As you go through your day living with bipolar disorder, internal cues about your mood, energy level, and ability to concentrate influence your choices, even if you’re not completely aware of them. You might get more sleep one night and feel especially energetic at the office, so you start a new project — but don’t credit the extra sleep and stay up late the next night. When it comes to longer-term decisions, we go by a kind of mental averaging about how we usually feel and behave. But we often want to be “better” than how we perceive we are.
If your body cues are extreme, unpleasant, or especially changeable or unpredictable, those decisions are more complicated, explains Elizabeth Brondolo, PhD, a professor of psychology at St. John’s University and author of “Break the Bipolar Cycle: A Day-by-Day guide to Living with Bipolar Disorder.” You may experience big shifts or swings in mood and energy with changes in the season, medication, and small and big stressors — even positive ones like a vacation. These shifts make it “much harder to stick to plans, form new habits, or follow a schedule,” she says. However, she has many patients who have learned to see their shifts clearly and manage them day-to-day.
At least half of all cases of bipolar disorder start before age 25, but some people have their first symptoms as children, while others may develop symptoms late in life. The condition is not easy to spot in the beginning, and many people are misdiagnosed as suffering from depression. They may live with it for years before they get the right diagnosis and treatment.
Adjusting to change isn’t an issue only for people with a diagnosed disorder. The skills Brondolo describes can help all of us live with our changing natures day to day, and as we get older and our circumstances and relationships evolve, sometimes dramatically.
Notice how you respond to light and sleep with the changing seasons. More than half of Brondolo’s patients with bipolar disorder reported a change this past spring. Some had trouble sleeping, others couldn’t concentrate, some became more irritable, others more depressed. How much sunlight you get affects the human body clock, known as the circadian rhythm. It’s possible that people with bipolar disorder have a gene variant related to circadian rhythms. We all need to make sure we get enough sleep and sunlight.
Notice associations with unhappy memories. Let’s say that last spring you fell into an energy slump just when people in your office became excited about baseball season. You began to feel left out. Then a coworker was promoted over you. Now, talk about baseball triggers anxiety that you’re not liked at work. Simply noticing the link can help you calm down.
Notice your self-criticism. Perhaps your fear is realistic — you’ve been avoiding unpleasant tasks and ducking conversations with your boss, who is showing signs of dissatisfaction. Your anxiety could be useful if it helps you buckle down. As Brondolo puts it, we use “satisfaction and pride to push us forward, and trust little doses of negative emotions will keep us on track.” The problem is when we overdose. Let’s say when you run into him in the hallway you have an ordinary conversation but don’t sound as confident as you’d like and say to yourself, “I really messed that up.” People with bipolar disorder can easily put themselves into a paralyzing downward spiral. They need to be gentle on themselves and look for help finding strategies that make it easier to stay on track. This is often true for all of us. Compassion is a better motivator than harsh criticism. Ask yourself, “What do I need to do a better job?”
Notice your self-image. Bouts of self-criticism are often tied to a negative self-image; we criticize ourselves especially roughly at a particular moment because we know (or think) we have a bad record in that area of life. People with bipolar disorder need to be especially careful to develop realistic and positive self-images to guide them and overcome memories of the times their illness led to bad results. Brondolo notes three common paths to negative self-images:
Because of a spell when you had trouble concentrating, planning, and working, you may have come to see yourself as incompetent.
You may have behaved outside your own standards — for example, being unfaithful to a spouse, overspending, or getting into fights — and see yourself as unacceptable.
You may have lost relationships, as we all do. You begin to see yourself as unlovable.
Each of those judgments may be attached to triggers, varying from a note in your mother’s voice, a place, a song, or the draggy feeling at the beginning of a cold. Doing our work competently, meeting our own ethical standards, and cultivating relationships are the tasks of all human beings. So is forgiving ourselves for our failures. See yourself in motion and allow yourself to grow into new, happier self-images, rather than seeing your abilities and nature as fixed from the past.
March 31, 2015
Christopher Nystuen, MD, MBA