So many of my bipolar symptoms were easily overlooked or explained away, delaying my diagnosis for years. Here’s how my mania and bipolar depression were masked by happenstance and circumstance—and what I learned from it all.
The Problem of Diagnosis for Bipolar
It seems the main difficulty in diagnosing bipolar disorder and other mental illnesses is that there’s no objective standard for diagnosis—we can’t take a blood test or have a scan performed that immediately gives us an accurate diagnosis (and therefore options for treatment). When it comes to diagnosing a mental health condition, doctors must rely on our current, observable behavior and our self-reported symptoms. And therein lies the problem.
This challenge is particularly acute for bipolar disorder, I’ve found, because—unless our daily functioning is seriously impaired—when we are in a state of mania or hypomania, we don’t often realize it or consider it an issue. No one goes to the doctor for feeling elated, setting grandiose goals, or seeking pleasure!
We go to the doctor when in the throes of depression. And—because we don’t recognize and/or report symptoms of hypomania or mania—we often end up with an inaccurate diagnosis of unipolar depression. Although the two have similar symptoms (feelings of hopelessness, suicidality, deep sadness, and so on), how they operate in the body can be significantly different. Plus, a delay in correct diagnosis means effective treatment options are postponed or aren’t considered, and mood stability is pushed off further into the future.
While reflecting on this issue and looking back to my past, I realized how so many of my bipolar symptoms were masked by surrounding circumstances or were easily explained away.
My First Manic Episode & Never Getting Caught
When I was seven years old and in third grade, I started chasing the boys around the playground. The other girls wondered why. They had no idea what I had in mind to do if I ever caught one—I was going to kiss him on the cheek. I never managed to catch up with the boys, but I spent a couple of months exhibiting this behavior. It was put down to simple misbehavior; I don’t remember ever getting in trouble for it because, again, I never caught anyone. But, looking back, I believe that was the first manic episode I ever experienced.
Bipolar Depression or PMS?
As I got older, I regularly experienced severe issues with functioning just before and during my menstrual cycle. When I was about eighteen, I read a book addressing mental health in women that discussed a newly labeled syndrome, premenstrual syndrome (PMS). As I reviewed the symptoms, I felt like the book was reading my mind—difficulty functioning, crying spells, concentration difficulties, and so on.
When I was in college, these symptoms became so all-consuming that I went to the student health center. I described my crying spells, my cramps, my inability to type correctly or drive well during my periods, and I was prescribed full-time birth-control pills, plus a kind of catch-all medication for depressive symptoms, to be taken during my period. How did they know I had PMS? Because my description of my experiences matched what was understood about it in the late 1980s.
I carried this diagnosis through my early married years and stayed on the medication through my gynecologist, who also took me at my word about my symptoms and did not suggest further evaluation when it turned out that I now needed the antidepressant all the time—not just during my periods.
Post-Partum Depression and Obsessive-Compulsive Disorder, or Bipolar?
Before I had my first child, I read up on postpartum depression. After she was born, I fell into exactly that—or so I thought. I sought therapy and described my symptoms, including an obsession I had with a male co-worker—I had a crush on him that I recognized wasn’t rational. I had begun to avoid him, which was difficult because we had desks situated diagonally from each other.
Since I had not had these feelings prior to the birth of my child, I was diagnosed with post-partum depression (PPD) and obsessive-compulsive disorder (OCD). I was given a trial of a different antidepressant (an SSRI), and I continued therapy for a year. My counselor said he had never seen anyone who could resist compulsions like me.
When I went back into depression after my third child was born, I found a newly opened clinic that specialized in postpartum depression—I had the same symptoms, including an obsession with a man other than my husband, that was beyond anything I had ever experienced. I went there and received treatment for six months until my counselor finally suggested that there might be more to my symptoms, based on the history that had come out over the course of my treatment.
Even after being seen by a psychiatrist for depression and being hospitalized for suicidality, it took an episode of full-fledged psychosis before my manic symptoms became obvious to my treatment team.
At last, I was properly diagnosed with an illness for which I had likely been symptomatic since the time I started chasing boys in third grade.
To put the problem with diagnosis more simply: Where do we draw the lines?
When is cleaning your house a function of obsessive-compulsive disorder or simply a desire for a clean and practical living space?
When is worrying about the future considered prudent planning ahead, and when is it clinical paranoia?
When is a desire to be alone classified as simple introversion versus the more serious social anxiety?
All of this is to say that mental illness is hard to diagnose. So, here is what I have found useful along the way:
Being as open and honest about symptoms is a must when dealing with any mental health professional.
Don’t be afraid to seek second or third opinions.
Educate yourself about your symptoms and the possible connections they have to different conditions.
Keep track of your family history, if possible.
And seek out solutions that work for your particular constellation of symptoms.
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