (PTSD) and they want you to take a medication that you do not want to take. If you believe they are providing you with unsatisfactory service, then you might want to consider seeking a second opinion. If the second opinion is consistent with the first, it could be very telling. A second opinion could also provide information about how next to proceed.

If you’d like to write back and provide more information about how you define negative consequences, in reference to your first question, then I might be able to provide you with a more specific answer. I wish you the best. Please take care.

Dr. Kristina Randle

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