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Information about bipolar disorders

What is a bipolar disorder?

Everybody knows about mood swings. There are days on which one finds oneself in a depressed mood during which everything appears exhausting and one’s self-confidence is “dented”. In times in which for example one is in love on the other hand one feels elated and euphoric; everything is done without any trouble in an easygoing and happy mood.

In bipolar or also manic-depressive disorders these mood swings go far beyond the normal extent and are independent of the life circumstances. The mood swings range from very depressive to very manic with all characteristics lying between these extremes. Symptoms of mania are e.g. an intensive feeling of elation and self-confidence, a clearly increased efficiency and productivity, reduced sleep requirement and sleeplessness, invasiveness or talkativeness in contact with other people. Symptoms of depression on the other hand are an increased feeling of sadness, lack of drive, lack of interest in things that would normally make one happy, a tendency to brood constantly, pessimistic thoughts about the future, sleep disorders, waking up early in the mornings and an increased sleep requirement.

The persons afflicted feel themselves at the mercy of their mood swings and feel that these are too difficult to influence, particularly in the initial stage. The repeatedly occurring manic-depressive phases often lead to considerable suffering both in the person afflicted him / herself as well as in the people in their surroundings.

Listed below, some particular aspects of the bipolar disorder as well as their particular dynamism are described. Afterwards, these are followed by manifestations and background.

Particular aspects of bipolar disorders

  • Loss of sense of time: Unlike general mood swings, in bipolar disorders the sense of time can be lost. The depression appears interminable and inescapable, was always so and always will be; correspondingly, the desperation is unending. The mania is experienced as a source of inexhaustible energies; correspondingly, overestimation of one’s capabilities and risk-taking behaviour become boundless. The real vicissitudes of the disorder cannot be perceived.

Therapy must achieve the almost impossible feat of conveying hope without superficially reassuring the person affected, for that would rightly be perceived as ridicule. It must give back the sense of time. As a matter of course, this works better in self-help groups or in special group therapies: in other patients, the phase that they are particularly suppressing just now remains visible. Through the arrangement of the polarity more mobility with a tendency to the centre becomes possible again.

  • Problem of overconformity: Persons with bipolar mood disorder tend to appear overconformed on closer inspection. In their socialization they have learnt to satisfy the expectations of others and accept the standards of others undiscussed. They make every effort to please everybody. Their own standards are mostly unconscious and conflict strategies are underdeveloped. The depression makes this dilemma self-evident and sharpens it almost like a caricature of itself. The mania appears as an escape attempt in the direction of unconventionality, yet the liberation cannot be really fulfilled and is caught up with by the disorder.

The task of long-term therapeutic care is consequently not to make perfect the conformity but to help develop one’s own standards, question other person’s expectations and accommodate unusual aspects or wishes in everyday life instead of always retaining them for the mania.

  • Significance of the feeling of self-worth: People with bipolar disorders have a life history just like other people. Their phases have a start and an end – with or without treatment. Their symptoms have a developmental history – as well as the resources and coping strategies available. Perhaps the somewhat simplified comparison with bank accounts is helpful: anyone who has money on their savings account can overdraw their current account without running into trouble. Anyone who has used up the reserves no longer has any credit. And anyone who overdraws must pay high interest payments. The feeling of self-worth must be used as currency. It goes without saying, ego-strengthening experiences, love and affection and self-esteem promoting events have a protective effect and the opposite are harmful. These effects are not restricted to any phase of life and also not to the time up to the onset of the disorder. They are relevant to the treatment of the disorder, which is why it is already astounding how very little we sometimes manage to avoid personal offences in and through treatment.

The primary task of acute and long-term treatment is to avoid new personal offences and help to handle old ones, to exercise and incorporate resources and ensure and support individual family / social resources.

  • Interactions: Obviously, there are differences in the way in which we develop or lose feelings of self-worth: many persons are nervous more quickly when their account is overdrawn; others manage to gamble successfully. The emotional battery can empty and fill up more quickly or slowly. The feedback from social perceptions, emotional processing and control of the drive can take place more or less directly. Correspondingly, the range of one’s own emotionality and susceptibility to distinct phases grows. Persons with bipolar mood disorders not only take personal offence more easily, they also have or develop a highly sensitive perception and react more quickly using their entire energy balance.

The treatment must sensitize the person affected for these interactions so that the possibility of self control is strengthened.

  • Typical thought patterns / psychic momentum: Depressive thought patterns lead to significant distortions of perception of the one’s own and another person’s accomplishments: disappointments are attributed to one’s own personality, successes to others. Plans lead almost inevitably to failure. The anticipation of defeats feigns sovereignty and yet always leads to desperation. In manic phases similar distortions have an effect in the opposite direction.

It is important to reverse this mechanism: with perseverance and calmness, the first therapeutic steps must always be challenged until they are so small that success is inevitable. In this regard, the involvement of other persons afflicted in the group setting is helpful.

  • Social interactions: Bipolar disorders affect and put a strain on the close relatives to a high degree. This applies to parents and siblings as well as compared with schizophrenic psychoses cumulatively also to partners and children. While the patients are torn between highs and lows, in particular the relatives stand in the force field of closeness and distance: How can I protect myself? What distance do I need in order not to endanger my own love? What closeness can I still tolerate?

Relieving the relatives (individually or in groups) also has a therapeutic effect for the patients. Work with patients with bipolar mood disorders without taking into account the relatives (separately or jointly) is a medical malpractice.

  • Somatic momentum: That the cerebral metabolism is involved in extreme mood swings should not be a great surprise to anybody, for this applies to all emotional states and actions. Alone, it can explain them just as little as for example amorousness. In the meantime, it has even been demonstrated that the changes in serotonin are rather the consequence of privations and frustrations, however with a possible tendency to increase the sensitivity to subsequent occurrences (Aldenhoff 1997).

With the concept of the “biological scars” drug-treatment strategies can also be better substantiated than with the all too simple and false image of direct causality. At the same time, the patent and the therapist remain obliged also to reflect on more complex backgrounds as well as individual and social resources. The drug treatment is complicated enough anyway: antidepressants do not always work and not immediately, they increase the risk of suicidal tendency in the short-term and the risk of a swift (change to mania) in the long-term. Phase prophylactic agents do not save at least half of the patients from relapses and antimanic neuroleptics, even stronger than other substances, have even significant side effects. All together therefore have to grapple with acceptance and cooperation problems. It is all the more important to incorporate and integrate the drug treatment into an overall psychotherapeutic culture; without this, although necessary, they are very difficult to assume responsibility for.

  • Interactions: The distinction between endogenous (internal), exogenous (external) and reactive states was for good reason abandoned; in a varying degree of emphasis, these factors are always represented. Moreover, we know in the meantime very much more about their interactions: psychotherapy also influences many essential physiological variables. Even the genes do not have a deterministic effect, do not determine the person but underlie complex physiological processes, also react to environmental conditions and can be "awoken" in their effectiveness through life crises.

The interaction between psychic, social and somatic factors is so complex that monotherapies can hardly still be substantiated.

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