Callie Smith | Bipolar Disorder

Bipolar Affective Disorder

“OMG, I seriously think I'm Bipolar!” I’m sure we’ve all heard someone say that. They have mood swings so they assume they MUST be bipolar. We want to take this time to clear a few things up about Bipolar Disorder symptoms and what else might be going on.

Bipolar Disorder Treatment

Bipolar disorder is characterized by periods of fluctuations in mood that range from depression to periods of mania or manic episode. Mania includes things like elevated mood, irritation, speaking at a rapid pace, racing thoughts, impulsivity, reckless behaviours like excessive spending, sexual promiscuity, and lack of need for sleep. These symptoms interfere with work and social life and last from a few days to over a week. Other potential symptoms include:

  • depressed mood
  • environmental factors
  • mood episodes
  • mania and depression
  • major depressive episodes

If you relate to these things, you may want to speak to your family doctor about getting a referral to a psychiatrist, so they can assess if you require mood stabilizers. That being said, some of the signs of mania may actually be more reflective of overactive dysfunctional needs (D.N.s) and the opt-outs that follow. So, what does that look like?

If you are terrified of failure because of how failing would reflect on you as a person, the drive to succeed can become all-encompassing. As a result, you dive headfirst into your work, say yes to everything, work late into the evening, put immense pressure on yourself, feel stressed and overwhelmed, then take it all out on your family at the end of the day. You basically live in a pressure cooker that eventually needs to burst. You may pull back on sleep in favour of work and feel like your thoughts are all over the place.

Cue the opt-outs, these are the great equalizers. So, if we feel mild stress and pressure, we may opt out by zoning out on Instagram and mindlessly stuffing guacamole into our mouths. But, if we feel completely overwhelmed and maxed out then our opt-outs need to match in intensity, so we may spend thousands of dollars on stuff we don’t need, have an affair, and crash so hard that we impulsively and uncharacteristically quit our job.

In other words, what looks like mania, i.e. lack of sleep, racing thoughts, and impulsive and irresponsible decisions, can be a sign that our D.N.s are running wild and unchecked, and are essentially calling all the shots.

Bipolar disorder is uncommon, with around 1.5% of Canadian adults meeting the criteria in the last 12 months, according to Stats Canada in 2012. Another thing that is often happening when someone thinks they “are so bipolar” is that their emotions feel unpredictable/all over the place because their limiting beliefs (L.B.s) are being triggered. When this happens, our emotions can change on a dime and go from 0-100 in what seems like the blink of an eye.

If your “bipolar” looks like the following, you may want to think about checking your L.B.s:

  • You think things are great with your new boyfriend and you have a lovely date, it’s all going good, but then he mentions he has to go to an event with his boys on a night that you tentatively had plans together. You’re suddenly so pissed but because you want to still seem attractive, you do that shut down, “I’m. fine.” thing and silent stew to yourself for the rest of the night. Or, you say screw it and tear him a new one on the spot, then feel immense guilt and shame immediately after.
  • You work your butt off all day to perform at the highest level so you can get that raise and be a solid provider for your family, but you walk through the door at the end of your busy day and your wife has forgotten your dry-cleaning that you need for tomorrow. Your level of frustration goes through the roof like THAT. Does she not know how hard you work and yet she can’t do this one freaking thing for you!?
  • You spend all day cleaning the house and trying to have a nice dinner ready for your husband and when he gets home he innocently asks if you picked up his dry-cleaning like you said you would. Immediately the rage bursts thru your brain. You literally Do. It. All. and are expected to make everything happen without any help but it is NEVER ENOUGH.
  • Or maybe you write out a long and thoughtful message to a friend and all they can muster is an unenthusiastic “thanks.” And you went from loving them to wanting to scream at your phone and never speak to that person again in the matter of one text…

After reading this, if you do think you have bipolar disorder, you should seek a referral from your general practitioner to see a psychiatrist. Otherwise, if you relate to the types of quick and instant mood changes discussed, it is likely that rather than being bipolar, you are experiencing the immediate surge of emotion that comes when our L.B.s are triggered… and that’s where we come in!

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Obsessive Compulsive Personality Disorder

Obsessive Compulsive Personality Disorder (OCPD) is one of the ten personality disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. A personality disorder is an enduring pattern of inner experience and behavior. The ten types of personality disorders are divided into three subcategories, which share some defining features within the subcategory. Obsessive Compulsive Personality Disorder is a Cluster C personality disorder. Other Cluster C personality disorders are avoidant personality disorder and dependent personality disorder. All three of the Cluster C disorders share a common experience of intense anxiety.

In order to meet criteria for a personality disorder, someone needs to show at least two of the four core features. The four core features of personality disorders are (1) rigid, extreme and distorted thinking patterns; (2) problematic and excessively emotional responses; (3) impulse control problems, and/or; (4) significant interpersonal problems. Keep in mind that, when most people read about personality disorders, they identify with some or all of the traits that make up a disorder. It’s not as simple as sharing traits with someone who has a personality disorder — for personality traits to be a diagnosable clinical problem, they need to cause distress or disability. Also keep in mind that, even if you don’t meet the criteria for a mental illness related to personality, you might still want to address some traits that you are finding difficult for yourself or others and a psychologist can certainly help with that! I will be putting together another blog post in the near future that talks about personality in general, so keep an eye out if you are interested in learning more about how psychologists conceptualize personality.

A Note About OCD & OCPD

A significant amount of confusion exists between obsessive-compulsive disorder, and obsessive-compulsive personality disorder. Both can look similar, and make things more confusing, they have very similar names. The purpose of this blog post is not to discuss obsessive-compulsive disorder (OCD) at length. For an in-depth description, see my earlier blog post that examines obsessive-compulsive disorder.

Some differentiating features of the two issues include whether or not the person with the disorder is aware of the issue, and how a person is doing at work. People with OCD are aware that there is an issue and seek help. They often feel tortured by their symptoms — they recognize the obsessions and compulsions are unreasonable and interfere with their lives. On the other hand, people with OCPD often don’t believe there is anything wrong and don’t believe they need therapy — at least, not initially. Clients with OCPD often come to therapy because significant people in their lives are struggling with them or are feeling controlled by their behaviours and rigidity. As these close relationships suffer, those significant people, in turn, will ask the person with OCPD to consider seeking help, or the person with OCPD will attend therapy thinking there is something wrong with the people around them. Often people with OCPD believe their way is the “right and best way,” and feel comfortable with their self-imposed sets of rules and believe others should comply.

When it comes to work and school performance, people with OCD typically struggle in these areas. Compulsions often get people with OCD in trouble at work — taking long periods of time away from their work station, or detracting from a focus on projects to meet. For people with OCD, obsessions also infringe on the ability to focus or effectively do their work. It is also often the case for people with OCD to pick professions which allow them to hide their symptoms better from others to avoid embarrassment. Unlike OCD, work and school performance are typically quite high for people with OCPD. Many of the traits in OCPD, such as preoccupation with details and organization or the need for perfection, translate well in most work settings. It is often the case that individuals who are spending time at work outside of their regular schedule to review their work and make sure it is “perfect” are celebrated and the behavior is reinforced. However, their interpersonal relationships suffer a great deal. This may be due to work/life balance as in the example above, but also typically includes strained relationships with co-workers and managers due to the rigidly high standards people with OCPD hold for themselves and others. Another issue that is common for people with OCPD is an inability to “see the forest for the trees” — they become so caught up in the details that they lose sight of the bigger picture and may spend overtime hours or try to extend deadlines on projects consistently to avoid submitting subpar work.

What Obsessive-Compulsive Personality Disorder Looks Like

People with obsessive-compulsive personality disorder are persistently preoccupied with order, perfectionism, and control of self, others, and situations. This persistent pattern is shown by having four or more of the following:

  • Preoccupation with details, rules, schedules, organization, and lists
  • A striving to do something perfectly that interferes with completion of the task
  • Excessive devotion to work and productivity (not due to financial necessity) resulting in neglect of leisure activities and friends
  • Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values
  • Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value
  • Reluctance to delegate or work with other people unless those people agree to do things exactly as you want
  • A miserly approach to spend for themselves and others because they see money as something to be saved for future disasters
  • Rigidity and stubbornness

Also, these patterns must have begun by early adulthood.

The preoccupation with rules, regulations, orderliness, and perfection sounds great in theory. However, in a person who has OCPD, it becomes so intense that they become very difficult people. These preoccupations come with a need for control which is at the expense of flexibility, openness, and efficiency. The need for control over themselves, others and the environment is driven by a preoccupation with order so behaviors, feelings, and thoughts are consistent with their sense of self. This is where the belief that everything would be fine if people just conformed to their way of doing things comes from. In contrast, someone with OCD will experience their symptoms as inconsistent with their sense of self, leading to a feeling that they are being tortured by their obsessions and compulsions.

What causes Obsessive Compulsive Personality Disorder?

Like most mental health issues, it is difficult to find one specific root cause that is common across all people who have OCPD. However, a number of theories do exist about the sorts of environments and personal characteristics that might predispose someone to develop OCPD. A specific form of the DRD3 gene has been implicated in OCPD, but environmental factors still need to trigger this gene for people who are genetically predisposed to developing OCPD. We subscribe to two theories at shift regarding environmental factors: the role of parenting styles and the role of childhood trauma in the development of OCPD.

A variety of researchers and theorists have drawn conclusions that people with overly controlling or overly protective parents often develop OCPD as a long term response to this parenting style. Additionally, research supports the theory that children who are consistently harshly punished by their parents can develop OCPD traits as a way to try and be perfect and obedient to avoid punishment. In regard to trauma, researchers have examined the development of OCPD traits as a means of coping with the experience of physical, emotional, sexual or other psychological abuse in childhood. One study in 2002 by Aycicegi, Harris, and Dinn identified experiences of psychological control (psychological manipulation and the use of guilt) as a theme in childhood as a unique predictor for the development of OCPD. A controlling parenting style, in the same study, was associated with OCPD as well but was also associated with the development of a broad range of depressive and anxiety issues. If you are interested in reading this study, the reference is attached at the end of this blog post.

How do we Treat Obsessive Compulsive Personality Disorder at Shift?

When we work with people who have OCPD here at Shift, we utilize the Shift Protocol. The Shift Protocol integrates aspects of Cognitive Behavioural Therapy (CBT) and Bi-Lateral Stimulation (BLS) which is the major component of Eye Movement Desensitization and Reprocessing (EMDR). Our goal is to explore with each of our clients the underlying experiences, early in life, which have resulted in specific beliefs about the self, others, and the world. Once we have explored and identified these beliefs, we then work to examine and reprocess these beliefs.

Through reprocessing the underlying beliefs which have been developed in early life and reinforced time and time again throughout life, we can build a better awareness of how an individual with OCPD is impacting the people around them and how the symptoms of OCPD are getting in the way of the person with OCPD creating their custom built and preferred reality. By getting to the root causes, whether they be linked to traumatic childhood experiences, parenting styles, or other causes, we believe that a person with OCPD can live a more intentional life — one less focused on control, perfectionism, and work.