Bipolar Disorder, ADHD and Panic Disorder
Often, you may have a number of symptoms that don’t seem to quite fit into the ‘symptom cluster’ called Bipolar Disorder. These additional symptoms are sometimes indications of co-occurring disorders. Missing these other problems can mean the difference between a full rich life and a life of 'just getting by'. Two other symptoms clusters that co-occur approximately thirty percent of the time include Attention Deficit Hyperactivity Disorder (ADHD) and Panic Disorder. For co-occurring chemical dependency please see Bipolar Disorder and Drug/Alcohol addiction.
When you experience both symptoms of ADHD and Bipolar Disorder you may find that you struggled in elementary school and then new symptoms or at least a worsening of previous symptoms appeared in your junior high or early high school years. It can be difficult to discern as the full spectrum of Bipolar symptoms often don't become evident until one's early twenties. Also some struggle with exaggerated symptoms of 'the terrible teens' (a take off of 'the terrible twos!) that resolve in their twenties. Also, the symptoms of ADHD often become worse with the increasing academic and social expectations of junior high and high school. Frequently this is when women first notice their difficulties with ADHD.
Please keep all of this in mind as a you may not fully respond until both tendencies are addressed in a wholistic fashion. My main tip here would be the day to day consistency of symptoms of ADHD and their reactive pattern. While in Bipolar Disorder there exists a degree of reactivity but day to day unpredictability is the name of the game. For example, family members of someone with ADHD will often say, "its always the same struggle every morning" while with Bipolar Disorder the comments are more like, "I never know how the day will begin, some days we're OK and other days..."
Please understand, the people who know and love us often know more about how we are doing than we do. We can add what they notice to what we notice about ourselves and take advantage of both sets of information!
Bipolar Disorder, Obsessive Compulsive Disorder and Eating Disorders
During the early teen years, eating disorders and Obsessive Compulsive Disorder (OCD) can creep in. Clinicians may miss these disorders in the drama Bipolar Disorder can create in your life. Often, the obsessions of OCD and eating disorders carry a feeling of shame. While you may freely discuss your Bipolar highs and lows, very simple obsessions may fill you with shame particularly when initially seeing someone.
Clinicians don't expect anyone to share all of their life events on the first visit. It takes time for trust to form. I encourage you to share as much as you can to avoid slowing down your progress or possibly ending up with answers that don't work for you. I also encourage you share of ‘the rest of the story’ as your relationship with your therapist becomes more comfortable. Knowing that it is normal for a person to leave out some details of their story may led your therapist to repeating some of their questions as time goes by. Often others never mention any of these unless we specifically ask.
Your therapist may even sense that there may be more that needs to come out. Often, however, they will allow you to take the time you need to feel comfortable. This allows yet another layer of trust to form and is a sign of a solid relationship. (As long as you feel you will be able to eventually be able to get it all out on the table!) If you feel otherwise please let your therapist know. They can then help to find another therapist who you may feel more comfortable with. No therapist, no matter how skilled, can help everyone and we know that and won't be offended.
Bipolar Disorder and Panic Disorder
A diagnosis of Panic Disorder can be very tricky to make in this situation. The question will be, "Are these true panic attacks or are these symptoms of a mixed manic episode?" Again, both conditions may require treatment that may differ substantially. To receive help for Bipolar mood swings only to be stuck in your home due to untreated panic disorder with agoraphobia would not likely be considered an optimal outcome!
Another problem is the opposite issue. Say you believe you are having panic attacks and are being treated with cognitive behavioral therapy (CBT) and an antidepressant. Again, are these panic attacks or mixed manic episodes? If this is Bipolar Disorder we have not only missed the diagnosis, we are prescribing a medication that will likely make the Bipolar symptoms worse. One place to look carefully investigate is your family history. If you have Bipolar Disorder there is likely a more substantial family history of people with similar issues although a formal diagnosis may not have been made. Bipolar Disorder is approximately 85 percent heritable while depression, Generalized Anxiety Disorder and Panic Disorder fall in the 40 percent range.
Next you can look at the episodes themselves. How long do they last? Panic attacks usually last a few minutes to a few hours followed by a general sense of foreboding. A mixed episode is usually one to several days although not always. Another question to ask yourself is when did they start? Bipolar Disorder usually begins in some manner in the early teens. Panic Disorder usually begins in the later teens and twenties. Carefully consider all of the symptoms of a mixed manic event. A mixed event is more about pressured thought and speech which is usually qualitatively different from even stark anxiety. If you still can’t tell, then consider looking into medical treatment for your Bipolar Disorder at least at first and cover both illnesses in your psychotherapy. Please also realize that these two symptom clusters co-occur approximately 30 percent of the time. Make sure that you and those who support you are all on the same page allowing everyone every opportunity to deal effectively with these symptoms...and thrive! (By the way...Do you want to know the best way to prevent relapse?...Grow your love and compassion for yourself and all those you share you life with!)