Misdiagnosing Personality Issues as Bipolar I Disorder
The manic phase on the Bipolar I Disorder is typically misdiagnosed as a Personality Disorder.
Within the manic phase of Bipolar Disorder, patients exhibit numerous of the signs and symptoms of specific personality problems, such as the Narcissistic, Borderline, Histrionic, or perhaps Schizotypal Character Issues: they are hyperactive, self-centered, lack empathy, and are handle freaks. The manic patient is euphoric, delusional, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.
The Bipolar Disorder got its name because the mania is followed by - typically protracted - depressive attacks. A equivalent pattern of mood shifts and dysphorias happens in several character problems such as the Borderline, Narcissistic, Paranoid, and Masochistic. But whereas the bipolar patient sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - individuals with personality problems, even when depressed, in no way drop the underlying and overarching structure of their major mental health difficulty. The narcissist, for example, never foregoes his narcissism, even when down and blue: his grandiosity, sense of entitlement, haughtiness, and lack of empathy stay intact.
From my book "Malignant Self Enjoy - Narcissism Revisited":
"Narcissistic dysphorias are much shorter and reactive - they constitute a response for the Grandiosity Gap. In plain words, the narcissist is dejected when confronted using the abyss between his inflated self-image and grandiose fantasies - as well as the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. However, a single dose of Narcissistic Supply is enough to elevate the narcissists in the depth of misery to the heights of manic euphoria."
The etiologies (the causes) from the Bipolar Disorder and of character problems differ. These disparities clarify the distinct manifestations of mood swings. The supply of the Bipolar's mood shifts is assumed to be brain biochemistry. The supply on the transitions from euphoric mania to depression and dysphorias inside the Cluster B personality problems (Narcissistic, Histrionic, Borderline) would be the fluctuations inside the availability of Narcissistic Provide. Whereas the narcissist is in complete control of his faculties, even when maximally agitated, the bipolar frequently feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her consideration span (distractibility), and his/her motor functions.
The bipolar is prone to reckless behaviors and substance abuse only throughout the manic phase. In contrast, men and women with personality issues do drugs, drink, gamble, shop on credit, indulge in unsafe sex or in other compulsive behaviors both when elated and when deflated.
As a rule, the bipolar's manic phase interferes with their social and occupational functioning. A lot of patients with personality problems, in contrast, reach the highest rungs of their neighborhood, church, firm, or voluntary organization and function reasonably properly most of the time. The manic phase of Bipolar often calls for hospitalization and includes psychotic characteristics. Individuals with personality disorders are seldom if ever hospitalized. Furthermore, psychotic microepisodes in specific character issues (e.g., the Borderline, Paranoid, Narcissistic, Schizotypal) are decompensatory in nature and seem only under unendurable pressure (e.g., in intensive therapy).
The bipolar patient's nearest and dearest also as ideal strangers react to his mania with marked discomfort. The continual, unwarranted cheer, the emphasized and compulsive insistence on interpersonal, sexual, and occupational, or specialist interactions engenders unease and repulsion. The patient's lability of mood - rapid shifts in between uncontrollable rage and unnatural good spirits - is downright intimidating.
Similarly, people with personality disorders also garner unease and hostility from their human environment - but their conduct is more often regarded to be manipulative, cold, and calculating, seldom out of manage. The narcissist's gregariousness, as an example, is goal-orientated (the extraction of Narcissistic Supply). His cycles of mood and affect are far significantly less pronounced and significantly less fast.
From my book "Malignant Self Really like - Narcissism Revisited":
"The Bipolar's swollen self-esteem, overstated self-confidence, apparent grandiosity, and delusional fantasies are akin towards the narcissist's and are the supply from the diagnostic confusion. Both varieties of individuals purport to give suggestions, carry out an assignment, accomplish a mission, or embark on an enterprise for which they're uniquely unqualified and lack the talents, capabilities, understanding, or encounter required.
However the bipolar's bombast is much more delusional than the narcissist's. Tips of reference and magical thinking are common and, in this sense, the bipolar is closer for the schizotypal than for the narcissistic."
Sleep issues - notably acute insomnia - are typical in the manic phase of bipolar and uncommon among individuals with character disorders. So is "manic speech" which is pressured, uninterruptible, loud, rapid, dramatic (includes singing and humorous asides), sometimes incomprehensible, incoherent, chaotic, and lasts for hours. It reflects the bipolar's inner turmoil and his/her inability to manage his/her racing and kaleidoscopic thoughts.
As opposed to subjects with character disorders, bipolars in the manic phase are usually distracted by the slightest stimuli, are unable to concentrate on relevant data, or to preserve the thread of conversation. They may be "all more than the place": simultaneously initiating quite a few business ventures, joining a myriad organization, writing umpteen letters, contacting hundreds of friends and excellent strangers, acting within a domineering, demanding, and intrusive manner, totally disregarding the requirements and feelings on the unfortunate recipients of their unwanted attentions. They seldom comply with up on their projects.
The transformation is so marked that the bipolar is usually described by his or her closest as "not being himself of herself". Certainly, some bipolars relocate, change name and look, and shed contact with their "former life". Like in psychopathy, antisocial or perhaps criminal behavior just isn't uncommon and aggression is marked, directed at both other folks (assault) and oneself (suicide). Some biploars describe an acuteness of the senses, akin to experiences recounted by drug users: smells, sounds, and sights are accentuated and attain an unearthly high quality.
Men and women with personality problems are mostly ego-syntonic (the patient feels good with himself, with his life generally, and with the way he acts). In contrast, bipolars regret their misdeeds following the manic phase and try to atone for their actions. They comprehend and accept that "something is wrong with them" and seek support. During the depressive phase they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).
Finally, personality issues are usually diagnosed in early adolescence. The full-fledged bipolar disorder seldom happens just before the age of 20. The pathology of the bipolar is inconsistent. The onset on the manic episode is fast and furious and outcomes inside a conspicuous metamorphosis from the patient. With all the exception of the Borderline patient, this is not the case in personality problems.
A lot more about this subject right here:
Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis I Issues. Harvard Evaluation of Psychiatry, 3, 326-340
Stormberg, D., Roningstam, E., Gunderson, J., & Tohen, M. (1998) Pathological Narcissism in Bipolar Disorder Patients. Journal of Personality Issues, 12, 179-185
Vaknin, Sam - Malignant Self Enjoy - Narcissism Revisited - Skopje and Prague, Narcissus Publications, 1999-2006
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