Bipolar Disorder: Just Another Manic Monday? How to Tell if You or A Loved One Has Mania

By Tracy Latz

Is There Such a Thing as ‘Manic Season’?

Many of my patients who have been diagnosed in the past with Bipolar Disorder have heard me ask them during their visits with me in the early spring season: “How has your mood been? You know we are now in ‘Manic Season’.”

Mania can actually occur any time of the year if one is given the “perfect storm” of situational stress or sleep deprivation. However, just as depression can often be more prevalent in the darker months of late fall and winter, mania too is often associated with the season of spring with the rapidly increasing length of daylight hours. The decrease in exposure to daylight in the fall/winter months can lead to a decrease in the production of neurotransmitters serotonin and/or dopamine for many sensitive people which can in turn be experienced as depression or anxiety- also known as Seasonal Affective Disorder (see our post on SAD).

The increase in exposure to sunlight in the spring (from about March 1st until about the end of May) can lead to an increase in the production of serotonin and/or dopamine in some sensitive individuals to create feelings of euphoria. This can lead to what many people sense as a slight boost in energy and elevation in mood known as ‘spring fever‘ or it can cause some people to have a more marked increase in mood and energy level known as ‘hypomania‘ that can eventually lead to full-blown ‘mania‘ where a person can then become quite angry or irritable – or even violent. A person in a full manic episode may begin to feel so out of control due to their thoughts or behaviors that they may begin to feel trapped and that suicide is the only way out.

What Are the Symptoms of Mania?

• Experiencing for most of the day (nearly every day) for a period of at least a week of abnormally and persistently elevated/expansive (excessive happiness/joyfulness out of the realm of norm for the circumstances), euphoric  or sudden irritable/angry/hostile mood

• During the period of mood disturbance at least 3 of the following symptoms (4 if the mood is only irritable) have been present to a significant degree:

1. Inflated sense of self or grandiose thinking
2. Decreased need for sleep (feels rested after just 2 to 4 hours of sleep)
3. More talkative than usual or has an internal pressure to keep talking (rapid speech that is difficult to interrupt)
4. Flight of ideas (jumps from one thought to another in an unrelated manner) or a subjective report of the person that their thoughts are racing from one to another
5. Distractibility (attention easily shifted to unimportant or irrelevant external stimuli)
6. Marked boost in energy level/activity (social, work, school or sexual) or significant agitation
7. Excessive involvement in pleasurable activities or risky behaviors that have a high potential for painful consequences (spending money on buying sprees that cannot afford, gambling, high sex drive, sexual indiscretions, or foolish business investments)

• Symptoms have been severe enough to cause marked impairment in ability to function at work or school, in usual social activities, or in relationships with others; or severe enough to be hospitalized to prevent harm to self or others

• Severely manic people can become psychotic (seeing things/hearing things others cannot see, experiencing increasing paranoia, preoccupation with political or religious ideation to the exclusion of usual activities, having an inability to connect thoughts to form intelligible sentences, or believing they have “special powers”)

• Symptoms are NOT initiated and maintained by a known organic cause such as illicit or prescription drugs causing a mood disturbance

Hypomania is a much milder form of mania where there is only mild disturbance in ability to function and there is no psychosis involved.  In hypomania the fast ideas, increased creative bursts of activity, feelings of elevated confidence, boosted sensuality, and euphoria is exciting and the tendency is to want to continue to experience that state of mood.However, it is nearly impossible to “ride the crest of the hypomanic wave” without crashing into either full-blown mania or depression. Many historically well-known artists, musicians and performers have had some of their most creative work manifest during periods of hypomania.

What If I (or my Loved One) Has Bipolar Disorder: What are the Early Warning Signs of Mania?

1. The first thing that I tell my patients or family members of patients to look out for is a decreased need for sleep. It is time to take action (call the treating provider or take something other than alcohol or illicit drugs to assist with sleep) if a person with a known diagnosis of Bipolar Disorder is sleeping 4 hours or less for 3 nights in a row.
2. Stress may trigger mood disturbances – become aware of and monitor for mood changes during periods of time with increased stress. NOTE: Stress may be good (weddings, births, celebrations, holidays, promotions, positive moves, etc) OR stress may be bad (death, loss of job or relationship, divorce, physical illness, surgery, etc).
3. Increased energy or increased talkativeness
4. Increasingly impulsive behaviors

What Can I Do To Help Stabilize My (Or My Loved One’s) Mood?

1. Consider evaluation by a trained mental health professional to discuss the risks and benefits of use of mood stabilizing medication, psychotherapy, or other treatments as well as to assess for suicidal or homicidal thoughts and psychosis.
2. Good, well-balanced nutritional intake with avoidance of highly processed, high sugar or caffeine-containing foods or beverages. A diet with good hydration and a balance of daily essential vitamins, protein, reasonable amount of carbohydrates and omega-3 fatty acids can assist with stabilizing mood.
3. Avoid alcohol or opiates/pain pills (while it may initially cause sedation or drowsiness, it tends to eventually fuel either mania or a crash into depression)
4. Avoid psychoactive substances or hallucinogens- while this may seem obvious at first, I have seen many people who will intentionally use cannabis (pot, marijuana) to attempt to “relax” yet the effect in bipolar disorder actually worsens paranoia or psychosis. I also have seen many bipolar patients who will intentionally us pot, hallucinogens, or speed/cocaine to attempt to get into a hypomanic state in an attempt “feel that good again”.
5. Avoid stress – develop a daily centering practice such as meditation, qigong, yoga or time spent walking calmly in nature. We live in a busy, hectic world and it is important for all of us to become quiet and go within in a mindful, centering manner to restore our inner peace daily.
6. Regular exercise – this helps us burn off excess energy during the day and feel tired at our regular bedtime at night. It can assist with resetting our natural internal biorhythms, including our sleep-wake cycles.

Is Mania the same thing as a Mixed Manic Episode?

No, during a manic episode, the symptoms include only the ones listed in the above “Symptoms of Mania”. During a Mixed Manic Episode, a person experiences symptoms of BOTH depression and mania- which can be confusing to both family members, the person with the symptoms and to primary care physicians who may not have been trained to look for this condition. Often the patient will complain or feeling depressed, yet the family members and the treatment provider who spend an hour with the person will begin to see signs of mania such as irritability, mood lability (rapid shifting from sadness to anger to inappropriate laughter or silly behavior). If asked in an interview, the person will begin to let you know of decreased sleep (4 hours or less per 24 hour period) and other signs or symptoms of mania in addition to depressive symptoms. If the manic side is missed and the person is only treated with an antidepressant, they are at high risk for becoming fully manic and possibly paranoid or psychotic.

Is Bipolar Disorder the same thing as Cyclothymia or Borderline Personality Disorder?

No. Cyclothymia is often considered a milder form of Bipolar Disorder. The hallmark is that for a period of at least 2 years there is a presence of numerous hypomanic episodes and numerous periods with depressed mood or loss if interest or pleasure in usual activities that do not meet criteria for a major depressive episode. The repetitive mood disturbances typically last for only a few days and are not solely attributable to reaction to stress or external stimuli or substances.

Borderline Personality Disorder is not the same as Bipolar Disorder either. Bipolar Disorder is considered a major mental illness while Borderline Personality Disorder is considered to be a “characterological” or personality disorder. I have never liked the term “personality disorder” as it seems to denote an idea that someone has a defective personality. What it really is referring to is a pattern of maladaptive coping strategies and ways of thinking about one’s self and the environment that can cause dysfunction at work, school, in the family, social or intimate relationships. I have seen many people with Borderline Personality Disorder who were misdiagnosed with Bipolar Disorder. You can see mood swings with both conditions; however, the mood swings in Borderline Personality Disorder are short-lived (only lasting usually a few hours and rarely more than a few days) and tend to be due to emotional reactivity to an environmental or relationship stressor.

Hope this is helpful! These are the questions family members and patients most often ask me about Mania, Bipolar Disorder & Borderline Personality Disorder.

Happy (and a Balanced Healthy) Spring to you all!

Tracy Latz, M.D., M.S. (a.k.a. one of “The Shift Doctors”)

- To learn more about “The Shift Doctors”, their books, videos & meditation CD’s visit www.shiftyourlife.com   **The Shift Doctors (Tracy Latz, M.D. & Marion Ross, Ph.D.) are available for keynote talks, classes, events or for seminars (1/2 day or up to 2 day) on personal transformation, team-building, motivation, anger management, intuitive development, or collaboration for private groups, conferences, corporations or corporate events. Contact them at info@shiftyourlife.com or find out more about them at www.shiftyourlife.com .

Source: Shift Your Life

Personality Disorders: How to Deal With a Control Freak

If the person you live with is bossy and domineering, has the last say in everything, refuses to listen to you on each and every occasion you try to make your voice heard, controls all the money in the house, and verbally or physically abuses you (or sulks until you submit to him/ her), then this person is a control freak to an extreme extent.  If they are only some of these things; then, there is room for improvement, if and only if they are willing to get help!

Do you know someone who has to dictate and tell everyone how to do things all the time and control everything around them? How can you deal with them and not let them drive you crazy? Here are some steps that really work.

Steps

1. Understand that control freaks are people who are terrified of failure. They can not trust that anyone will do a better job than they will. It is a personality disorder stemming from childhood that can cause misery in the work place and at home. Most "control freaks" are unhappy and insecure people who don't understand how their words and actions can affect people.

2. Behave consistently calm and patient with them. Getting angry just doesn't work. If it is a personal relationship and it has become abusive-get out and leave. Tell them you need a break from them for now and move on in your life. They will not get better until they seek long term therapy. If it is someone in your family just try to stay out of their way. Sometimes it may seem there is just no pleasing the control freak. They will criticize you on everything and it is very hard not to take it personally. It can make you furious and hurt your feelings.The WORST thing you can do is fight with them because it just wastes your time. They will not and can not change without help. This is their deep seated problem not yours. If you're a teen- try to be agreeable and keep very busy all the time. You can stay away and get out of the house by doing sports or getting really good grades. Tell them you would love to hang out or talk but you are busy with studying, playing, etc. Make up good excuses. Then go out and find really nice people who make you feel good about yourself. Try to have high but realistic goals and achieve them just for YOURSELF. This will also make you happy and content with yourself.

3. Monitor their anxiety levels. A control freak has no coping skills when they are stressed and that is when they run over people. They believe that no one can do as good of a job at something as they will. They will get bogged down because they have taken too much on for themselves and then strike out. Try to be alert to the mood change and be on your toes.

4. Running a business with a "control freak" or with someone who is controlled by a control freak is pure misery as they will reject most or all of your ideas. Don't take it personal-it is not that your ideas are bad but that they did not think of them. Be supportive and positive but understand your voice will not be heard.

5. Stop suggesting new ideas in the workplace if you are an employee. Just keep agreeing with them to keep the peace and try to keep them from getting worried about your end. You may need to reassure them constantly that they are the "boss" and you value your job. If possible start looking for a new job.

6. Realize that your life is important. There are always other jobs and other people to have healthy relationships with. If the situation is intolerable, don't torture yourself and find a way out. No one should be given have the power to "control" your life. It is your life. Don't forget it. For teens, you have to wait until you are at least 18 years old before you can work and be on your own. Or ask your parents to pay for college if they have the money. Apply to colleges that are out of state.

7. Choose to forgive. Control freaks are riddled with fears and insecurities that leave them never satisfied and happy. They demand perfection from themselves and we all know that perfection is not easy to achieve if not impossible. You can leave and find happiness for yourself, they may never find peace in their lives.

8. Start to build your own self esteem. It has most likely taken a hit. Be kind to yourself. If you are under the thumb of a control freak, they might have convinced you that you are worthless to stop you from moving on and leaving them. Don't believe them for one minute. Control freaks like to make people feel insecure about themselves. Don't fall for their tricks. Start to distance yourself slowly.

9. Design a plan to either stay and continue the work/romantic relationship or leave but set a time limit so you will feel you have some control over the matter. If you are living with a control freak, don't think you can change him, you can not. He might get worse as he gets older

   Tips

   • Try to avoid getting in a relationship or working for a control freak if possible. There are red flag warnings that the person is one if they need to insist everything be done only their way, find faults constantly in other people, are not able to relax and let other people take charge of a project. They made need to control your every action in a personal relationship. They can be insanely jealous and possessive for no reason.
   • When dating, make sure you look for the signs. Jealousy and guilt can be a way of controlling people. Control freaks are very good at manipulation as well. Keep your eyes and ears open! Look for any signs.
   • Be wary if he or she wants to do everything for you in a relationship. Drive you, shop for you, etc. Test them by telling them you have other plans for a weekend. If they can't stop calling you and trying to be involved in your life, you have a potential "control freak". Be warned- you are heading for a disaster.
   • It is more important for a control freak to feel they are right about something than the relationship with you. If it is a boss, just agree with them on the small things even if you don't. However don't compromise yourself either by breaking the law or hurting other people. Stand your ground and be the person with morals and values.
   • If you are a teenager and your parent is a control freak-you will have to be very patient and live with it. Try to humor them and get out of the house without ruining your education.
   • They may use emotions to control you eg they may panic about things because this will draw you into their control when you sympathize with them.
   • They may say they care about you and that they only do the things they do because they care, this can make you feel at ease about things and perhaps wonder if you were taking the things they do wrongly (You Are Then Under Their Control).
   • They may make you feel that you are paranoid and indeed it is you with the problem, this can cause your mental wellbeing to be harmed, it is not you with the problem but this tactic may put you off guard which it was designed to do by the controller.
   • Learn how to honestly assess your own strengths and failures, possibly by discussion (privately!) with a third, uninvolved party. Be sure to choose someone who can be trusted with the information, who understands how to deal with similar situations, and knows you well enough to give you accurate feedback. No one is -all- good or -all- bad, everyone has their strengths and weaknesses. When you know the truth about yourself (good -or- bad), you won't be fooled by the control freak's emotional whims and tactics.

Warnings

• Control freaks are very difficult and sometimes even dangerous when they are rejected in a personal relationship. Be very careful in breaking it off with them. If possible, make them break up with you. That way it is their idea and will sit better with them.
• Record any possible threats they make to you if they won't let you get out of a relationship. Then go to the Police. Get a restraining order if possible, although this can sometimes be taken as public humiliation by the person you want the restraining order against. Control freaks could also be dangerous if you challenge or they feel that you challenge their control, losing their control is not an option and they may lash out to regain control or they may become agitated or depressed if they are feeling the control slipping away from them. This can sometimes motivate them to seek some sort of revenge against you to regain a feeling of control over the situation. In the case of the other person seeking some sort of violent contact with you, a restraining order will not prevent them from breaking the law if they choose to do so. The Police may not get there in time to help you, but if the Control Freak is not in your house or placing you in a situation where you are in immediate danger, but is merely harassing you, calling the police is a good idea.
• Move out of town or into a shelter if you feel you are in danger and have no close friends to stay with you. If you do have close friends or family to stay with, it would be wise to make sure that they are able to protect both you and themselves. Ask someone who you feel safe with, and who is willing to stand up to the control freak, and ideally someone who the control freak wouldn't want to get into a confrontation with (i.e. someone they feel they can't control).
• Regardless of personal morals or ideological beliefs, you have a right to preserve your own life, so this is not the time to be shy about firearms or any other weapons as a possibility for self-defense. If you have children that you are running with, you have an obligation to protect them any way you can.
• Learn how to defend yourself. While not every control freak can be moved to violence, the possibility is there. Be prepared.

Bottom-line:  Try not to get into a relationship with a control freak, whether it is personal or business and if you have, get out of it if you can!  The control issues they have and other issues they create to go along with the need to control are their problems, not yours and are not caused by you, just perhaps agitated by you or your behavior.  Control freaks negatively affect themselves and those around them.  They need professional help and must be willing to change. If not you are sentencing yourself or a world of hurt as long as you stay in the relationship!  Perhaps you need to look into your motivations as well!

WikiHow contributed to this article.

Cross-Posted at AskMarion