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Q: Frequency of Cycling
In the interview of Jane Pauley she was describing her rapid cycling
as occurring one or more times during one conversation. I've always kinda
thought that was what was happening but I've never heard it described by anyone
else in that manner or even in a diagnostic manual. Does it really happen
that way? Also, Jane said she was diagnosed as having Bipolar III which to
my knowledge is not a DSM IV diagnosis. Is that a legitimate diagnosis or
just an easier way of describing hypomania that occurs as a result of taking
SSRI's?
Dear Ms. S' --
Interesting. Cycling occurring one or more times in a conversation? You know
there are psychiatrists out there who have trouble swallowing the idea of "ultradian
cycling", a non-DSM term meaning more than one mood cycle within a day. So to
be sure there are people who would wonder if "within a conversation" could be
truly a "bipolar" phenomenon.
The description I like best of what it's like to have
bipolar mood/energy instability is from Kay Jamison, Ph.D., who wrote, with
Frederick Goodwin, the "bible", Bipolar Disorder, back in 1990; and who
has bipolar disorder herself. Here's how she describes the pace and quality of
mood shifting:
"The clinical reality of manic-depressive illness is
far more lethal and infinitely more complex than the current psychiatric
nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and
energy levels serve as a background to constantly changing thoughts,
behaviors, and feelings. The illness encompasses the extremes of human
experience. Thinking can range from florid psychosis, or "madness," to
patterns of unusually clear, fast and creative associations, to retardation so
profound that no meaningful mental activity can occur. Behavior can be
frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish,
and dangerously suicidal. Moods may swing erratically between euphoria and
despair or irritability and desperation. The rapid oscillations and
combinations of such extremes result in an intricately textured clinical
picture."
(Notice how I ducked the question. Deliberate. How
would one "really" know? The alternative explanation is usually that a person
who might experience such fluctuations has a personality disorder (a term I
hate), primarily "borderline", and that's why they are so mercurial. The
distinction between bipolar and borderline gets pretty thin in most spots, as
discussed in this essay on
borderline and
bipolar disorder.
Secondly, is "Bipolar III" a legitimate diagnosis or
just an easier way of describing hypomania that occurs as a result of taking
SSRI's? You're right that it describes hypomania occurring only in the
context of an antidepressant, and that it is not an official DSM diagnosis. But
it is fairly widely recognized as a description, thus perhaps "legitimate"?
Ms. Pauley's courageous public declaration of her
bipolar disorder is worth being aware of, as she is one of the most high profile
and current figures to risk breaking the stigma barrier. Thanks for bringing it
further attention.
Dr. Phelps
Published December, 2004
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