Spending Sprees in Bipolar Disorder

By Jane Collingwood

Spending Sprees in Bipolar Disorder
People with bipolar disorder experience severe mood swings which can last several weeks or months. These include feelings of intense depression and despair, manic feelings of extreme happiness, and mixed moods such as depression with restlessness and overactivity.

The disorder can also lead to impulsive spending sprees, usually during manic episodes. These can extend to cars, holidays and computers, costing thousands of dollars, as irrational decision-making takes hold. It may be wild “self-medicating” shopping sprees, unwise investments, extravagant gifts to family, friends or charity, or spending a fortune on gambling.

People with mental health problems are already more likely to be debt-ridden than the general population, and the number is even higher among those with bipolar disorder. Financial troubles can lead to problems such as stress, anxiety, depression and suicide even among those not officially diagnosed with a mental illness.

Can’t Find Money To Eat

The UK mental health charity Mind says debt is leaving thousands of people with bipolar disorder struggling to find money to eat, stay warm and pay the rent. They wrote a report stating, “People who have been diagnosed with bipolar disorder may have particular problems managing their finances. During a manic, or ‘high’ phase, people can feel euphoric, brimming with ambitious schemes or ideas, their confidence excessively high. They may reach financial decisions that seem sensible to them at the time but which, in retrospect, are not. People may spend extravagantly and build up considerable debts.

“After a high phase is over, they are often shocked at what they have done and by the consequences they face. This spirals out of control very quickly and can be very daunting.” During a low phase, the person may feel so depressed they are unable to leave the house or even answer the phone. Unopened bills can pile up.

Comedian and writer Stephen Fry spoke out about his experiences on behalf of the charity Mind. He said: “My own bipolar condition has caused me to go on plenty of giddy spending sprees. Because so much stigma still surrounds mental health, many people can’t get a job, are on the poverty line, and can’t get credit from anyone but doorstep lenders charging up to 400 percent interest.”

Mind’s chief executive, Paul Farmer, adds that people with bipolar disorder can become trapped in a spiral of debt that further compounds their mental health problems. He believes that procedures need to be put in place that allow people to protect their finances while still retaining autonomy. Customers with mental health problems should be able to ask their bank to monitor their account for unusual spending patterns, and should be treated appropriately if they miss repayments.

Getting Out of Debt While Bipolar

Mental health professionals can sometimes offer advice and help individuals set a realistic budget. They may be able to help set up a repayment plan to creditors and teach financial management skills.

Friends and family may be able to assist by creating checks and balances to prevent manic spending sprees. If in agreement, they could monitor the individual’s money from a distance. Psychoeducation could also be a good idea. This is teaching people with bipolar disorder about the illness, its treatment and how to recognize triggers which might cause relapse so that early intervention can be sought before a full-blown illness episode occurs. The approach may also be helpful for family members.

In addition, there are support groups available for patients and their family members to help them talk openly about the condition. Studies suggest that the availability of social support increases the chances of employment in patients with bipolar disorder compared with those patients without support.

As always in bipolar disorder, lifestyle decisions such as exercising and eating well can help avoid problems. Keeping regular sleeping patterns is thought to be helpful in preventing episodes, as is avoiding excessive stimulation such as caffeine or stressful social events during the onset of a possible manic episode.

When tempted to make a large purchase, people with bipolar disorder might feel able to alert their spouse, partner or friend in time to discuss the purchase. There may also be the possibility of delayed order processing which needs a second approval at the end of a cooling off period before final confirmation.

Whether it is repairing the damage caused by excessive spending during manic episodes, dealing with loss of earnings as a result of illness, or taking steps to prevent future problems, financial health is a top priority. It can be as important a factor in staying well as any other form of help, treatment and support.

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Dialectical Behavior Therapy: Radical Acceptance

By Christy Matta, MA

For many, reality is hard to accept. Unexpected and overwhelming events like lost jobs, physical illness and financial problems can make us want to give up or refuse to acknowledge the realities of our circumstances.

In Dialectical Behavior Therapy, the ability to accept life, the reality of circumstances in which we find ourselves and the painful events that each of us must endure is taught as a skill.

These skills can be difficult to teach and learn because the ability to respond to the world as it is, is an underlying attitude towards life. These skills, taught in the Distress Tolerance Module of the skills training group, include strategies to get both our bodies and our minds into more accepting attitudes.

Below are a few exercises on acceptance:

Body Awareness

To cultivate a more accepting state of mind, increase awareness of your body. Start by simply bringing your awareness to the position of your body. This can be done any time and any place. Whether you are walking, standing or sitting, notice your position. Become aware of the purpose of your position. For example, are you folding your arms across your chest in a defensive stance or are you tapping your foot in anxiety. If you notice that your mind has drifted, bring your attention back to your breath. It can be helpful to practice breathing exercises, such as counting each breath or saying “in” with each inhale and “out” with each exhale.

Turn Your Mind

Acceptance requires a choice. You have to turn your mind towards accepting reality, rather than rejecting and judging reality. You must commit to accepting the current situation and reality over and over. Each time your mind tells you it’s unfair or shouldn’t be as it is, you must turn your mind towards acceptance.

Be Willing

When the world seems unfair and you’re feeling stuck, depressed or frantic, it’s natural to want to give up, try to fix what can’t be fixed, or simply refuse to tolerate the situation. Instead of trying to impose your will on reality, focus on doing what works. Do just what is needed in each situation. Your job is to simply do your best, whatever the world throws at you.

Accepting reality can become a habit. If done regularly, it can reduce stress and anxiety and improve your ability to identify and solve the problems in your life. What helps you accept life as it is?

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Know Your Triggers

Often we get caught up in life and forget that it's often our life styles that lead to bipolar disorder symptoms.

If you've been ill lately and can't seem to find relief, there are specific areas you can look at and make changes. I know this because I need to do the same for myself these days.

The following list will help you examine where your life is today and how your behavior and the behavior of those around you might be making you ill.

Doing too Much: Is there any chance you're doing too much these days? Or maybe there is simply too much going around you that you can't change. I remember when I was in the process of selling my house, sending my second book to publishers, going through a break-up and trying to be there for a family member who is getting a divorce. It's too much. I could personally can handle it, but my bipolar disorder brain could not. Period. I had to get some help. So, I explained that others would have to help me with the move. I was simply not in a position to deal with all that was going on. I told the family member that I cared about him very much and that I was here for him, but I couldn't really get involved in his situation. This may be similar to your life these days. If you're taking on too much and simply can't stay stable, it's ok to back down and say, I can't do it all. It doesn't make you weak. It just means you're taking care of yourself. This can be especially difficult if the doing too much is caused by your work, but once again. If you don't take care of the problem now, it might really affect your work adversely in the future. It's always a balance.

Here are some ideas for what you can do if there's too much going on in life:

- Choose one project only. The others will have to wait. Be honest with people and tell them that you want to get stable and this means you can't be everywhere all of the time and you can't be the person that everyone turns to if they have a problem.
- Remind yourself to treat bipolar disorder first. The whole point of management is to use the tools you have to stay stable. If you stop using them, the illness will take over.
- Take a break for a few days and don't do anything. I know this helps me, even though it's hard to do.

When I read the above list I think, sure Julie. This sounds good on paper, but it's hard in real life. Yes, that's true. But I know that if I don't take care of myself the depression will get worse, the psychosis will return and the mania just might pay me a little visit. I want to prevent mood swings instead of being in constant crisis control.

Relationships: Is there someone in your life whose behavior makes you ill? Maybe they're always telling you what's wrong in their lives. Maybe they tell you what they think is wrong with you! Maybe they try to change you. Is there someone in your life who likes to pick fights? Do you have a relationship with someone who is verbally or physically abusive? I know from personal experience that our bipolar brains simply can't handle abuse. Ever. We will get sick if someone abuses us. Even if it has nothing to do with us. Even if it's a stranger - and es pecially if it's someone we love. I've always felt that we get enough abuse from the illness itself. We certainly don't need abuse from someone on the outside. I don't stay in abusive relationships. Period. I can't. I will end up in the hospital. And no person is worth that. If I know someone who literally tells me all that is going wrong with them every time we meet, I don't see them. If I do have to see them, I don't participate in the conversation. Or I lead it in a different direction by saying, "Tell me what's going well for you right now. I'm interested." If I know someone who for years has complained about their lives and never done anything about it. I don't hang around that person. Yes, even if it's a family member. This has nothing to do with love. It's protection.

If someone is cruel to me, it's my obligation to take care of myself by leaving. If you're in this situation right now, you know how hard this is. If we love someone and they hurt us, leaving seems impossible. But I can tell you it is possible. It's painful and it's sad, but it's better than being suicidal or out of control manic.

As my book for couples states in the triggers chapter, stressful relationships are one of the main triggers of bipolar disorder mood swings. It's up to us to do something about them. Here are some tips:

- If you have a stressful relationship with someone at work, try to limit contact or make it strictly business at all times. If it's too much for you, get help. Nothing is worth having to work with a jerk all day.
- Cultivate relationships with positive people. It takes time, but it is possible. I would say it took me about one year of living in my new city to really find positive, proactive, supportive people I can trust. Now I treat them like gold, because they are gold to me!
- Set limits with the people in your life and let them know you're doing this in order to stay stable.
- Read my book for couples. There are a lot of relationship tips in the book even if you're not in a relationship with someone who has bipolar disorder.
- Remember that you are precious. As new agey as that sounds. You matter and the people you hang out with are a reflection of what you think about yourself.

***

I hope this helps. These are just two areas you can look at if you're having mood swings these days. Of course, checking your meds helps as well. I know that I get so tired of having to manage this illness, but it's a reality of our lives if we have bipolar disorder. If you're a friend or family member of someone with bipolar disorder, please know that your help means so much. The more stable and supportive you are, the more stable and supportive we can be. Of course this can be hard if the person you love is going through mood swings, but if you can remember it's not on purpose: it's an illness! Maybe this will help you get through the tough times.

from Julie Fast's newsletter www.BipolarHappens.com

Man Gets Kicks Convincing Depressed People To Commit Suicide In Chat Rooms

MINNEAPOLIS — A nurse who authorities say got his kicks by visiting Internet suicide chat rooms and encouraging depressed people to kill themselves is under investigation in at least two deaths and could face criminal charges that could test the of the First Amendment.

Investigators said William Melchert-Dinkel, 47, feigned compassion for those he chatted with, while offering step-by-step instructions on how to take their lives.

By his own admission, William Melchert-Dinkel had a problem: He liked watching people kill themselves. He trolled suicide Web sites and chat rooms starting in 2005, posing as a 29-year-old female nurse who sympathized with depressed people and then offered 'expert knowledge' on the most effective way to commit suicide. At least two people did, say Minnesota authorities _ an 18-year-old college student in Canada and 32-year-old Mark Drybrough. (AP Photo)

"Most importatn is the placement of the noose on the neck ... Knot behind the left ear and rope across the carotid is very important for instant unconciousness and death," he allegedly wrote in one Web chat.

He is under investigation in the suicides of Mark Drybrough, 32, who hanged himself at his home in Coventry, England, in 2005, and Nadia Kajouji, an 18-year-old from Brampton, Ontario, who drowned in a river in Ottawa, where she was at Carleton University.

While the victims' families are frustrated that no charges have been filed, legal experts said prosecuting such a case would be because Melchert-Dinkel didn't physically help kill them. In the meantime, he has been stripped of his nursing license.

"Nothing is going to come of it," Melchert-Dinkel said of the allegations during a brief interview with The Associated Press. "I've moved on with my life, and that's it."

The case came to the attention of Minnesota authorities in March 2008 when an anti-suicide activist in Britain alerted them that someone in the state was using the Internet to manipulate people into killing themselves.

Last May, a Minnesota task force on Internet crimes Melchert-Dinkel's computer and found a Web chat between him and the young Canadian woman describing the best way to tie knots. In their search warrant, investigators said Melchert-Dinkel "admitted he has asked persons to watch their suicide via webcam but has not done so."

Authorities said he used such online aliases as "Li Dao," "Cami" and "Falcon Girl."

The Minnesota Board of Nursing, which revoked his license in June, said he encouraged numerous people to commit suicide and told at least one person that his job as a nurse made him an expert on the most effective way to do it.

The report also said Melchert-Dinkel checked himself into a hospital in January. A nurse's assessment said he had a "suicide fetish" and had formed suicide pacts online that he didn't intend to carry out.

In excerpts of a Web chat between Kajouji and Melchert-Dinkel, provided by Kajouji's mother, he allegedly gave the young woman both emotional support and technical advice on hanging.

"im just tryin to help you do what is best for you not me," one message said, posted using the alias "Cami." Kajouji's mother said she was given a transcript by Ottawa police.

In another exchange, "Cami" tried to persuade Kajouji to hang herself instead of jumping into a freezing river: "if you wanted to do hanging we could have done it together on line so it would not have been so scary for you"

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Bipolar Disorder and Coffee

Coffee I Love Coffee, but my anxiety hates it…

Why does caffeinated coffee taste so good? I am not someone who likes caffeine. It actually makes me feel quite awful. But I love the taste of coffee. I know that I should only have decaf. It tastes ok and doesn’t make me anxious.

But regular coffee just tastes SO much better. I find that I let my guard down in order to have real iced coffee. Not the decaf Americano iced coffee, but the kind of coffee that is cold brewed and wonderful. And it’s only available as regular coffee.

Is it worth it? No. It takes at the most 10 minutes to sit and drink an iced coffee while I work. I can then have HOURS of anxiety from just one drink. In fact, once the anxiety starts, it can affect me all day. I know that if I have an iced coffee about once a month, and I have it on a day where I’m not anxious, I can handle it. But if I drink coffee a few times a week, the caffeine accumulates in my body and my anxiety gets much, much worse.

My coauthor Dr. John Preston always tells his clients to carefully watch their caffeine consumption. I have to agree with him. For those of us with anxiety, no caffeine is the ONLY way to go. My friend Sherri is on Zyprexa and if she makes the mistake of having regular coffee, the caffeine and Zyprexa interact and make her really anxious and shaky. Also, be careful at the coffee shop. Starbucks has messed up my order many, many times. I always know if it’s real coffee though- by the taste! I take it back and say, “Are you sure this is decaf?” And they will say, “No! I missed that one.” Just great.
Are you anxious? Do you drink coffee? Switching to decaf is not that hard. You just have to give up some taste to reduce your anxiety. I prefer the lower anxiety.

from Julie Fast's newsletter www.BipolarHappens.com

Childhood Abuse Linked to Migraines and Depression

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on September 5, 2007

Woman Adult health problems among women may be traced to childhood abuse. According to a new study, a history of childhood abuse is more common in women with migraines who suffer depression than in women with migraines alone.

The study is published in the journal Neurology®, the medical journal of the American Academy of Neurology.

“This study confirms adverse experiences, particularly childhood abuse, predispose women to health problems later in life, possibly by altering neurobiological systems,” said study author Gretchen Tietjen, MD, with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology.

Researchers surveyed 949 women with migraines about their history of abuse, depression and headache characteristics. Forty percent of the women had chronic headache, more than 15 headaches a month, and 72 percent reported very severe headache-related disability. Physical or sexual abuse was reported in 38 percent of the women and 12 percent reported both physical and sexual abuse in the past. These results for abuse are similar to what’s been reported in the general population.

The association between migraines and depression is well established, but the mechanism is uncertain. The study found women with migraines who had major depression were twice as likely as those with migraines alone to report being sexually abused as a child. If the abuse continued past age 12, the women with migraines were five times more likely to report depression.

“The finding that a variety of somatic symptoms were also more common in people with migraine who had a history of abuse suggests that childhood maltreatment may lead to a spectrum of disorders, which have been linked to serotonin dysfunction,” said Tietjen.

“Our findings contribute to the mounting data that show abuse in childhood has a powerful effect on adult health disorders and the effect intensifies when abuse lasts a long time or continues into adulthood,” said Tietjen.

“The findings also support research suggesting that sexual abuse may have more impact on health than physical abuse and that childhood sexual abuse victims, in particular, are more likely to be adversely affected.”

The study also found women with depression and migraines were twice as likely to report multiple types of abuse as a child compared to those without depression, including physical abuse, fear for life, and being in a home with an adult who abused alcohol or drugs.

“Despite the high prevalence of abuse and the increased health costs associated with it, few physicians routinely ask migraine patients about abuse history,” said Tietjen.

“By questioning women about their abuse history we’ll be able to better identify those women with migraine at increased risk for depression.”

Source: American Academy of Neurology

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Despite Abuse, Women Stand by Their Man

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 13, 2010

Despite Abuse, Women Stand by Their Man A new study seeks to determine insights into the behavior of women entrenched in an abusive relationship with their male partner.

Researchers discovered that many who live with chronic psychological abuse still see certain positive traits in their abusers — such as dependability and being affectionate — which may partly explain why they stay.

“We wanted to see whether survey information from women who were not currently seeking treatment or counseling for relationship abuse could be a reliable source for identifying specific types of male abusers,” says Patricia O’Campo, a social epidemiologist and director of the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto.

She adds that past research has underscored abused women’s personal evaluations of their intimate relationships — specifically, their commitment to the relationships and positive feelings about the abuser or the relationship — as critical in their decisions to continue or terminate abusive relationships.

“We wanted to learn more,” says Dr. O’Campo, who co-authored the study with researchers from Adelphi University.

Using survey data from a project funded by the U.S. National Institute of Mental Health, the researchers explored the experiences of 611 urban-dwelling, low-income American women.

Overall, 42.8 percent of those surveyed said they had been abused by their intimate male partners in the year preceding the survey.
Psychological abuse was significantly more of an ongoing problem than physical abuse, while sexual abuse was reported as least common.
A relatively small number of women (2.3 percent) perceived their partners as extremely controlling, while 1.2 percent reported that their partners engaged in extreme generally violent behaviors.

But a considerable number of women felt their abusive male partners still possessed some good qualities: More than half (54 percent) saw their partners as highly dependable, while one in five (21 percent) felt the men in their lives possessed significant positive traits (i.e., being affectionate).

Based on the survey findings, the researchers divided the male abusers into three groups: “Dependable, yet abusive” men (44 percent of the sample) had the lowest scores for controlling and generally violent behaviors, and the highest scores for dependability and positive traits.

“Positive and controlling” men (38 percent of the sample) had moderately high scores for violence and also for dependability and positive traits. However, they were more controlling than men in the first group, displaying significantly higher levels of generally violent behaviors.

“Dangerously abusive” men (18 percent of the sample) had the highest scores for violence, controlling behavior and legal problems and the lowest scores for dependability and positive traits.

The researchers say their findings suggest there is value in studying the problem of male violence through the perceptions of abused women, including those who are currently “outside” the social services and legal systems designed to help them.

“The importance of listening to women’s voices cannot be highlighted enough and needs further exploration,” says O’Campo.

“This is just one step toward potentially increasing our understanding of how to find additional ways to improve women’s safety.”

Source: St. Michael’s Hospital
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How To Improve Medication Compliance

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 31, 2010

How To Improve Medication Compliance Taking a daily medication can literally mean the difference between life and death — yet people forget to take their meds all the time.

A new study has found that changes in daily behavior have a significant effect on whether we remember to take our medication, and that these changes influence older and younger adults differently.

“We’ve found that it is not just differences between people, but differences in what we do each day, that affect our ability to remember to take medication,” says Dr. Shevaun Neupert, lead author of a paper describing the research.

That’s good news, because it means there’s something we can do about it.

“This is the first time anyone has looked at the effect daily changes in how busy we are affects our ability to remember medications. We also learned that these changes in daily behavior affect different age groups in different ways. For example, young people do the best job of remembering to take their medication on days when they are busier than usual,” Neupert says. “But older adults do a better job of remembering their medication on days when they are less busy.”

The researchers evaluated study participants who were on prescribed daily medications. The participants were divided into two groups: younger adults (between the ages of 18 and 20) and older adults (between the ages of 60 and 89).

For both age groups, the researchers found that participants were more likely to remember to take their medications on days when they performed better than usual on “cognition” tests, which evaluate memory and critical thinking.

“We found that cognition is an important factor in remembering medications,” Neupert says, “but that how busy we are is also important.”

This has very real applications for helping people remember to take medications that can be essential to their health and well-being.

“We’ve found such a disparity between young and old adults, that it’s clear we need to tailor our messages to these two groups,” Neupert says.

“For example, it is important for young people to stay busy and be active. That will help them remember to take their medications. However, we need to let older adults know that need to be particularly vigilant about remembering medication on days when they expect to be busier than usual.”

The study, “Age Differences in Daily Predictors of Forgetting to Take Medication: The Importance of Context and Cognition,” will be published in a forthcoming issue of Experimental Aging Research.

Source: North Carolina State University

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Depression or Bipolar?

By Kristina Randle, Ph.D., LCSW

A. If you are a regular reader of my column then you know that it is difficult for me to give an individual a reliable diagnosis over the Internet. Based on your letter it is possible that you have bipolar disorder. You have described periods of depression and mania. What you describe as being “a hyper mood” is fairly consistent with the description of mania. If you would like to read more about the signs and symptoms of bipolar disorder please click this link.

What can and should you do? Make an appointment with a mental health professional. He or she could help you determine if you meet the criteria for a diagnosis of bipolar disorder. You may want to choose a mental health professional who specializes in the treatment of bipolar disorder.

After you have been evaluated discuss with the clinician what type of treatment would be best for you. I would not recommend ignoring your symptoms. Aside from the fact that you may have bipolar disorder my concern is that you have suicidal thoughts. Individuals with bipolar disorder are more likely to attempt and complete suicide. This potentially places you at a higher risk for suicide. Suicidal thoughts need to be taken very seriously. I would advise anyone who is having thoughts of suicide to see a mental health professional immediately.

Writing a letter is a starting point but more needs to be done. I hope you will follow through and make an appointment with a mental health professional. If you have any further questions, please do not hesitate to write back. Lastly, here is a link to the Psychology Today website where you can search for a therapist in your community. I wish you well.

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Ten things friends and family members NEED to know about those of us with bipolar disorder.

10. If you blame us or put us down or get impatient or angry with us for bipolar disorder
behavior it simply makes us sicker!
Impatience never got us out of bed or made us less depressed. Anger never made us stop spending
when we are manic. Kind and realistic rules and limits do help. Telling us that you will not and cannot
live with us if we don't treat bipolar disorder first does help. But helping us help ourselves is the best
gift you can give us. The Health Cards can help you figure out what part of our behavior is bipolar
disorder and what part is just us. If you know what behavior is a symptom of the illness, you can then
treat the illness to help the behavior instead of getting so upset with us all of the time.
(We are upset enough with ourselves, believe me!)

9. Understand that we cannot always help you do things when we are sick. You may need help
around the house, with the kids, the bills, the laundry, etc. Deep down we know that, but sometimes we
are just too sick to do anything. Help us get well and then we can help you around the house more. Help us
get well and we will be a good friend, partner, daughter, son, grandson, granddaughter and parent. If you
expect us to be able to do normal things when we are sick, then you will only get more upset with us. If you
expect us to treat bipolar disorder first- that is reasonable and something we can work on together! Then we
can do the laundry and the dishes with pleasure. We can have fun in life.

8. Depression is very motivated. I don't know if there is a more successful illness in the world. It is a champ,
a winner! It sets goals and follows through with its goals. "I want Julie to be really sick and down on herself today.
I want her to stay in bed, eat junk and cry buckets of tears." And it sure does do a good job! Depression is serious
and motivated and strong. Without the right tools it is impossible for us to fight it. WE ARE NOT LAZY! WE ARE
NOT SLACKERS! WE ARE NOT DUMB, WEAK OR FAILURES! We are sick. Learn our individual signs of depression
by using the Health Cards and help us fight it. If depression is motivated and successful, then we all have to get
motivated and successful. If you see us sitting on the couch doing nothing day after day- don't get on our case
for being on the couch. Get some tools to help us get off the darn couch! Get motivated, serious and strong, just
like depression. Then teach us how to do this. Help us find the right mix of medications, alternative treatments and
lifestyle changes that make depression the failure instead of making us look like failures. We need your help to fight
this illness. We need your love to beat depression.

7. What you do in YOUR life makes a huge difference in how we experience our bipolar disorder
symptoms in OUR lives.
This is not fair on you, but it is a reality. It should be that you can do what you want and we can lead our own lives
and let you be you - but people with bipolar disorder cannot simply separate themselves from the things you do.
If you are stressed and unhappy and unhealthy, you have to know that it affects us greatly.

6. Bipolar disorder is a disability. It is not really recognized in that way right now, but it will be more so in the future-
many of us are dis-abled from leading the life we want and you want us to lead. We simply can't function like other
people can function. We can't snap out of it, therapy our way out of it or just get on with it- whatever the "it" is you
want us to do. WE HAVE TO LEARN WHAT WE CAN DO AND WE NEED YOUR HELP! Please know that stress makes
us sick- good stress, bad stress, stress that is none of our business- all stress makes us sick. Can you look at us differently? Can you see us as people who have an illness that often makes us unable to be "normal"? Can you hug us, love us and help us even when we make you scared, angry and embarrassed? Please help us turn a disability into an opportunity.

5. This illness is not about you. We are not trying to punish you or ruin your life. We do not want to treat you badly. It is a side effect of bipolar disorder when we change our moods. This does not make it ok- and it does not mean that it will not cause huge problems for you, but it is not about YOU at all.

4. If we are manic, spending money seems like a good idea. It is part of the illness. It is a proven symptom of
mania. We need your help in creating checks and balances so that we can prevent manic spending sprees. If you are
blind to what we are spending when we are well and then suddenly notice the $5000 we spend during a manic episode
and then get angry, it is not fair. Please be consistent and help us monitor our money at all times so no one is caught
unaware again. You can use the Health Cards to help us prevent manic spending sprees. We can't do it alone.

3. Medication side effects really, really suck. They often make us fat, tired, sick, scared, suicidal, seemingly stupid
and angry. We need help in adjusting our meds and telling the doctors what we need. It is not ok to have these side
effects and when we are in the middle of them and a doctor is telling us just to "wait and see how things go," we feel
helpless and want to give up. Help us find different medications and comprehensive treatments that do not have so
many side effects. Advocate for us if we are intimidated by our doctors.

2. Some of us with bipolar disorder cannot work like "normal" people. We cannot go to the office or keep a 9-5 job. It simply makes us too sick to function. Many of us have had a different job every year because we want so badly to fit in and be like everyone else. The reality is that we may need to find alternative ways to support ourselves and we truly need your help. Please understand that we WANT to be productive- we just have to find a different way of being productive. Going to an office really is not everything. If we need disability, help us get disability and understand that it is so very humiliating for intelligent people like us to have to get help from the government because we can't work. Never, ever make us feel guilty because we can't work! Help us find work that is non stressful, fun and helps us be independent. And if you are supporting us because we can't work- thank you so very, very much.

1. People with bipolar disorder are intelligent, funny, creative, free thinkers, different, loving and kind -
WHEN THEY ARE WELL.
People with bipolar disorder are demanding, sad, annoying, scary, self centered, all over the place, uncaring, dangerous, and crazy - WHEN THEY ARE SICK. In order to help us be all of the good things, bipolar disorder must be treated first. Use the Health Cards and any other books you may have to help us treat the illness first - for the rest of our lives. This is the ONLY way for us to have a good relationship. Because bipolar disorder does not want any of us to be happy. Friends and family are so important in the lives of people with bipolar disorder. We do not need you to take care of u s- not at all- we need you to help us take care of ourselves: Take care of yourself first, get the right
tools and then show us that you are willing to join us in our goal for a stable life. Always take care of yourself, but NEVER GIVE UP ON US!

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33 Tips and Tricks . . .

For Managing Bipolar Disorder

by Julie A. Fast

1. I check my moods daily. I try not to let an episode sneak up on me.

2. I know the absolute first signs of a swing and I take action at the beginning.
3. I educate the people in my life about the illness and how they can best help me.
4. I am now able to see who can help and who can't. I don't ask for help from the wrong people.
5. I try to accept my limitations.
6. When I am ill - I stop everything and do anything to get better, because I know that I don't have a real life when I am in the jaws of bipolar disorder.

7. I learn from others, but I try to learn to listen to myself as well. I know what works and what doesn't.

8. I use the Health Cards and I teach everyone I can how to use the Health Cards so that they are ready when I get sick.
9. I now know that making a spur of the moment change is not a solution for bipolar disorder. I have to be happy where I am before I can ever be happy anywhere else.
10. Impetuous decisions are a sign that I am not well.
11. If I'm in a situation I can't control, I have to say - it is not my ?Issue ?Battle ?Business ?And then I have to let it go!
12. If someone upsets me every time I see them and I have a mood swing every time I see them, it is up to me to completely change the interaction or not see that person at all.
13. Nothing is worth getting sick over--no one is worth a downswing.
14. Suicidal thoughts are normal because I have bipolar disorder. Knowing this helps me know that I need to work to get better instead of trying to figure out why I am having suicidal thoughts.
15. Voices that tell me lies are simply a part of bipolar disorder. I can totally talk back to these voices and tell them to leave me the hell alone.
16. If someone mistreats me, they are creating bipolar symptoms. I tell them to stop or I leave them.
17. Mood swings are normal because I have bipolar disorder, but they are not really acceptable. I have learned to do everything possible to prevent mood swings.
18. Medicines can often have side effects worse than the illness. I have the right and the obligation to search for meds that work for me and I have the right a nd obligation to supplement western treatments with holistic treatments such as the Health Cards that help me get better so that I can take less meds.
19. Living with bipolar is like being a chameleon- I never know if I am green or brown- well, chameleons live with this and I can too- I have learned to work with the illness.
20. I do not make life decisions when I am ill.
21. I do not make phone calls or send emails to friends when I am paranoid.
22. I know that psych medications can affect my driving. I am careful not to drive when I am on strong meds.
23. I make rules about my behavior and I stick to them, such as I WILL NOT CANCEL APPOINTMENTS.
24. If something makes me uncomfortable, I walk away--and I do not have to apologize or explain myself--I just walk.
25. I do not get involved in ANYTHING that does not dir ectly involve me such as a friend's relationship problems and I know that when I do get over involved that I may get sick and that I need to work to stay well.
26. No rubber necking. I really do not need to know what happened in an accident on the street or an argument in a restaurant.
27. I often do embarrassing things when I am ill. I accept that this is part of bipolar disorder and I try to learn from my mistakes.
28. I turned off the tv and kept it off until I was well enough to be selective (this took three years). This is one of the absolute best treatments for depression.
29. If people helped me a certain way in the past and it no longer works, it is ok to say- thank you so much for your help, but this is what I need from you right now.
30. I turned my focus from being sick to getting well and now that I am better, I focus on staying well. My manage ment never ends.
31. I take care of my friendships and educate my friends. Bipolar is known to leave a trail of wrecked relationships. I try not to let that happen anymore, but if it does, I learn from it and move on. It hurts and I cry, but I survive.
32. I listen to my inner voice and not the voice of bipolar. Do you know what your inner voice really says? I do- sometimes it's just a whisper, but it's the real me.

33. I never, ever, ever give up hope. Bipolar disorder is an illness - not my life. I can and will get better if I manage the illness daily.

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You've just read an excerpt of the book Bipolar Happens!. If you have found this helpful, I encourage you to get your copy of the complete book by following the link below.

Bipolar Happens! provides hope and inspiration for those with bipolar disorder as well as invaluable information for families. Written with stark and riveting honesty as only a person with the illness can do, you'll gain a deep understanding of what it is like to live with this illness and find practical steps for managing bipolar disorder.

Order your copy of Bipolar Happens! today - www.bipolarhappens.com/bipolar-happens/

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Do You Have Borderline Personality Disorder?

By Charles H. Elliott, Ph.D.

In the past several decades, we’ve watched the treatment of Borderline Personality Disorder (BPD) evolve from a virtually hopeless status with no clear answers as to what may work, to a far more sophisticated and hopeful array of possibilities (see our earlier blog on Increasing Hope for the Treatment of Borderline Personality Disorder). Have you ever wondered or worried that you might have BPD? The actual, current approach to diagnosing BPD is quite complex, but the four components that most folks with BPD demonstrate include:

Mood instability: A person with BPD may flip from feelings of joy to despair, sadness to profound anxiety, or affection to rage within minutes or hours. Sometimes these shifts occur many times throughout a given day. People with Bipolar Disorder, on the other hand, tend to have somewhat longer lasting moods though they also may demonstrate frequent shifts in mood.
Impulsivity: People with BPD tend to do things without thinking about the consequences first. Perhaps not surprisingly, this tendency often lands them in trouble. People with BPD also speak without thinking. They may lie to get out of trouble, exaggerate reality, or to lash out at others.
Disturbances in Thinking: We’re not talking about psychosis here although people with BPD do sometimes experience fleeting departures from reality. Rather, the more common disturbances in thinking that they have involve tendencies to see things in all or not, black and white terms with no shades of gray. Sometimes they are also inclined to having somewhat paranoid thoughts and see other people as maliciously motivated (though this “paranoia” does not reach psychotic levels very often).
Unstable Relationships: People with BPD are notorious for having struggles with interpersonal relationships. They get drawn into conflicts with other people and feel exquisitely hyper-sensitive to criticism or rejection.

If this description seems to fit you, please see a licensed mental health professional for a diagnosis. Although we see the mental health diagnostic system as highly flawed, there’s enough value in understanding the nature of your problems that we do recommend you get yourself checked out.

But if you discover that you have something like BPD, what should you do next? First, try not to blame yourself. BPD has a wide variety of causes including genetic, learning history, family issues, and traumas among others. No one asks to get BPD and frankly, BPD causes serious hurt and anguish to those who are afflicted with it. So what you do next is seek treatment, preferably from someone skilled in treating BPD with an approach that’s supported in the empirical literature. As we blogged previously, the primary approaches that have shown real promise in that literature include:

Dialectical Behavior Therapy (DBT)
Mentalization-Based Therapy (MBT)
Transference-Focused Psychotherapy (TFP)
Schema Therapy (ST)
Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Although DBT has the most support at this time, the others have been receiving increasing scrutiny and have exciting potential. Interestingly, they also do not seem especially incompatible with one another. One approach we’ve found particularly exciting is Schema Therapy, developed by Jeffrey Young, Ph.D. We’ll discuss that therapy in a later blog.

Charles H. Elliott, Ph.D. is a clinical psychologist and a Founding Fellow in the Academy of Cognitive Therapy. He is also a member of the faculty at Fielding Graduate University. He specializes in the treatment of adolescents and adults with obsessive compulsive disorder, anxiety, anger, depression, and personality disorders. Dr. Elliott is coauthor of: Obsessive Compulsive Disorder For Dummies, Seasonal Affective Disorder For Dummies, Anxiety and Depression Workbook For Dummies, Depression For Dummies, Overcoming Anxiety For Dummies, Why Can't I Get What I Want?, Why Can’t I Be the Parent I Want to Be?, and Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth.

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Why Women Stay with Controlling Men

By Marie Hartwell-Walker, Ed.D.

Why would a woman stay in a relationship with a guy who puts her down, hems her in, and perhaps even physically abuses her? Why would a woman hold down two jobs to keep the rent paid and food on the table while her boyfriend sits around smoking weed all day? Why oh why would a woman allow herself to be emotionally blackmailed by her boyfriend’s threats that he will kill himself or her or both if she even talks about leaving a relationship that is going nowhere?

There’s no easy answer. Often it’s a complicated mix of a number of answers. If you wonder why on earth you stay with the guy who keeps hurting you in spite of promises to do better, in spite of protestations that he loves you, in spite of your obvious distress about how things are going, see if you recognize yourself in any of these common reasons.

But please be careful not to jump to conclusions based on a list. It’s not at all uncommon for relationships to have some challenging times. Reasons for staying become problems when they become excuses or ways we fool ourselves into believing that things aren’t that bad when in fact they are. If you keep getting hurt; if you know in your heart that the relationship is diminishing you but you still keep going back for more, it may be time for you to get into therapy or to find the resources in your community that help women extricate themselves from a controlling or abusive relationship.

If you are always on the giving end in the relationship; if you’ve accepted indifference, abuse, or manipulation because you don’t believe you deserve or can get better, it’s time to take charge of your life and to make some changes. If your guy will agree, try out couples therapy. Couples can and do change with commitment to the process and love for each other. If your boyfriend won’t join you in the project, get some therapy for yourself. Build up your self-esteem, develop the skills you need to be successful in the world, and increase your confidence in yourself. A stronger you will be able to hold out for the loving relationship that you deserve.

As many you know, after three years of constant medications from 1995-1998, I gained over 80 pounds. I don't know the exact amount because after a certain point I was so profoundly depressed and upset by this weight gain that I stopped getting on the scale. I simply had an out of control appetite for three years. I couldn't stop. I know I weighed over 250 in 1998.

I asked for help from the doctors and the only reply I received was, "We will deal with the weight gain when the mood swings are under control." I was so naïve back then. I thought I had to only LISTEN to doctors. I know now that I have to WORK with doctors as a team. There is a lot more awareness today regarding the potential for weight gain, but as the medications haven't changed much, knowledge is not enough to deal with the problem. Gaining or losing too much weight needs to be addressed from the minute a person starts bipolar disorder drugs, especially as many of the mood stabilizers and antipsychotics used to treat bipolar disorder cause well documented weight gain.

The main reason seems to be that drugs themselves cause weight gain that is completely separate from a person’s diet and exercise level. This is especially true with antipsychotics where the weight goes to the belly area and is related to insulin and a diabetes risk. I know from a great deal of experience that some drugs used to treat bipolar disorder stimulate the hunger portion of the brain to the point that we no longer have a good sense of when we are full. (This is now backed with emerging research.) I have also had food hallucinations when I'm on certain meds. I actually hear voices that say, "You are going to eat until you are sick." No kidding! On the other side, a friend of mine took an anti depressant and AHDH medication and he has lost almost all of his body fat. Hey! Why didn't that happen to me! I should note that he has depression and not bipolar disorder. We tend to gain more weight.

I sometimes take an anti psychotic when the psychosis gets bad and within hours I'm craving junk. I crave it like I'm starving. I get images of cake, cookies, ice cream and candy. I think about it and fantasize about it. I want to eat big spaghetti dinners with a lot of bread and could literally drink Coke at every meal.

My friend Sherri, who is obviously much healthier food wise than I am, once ate a can of garbanzo beans late at night- right out of the can! She takes Zyprexa.

It's almost exactly like the food cravings caused by marijuana. (Before anyone writes me, I don't use marijuana to treat bipolar disorder. It messes up the brain and I can't risk that but I did use marijuana before I was diagnosed.) It's an odd phenomenon. I also remember taking Prozac in the 90's- (this was before doctors realized that no one with bipolar disorder should take an anti depressant without extensive questioning from an experienced mental health professional beforehand) and my appetite was simply gone. I used to walk into the kitchen and the thought of eating made me feel nauseas.

I've lost a lot of the weight I gained in the 90's. It hasn't been easy. I've found that consistent exercise with a lot of weight training and walking is the best way to keep my body healthy, but it has not been effective for weight loss unless I combine it with dietary changes. I know that if I approach losing weight as something I HAVE to do, I will rebel and eat junk just to feel better. Instead, I approach it as just another tool to add to my Health Cards. If I see eating healthy as a way to reducing weight gains caused by meds, I am more likely to think before I put a lot of junk in my mouth. I know that eating sugar is not my best food choice. I would eat it for every meal if I let myself. I'm lucky now that I don't need to take the meds that cause so much weight gain, but I still have to deal with the weight I gained so long ago. It's crazy!

A friend of mine has been on Zyprexa for a year. It has saved her life. She stays out of the hospital and is able to work more consistently. The problem is that she gained 30 pounds the first three months she was on the Zyprexa. She didn't change her eating and often walked miles a day and she still gained the weight and can't keep it off. What can a person do? Luckily the weight gain stopped at 30 pounds. Mine just kept on going. Our bodies are so different. She and I talked a lot about her dilemma. Her clothes no longer fit at all. She is depressed about the weight gain and she wants to stop the med. But her doctor doesn't think she is stable enough. When she lowers the Zyprexa, she starts to get psychotic again.

It's so unfair. She made a decision to stay on the Zyprexa despite the weight gain. It's all about weighing options. Weighing options- get it!

Her goal was to switch from the Zyprexa to Abilify as it has few weight gain problems. Unfortunately, it didn’t work as well as the Zyprexa. I'm just so thankful she's stable and of course her weight gain has no bearing on our friendship. Her partner is okay with it as well, but that is not much of a help when you can't wear your clothes and don’t like to look at yourself in the mirror! But you can adapt.

I can joke that I wish I could take a medication that made me lose weight, but if you're thin already this can truly be a problem. Often the restless energy caused by meds takes your appetite or you simply lose all desire and pleasure in eating. If you're in this situation, you have to treat eating as a task instead of waiting to be hungry. Even if the thought of eating makes you feel sick. Some meds can cause a drug induced anorexia feeling. So this is serious stuff. Remember, you don't have to want to eat in order to eat. Eat foods with a higher fat content. Eat yogurt and good cheese. Have some meat. Eat tortillas and tofu. Apples and bananas are good fillers. If you're stacking on carrots and celery, low fat foods or junk, your body will literally just burn it up. For you, eating has to be scheduled and required.

Walk. This is absolutely the best way to stay healthy and get the sunlight your brain needs. As you read this, maybe you're thinking- gosh, I'm so tired of reading all this information on how I need to walk. I don't have energy to walk! Well, guess what. You will definitely gain weight if you don't exercise when you're on weight gaining meds.

You can join a walking group if you won't walk alone. Make it something you want to do, not something you have to do. In the US there is a program called USA Fit. It starts in the spring and teaches people how to walk a marathon. I'm sure that no matter where you live, there are places to walk and people to walk with. This really can make a difference with bipolar disorder. Many people never start a walking program because they are waiting for the DESIRE to walk. The truth is you don't have to want to do something in order to do it. Depression will tell you it's pointless anyway. You simply have to say to yourself, I am going to walk and then wait for the good feelings that come regarding your body after the walk is over.

If I can go from an overmedicated, sick and despondent 250+ pound woman to someone who is at least healthy, alive and kicking and getting on with her life, you can do it as well. Give it time. This has been a seven year odyssey for me. The Health Cards gave me my life back, but now I have to use them daily to stay well. This means I can take less meds. I still get into the why me? Mode. But the reality is that my life is about managing bipolar disorder. This is an everyday process. I don't get a break. This goes for my eating as well. Do you sometimes feel it's too hard to deal with all of this? Well, you are not alone. It is very hard, but it can be done. And like me, you can be in a different place regarding your weight next year than you are now.

I now take Lamictal (Lamotrigine). I'm lucky that weight gain is not a side effect, because I simply don't know what I would do. I know I will NEVER be 80 pounds overweight again. I took Serequel a few months ago and gained 26 pounds in less than three months. I had to stop it for that reason. And yet, another friend of mine takes Zyprexa and has had no weight gain. You have to keep trying different meds and talk with your doctor about your options. I say that gaining more than 20 pounds is a PROBLEM that must be addressed. If you're losing too much weight, eat eggs with some meat, toast and fruit for breakfast.

You don't have to eat a ton, but get all of those food groups in there. This is not too hard to do and can make a real difference with your blood sugar. I know that I feel so much better if I have long periods between eating. It all depends on if you're overweight or underweight. If you have the money, hire a good personal trainer. A Pilates trainer, a professional body builder (natural, not one who uses steroids) or a really dynamic private yoga teacher can make all of the difference. When you pay good money for something there is a chance you will take advantage of it more than if you just have a monthly membership to a gym.

If you don't have the money for this, find your least expensive local gym and see what they have to offer -then really take advantage of their services. Become a regular at your favorite class and meet others who want to stay in shape.

And then get a training partner. It's too hard to stay in shape alone for most people. We need help and encouragement from someone. And most importantly, hang out with people who are healthy. If we are with those who like to eat for recreation, we will eat for recreation. If we are with those who actually think that recreation is a walk- we will walk!

Holidays are supposed to be such a wonderful experience. Television tells us this all of the time!
And yet for those of us with bipolar disorder- as well as those who love us- holidays can be very
stressful and ultimately unsatisfying for many reasons. This newsletter will cover some of the potential problems you may face in the next few months and then offer suggestions to help you manage and ultimately create a stable and loving environment so that you truly can experience the rewards of the holiday season.

STAYING WELL DURING THE HOLIDAYS

I guess the holidays sneak up on all of us no matter what part of the world we live in. In the states, we are getting
ready for Thanksgiving, Christmas, Hanukkah, and much more. It can be a very, very stressful time. Suicide is at its peak in the holiday season as well - while the excitement and travel associated with the holidays can send a person into mania overnight.

The Holiday Rush

Now is the time to get ready for the holiday rush. So many people with bipolar disorder either become overly stressed, irritated or manic from all the seasonal requirements or severely depressed during this 'cheerful' season. Let's make this year different. You can create a plan now for dealing with the holidays before the decorations and obligations take over your life and make you sick.

Think Ahead

What are your plans for the holidays? Have you thought about how the next months will affect your bipolar disorder symptoms? Maybe now is a good time to think seriously about what you need to do in order to stay healthy and stable during this frantic time.

The first step is to check in and determine how you currently feel:

- How are you doing right now?
- Where is your bipolar disorder on a scale from 1-10?
- Are you stable?
- Is there an upcoming event that causes anxiety just thinking about it?

Sometimes we get so caught up in life that our symptoms creep up on us and we're soon too sick to do anything.

Family and Friends Are Affected As Well

If you're a friend or family member of someone with bipolar disorder, you can ask yourself the same questions. How is my loved one? Is she stable? Is he doing too much? What can I do to make things easier? Does the person I love go through a tough period because of t he holidays? How can I help this year?

You Already Have the Tools

The good news is that learning to stop bipolar disorder mood swings is not always about learning something new. It's often about stopping something you're already doing. This is a simple way to get some stability in your life before the hectic holiday season starts. Personally, I'm going to do absolutely
as little as possible this holiday season. I will go to friends' houses and let them cook! I'm creating checks and balances now that will make sure that my time with friends and family over the holidays will be
relaxed and fun. I no longer buy presents and am very careful to be ready for family stress.

What Can You Do Now?

Is there anything you can stop now in order to prevent bipolar disorder mood swings over the holidays? Have you thought of what's coming up and how you will deal with the shopping, food and family obligations? It may b e a good time to add a holiday card to your Health Cards or ask someone for help in planning events. It's also a good time to reread any of my books you may have! If you're already depressed, you have to treat depression first and then get ready for the holidays. Waiting for the
holidays to make you feel better may not work as well as you would like it to. But feeling better before
the holidays will make a difference.

Tips for Staying Stable

Mania, anxiety and depression are serious problems during the holidays. It's important that you're ready with a plan before the symptoms start.

* Be very careful about sleep changes due to travel. Time changes are triggers of bipolar mood swings and we all have to be careful when we travel . One secret is to start the time change weeks before you actually leave. For example, if I'm traveling to a place with an eight hour time change, I will slowly make the change in the weeks before I leave so that I'm on the destination's schedule before I even get on the plane. This can prevent the mood swings that can really wreck vacations.

* Holiday parties are fun, but they sure are stimulating. There's lot of fun food and alcohol and many people see it as a time to let go. This can be over stimulating for those of us with bipolar disorder. You need to think carefully of what you can and can't do. Start to think now about the checks and balances you can set up in order to stay well. For example, limit the alcohol and junk food, go to the parties but leave early if you have to, and ask for help from friends and family.

* Say no without guilt. I really mean this. Just say no if you know that something is going to make you ill. Remember, you don't have to explain yourself to anyone and if cooking a holiday turkey (or whatever special holiday dinner you have in your country) is too much for you, then just say no. If decorating the house for the holidays is too much, then don't do it. You really do have the final say on what you do and don't do. Take advantage of this power and SAY NO! This may break a tradition at first, but if you explain the reasons, people often understand- at least they will when you do the same the next year!

* Families! Well, it can be pretty stressful for families during the holidays. Take your Health Cards with
you to family gatherings and use this time as a way to introduce your family to your management plan. Make a decision before you go to any get-together that you absolutely will not get into stressful discussions no matter how hard someone baits you. Picture yourself walking away and then do it if and when things get heated. Another solution is to have a holiday season away from your family. You have so many more choices than you think you have. Always make the choice that keeps you healthy. If you do find yourself in a contentious situation and you start to cry or have a panic attack, remove yourself from the situation and do everything you can to get back on track and join the party again.

* Spending is such a big issue during the holidays. When I first started using the Health Cards it became very obvious that the emphasis on spending had ruined the holidays for me. So I made a decision- I stopped giving presents completely and asked others not to give me presents. The relief was enormous and the holiday time became about family and friends again instead of rushing around in over stimulating shopping malls buying things that no one needed any way. I read a book called 'Unplug the Christmas Machine' and stopped seeing Christmas as a spending orgy and decided it was more about family. If you are religious, then this may be a good time to rediscover what the holidays mean to you outside of shopping. Whether it's Christmas, Hanukkah or the particular holiday your country celebrates, try to make this year the year you change the focus from things to people. It's a lot less stressful and very
few people ever became manic from a family hug! Believe it or not, just reading what I wrote here
makes me feel a little stressed. The holidays really can be overwhelming. I'm glad I'm thinking ahead.

* Try the daily check in. At a certain time every day, check in and ask yourself how you are on a scale of one to ten. This can help you slow down and see if a mood swing is starting. If you feel a symptom, go to the Health Cards and look in the What I Can Do column and stop the swing before it goes too far. I often set the beeper on my watch t o remind me to do a check in during stressful times.

* Loneliness. I've had quite a few letters from people who say they are very lonely during the holidays as bipolar disorder has taken most of their friendships. This is often a reality of this illness. As many of you know, I also lost most of my friends when I was ill. There are many things you can do to make these holidays less lonely, but over all I still suggest that working on becoming a good friend by stabilizing your bipolar disorder with the Health Cards is the first step in taking care of the problem. Here are some suggestions for making the holidays happy and fun when you're lonely:

- Volunteer to help others on the major holidays. Believe me, people in a homeless shelter, battered women's shelter, youth home, or hospital would love your company. Make it a goal to help others this holiday season and make sure you do the following: Don't talk about your problems and your illness when yo u do this work. This puts people off and is a barrier to new friendship. Try to get outside of this illness and be the real you. Listen to what others have to say and get interested in something besides your own mood swings. And yes, you can get out and do things even when you're depressed.

- If you have the money, go to a singles event for the holidays. Go there with the idea of making friends and being social. Make it a goal to listen to others and hear about their lives. Keep talk of yourself to a minimum and work on listening to what other people have to say. I emphasize the listening part because I know that when I was sick and lonely, I tended to talk about my problems constantly instead of
opening myself to learning about other people.

- Get back in touch with any family members you may have alienated when you were ill. Tell them about the Health Cards and ask them to work with you. It never hurts to try.

- Make it a goal that b y this time next year you will be healthy and stable enough to have strong and loving friendships. Do the work on yourself now so that you don't have to be lonely during the holidays ever again. If I can do it, you can do it too.

No matter what, if the holidays are important to you and you don't have any plans - now is the time to make plans. You don't want to be alone and depressed when everyone on TV is having so much fun. I've been through this and it's not nice. There is always somewhere to go and someone to see if you
plan far enough in advance. If you're already having suicidal thoughts, it's time to do something about them before they take over completely. Use the Health Cards, go see your doctor and get some help.
As you have heard me say many times, suicidal thoughts are a normal part of bipolar disorder but they have to be treated quickly and effectively so that you can get back to your normal life.

There is an event group throughout the United States called www.meetin.org. This group offers events throughout the holidays. The group is expanding to other countries as well. I have been a member for over a year and love it. You can also look for groups and events on www.craigslist.org.

*Think about the holidays before you simply rush into them.*

Start Your Plan Now

Hopefully these tips will help you to stop and take a look at yourself today, before the mad rush begins. This is the time of year I tell people with bipolar disorder to watch their stress levels very carefully. It
really is ok to say no to people and events if it means you can spend stable quality time with the people you love. Think about the holidays now and create a plan. That is what I'm going to do. I know you can do it as well. Make this a time to appreciate what you have and how far you have come, despite bipolar disorder. The holidays are not only about gifts or dinner parties, they are about people. And the best gift you can give anyone is your own health.

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I like to talk about psychosis- I want people to see that it has been around forever and that it's a very normal part of many mental illnesses, especially bipolar disorder- and yet it freaks people out. If you've ever been psychotic, it freaks you out too!

Here is a brief definition.

Psychosis is defined as a loss of contact or break with reality, which shows itself in a number of different ways including the following: paranoid thoughts- is someone talking about me, looking at me funny or following me? Hallucinations- where you see, hear or smell something that isn't there. Such as a rat running around a chair or hearing a voice that says, "Julie, you need to get out of this store!" Suicidal thought such as, 'Take that gun and kill yourself," are psychotic. I had my first psychotic thoughts in the form of hallucinations- when I got stressed and I was standing on a street corner- actually that doesn't sound too good- when I was waiting for a cross walk light- I saw myself walk into the street- and get hit by a car. My body would fly in the air and land right on the street in front of me. It scared me a lot. I used to call these visions 'death images' because I didn't know what they were. I thought everyone had them. I used to see a lot of dead bodies and severed hands when I walked in the woods too. That is just one symptom I had. These are all psychotic hallucinations.

Then there are delusions- where you have very unrealistic or even bizarre beliefs. I once drove by a beer commercial billboard and thought, "Is that a message for me? Did I do something wrong with that beer last night?' I would never drink that nasty beer anyway- but it seemed real. Psychosis is basically your brain going wonky- all of the chemicals and neurons that normally process information correctly start to process information both internally and externally falsely. What is hard to explain if you've never been psychotic is how real it feels. For example, when I get paranoid, I really believe it. Even if there is absolutely no information to prove that the feelings are real. Paranoia was always really bad for me in a classroom setting.

I've learned to manage my psychosis by keeping away from my triggers such as large groups, arguments and messing with my meds. I know the first signs that I'm getting sick and I talk myself out of it. If a voice tells me I have to leave somewhere, I say to myself, "Actually, I don't. That is just a voice and I'm not listening." I can work around it now- and I always know that when I get psychotic, I'm doing too much.

Mild psychosis can be self treated and major psychosis can be prevented by knowing the signs it's starting and getting help immediately. This may sound unrealistic, considering how serious psychosis can get, but there is usually a treatment window.

ABOUT THE AUTHOR: Julie A. Fast,
best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives -despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit: BipolarHappens.com

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It's often difficult to know the difference between the two main types of bipolar disorder. It can even be difficult for health care professionals to explain unless they have had special training on the topic. When you know the facts, you can see that the difference between the two is actually quite simple.

Bipolar I and Bipolar II (two) have the exact same symptoms in terms of depression and both have mania. The difference between the two diagnoses is the type of mania a person experiences. Bipolar I (one) has full blown mania while Bipolar I has hypomania.

What is the difference between full blown mania and hypomania you may wonder? The difference is intensity.

Full blown mania if untreated usually leads to a hospital stay- especially if it's someone's first episode. This episode usually starts around the age of 20. The mania can start off mildly with a sense of creativity and then spin out of control very quickly. When my partner Ivan had his first full blown episode it started with agitation and confusion, then moved into a complete behavioral change as he started to talk more than usual and couldn't hold a coherent thought. The night before he went into the hospital, he wasn't able to remember how to write a check or even have a normal conversation. He was seemingly very creative, but it was agitated and not fun and very scattered. He talked over people and moved around very rapidly. His face looked different and he talked with a different voice. He had what is called dysphoric mania- in other words he didn't feel very well! This mania was accompanied by severe psychosis.

Euphoric mania is the opposite of dysphoric mania. When it's full blown, it's very dangerous as it feels so good. The person almost always refuses help when they are really euphoric. When a person has euphoric mania, they feel no pain and have no reasoning ability- and most importantly, they can't see the consequences of their behaviors as they feel invincible. This is very, very dangerous mania as it can just seem like excessive enthusiasm, creativity and charisma from the outside.

All full blown manias lead to disasters and most people go into a deep depression if medications are not used successfully.

Hypomania

Hypomania is much less intense and doesn't put a person into the hospital. As with full blown mania, a person can have euphoric and dysphoric hypomania. Extreme psychosis is rare with hypomania- though it's common to have grandiose thoughts as well as negative thoughts. I get euphoric mania at the beginning of my hypomanias. Nothing feels as good as euphoric mania- absolutely nothing- but I always do something stupid and I always crash. I work very hard at preventing hypomania.

As I say in my book Take Charge of Bipolar Disorder, it's essential that you have a distinct diagnosis of either Bipolar I or Bipolar II as the treatments for the two can be quite different! You have to know if you have full blown mania or hypomania. No matter what form you have, the mania is serious- you can make horrible and life altering decisions when you're full blown manic or even hypomanic. Prevention is the only way to make sure this doesn't happen.

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Borderline Relationship Recovery 101

Whether you have Borderline Personality Disorder (BPD) or love someone who does, one of the enormous benefits we derive from recovery is improving our relationships.

In my coaching practice, I'd say difficulties with relationships are the number one reason why folks voluntarily seek counsel and guidance. When I see strained, chaotic interactions morph into calm, cooperative, and mutually supportive partnerships, well...it is one of the most joyous things I get to experience.

If it is your desire to have meaningful, fulfilling relationships, you can have them. You can even repair mistakes you made before you knew better.

And there are also times when those you wish to be close to have other plans, and just aren't interested in working on the relationship.

To be certain, the hardest relationships to rebuild are those where there is no longer any contact. But even in those circumstances, there are things you can do. Here are my top ten things to do to improve/win back/find the relationship you want:

1. Learn to tolerate distress a little better. Some conflict and difficult circumstances and discussions are a part of a normal, healthy relationship. If you can keep that in perspective, and not blow them up further, then these occurrences will just come and go. They can also serve as a time to develop intimacy, problem solve, and to learn to trust and support one another more.

2. Work on your sense of self worth. Other than learning how to tolerate distress, there is nothing that has improved my relationships more than this one. Why? Because now that I have a strong sense of who I am, I am not nearly as bothered that someone may be judging, leaving or criticizing me when they offer their perspective. I value (for the most part!) others input, can consider it, but it does not have to define me or my worth.

3. Improve your validation skills. Validating is a communication skill where you non-judgmentally listen to someone and let them know that their experience is real and understandable. This does not mean you agree with their position. This skill is very helpful in de-escalating strong emotions in another, and in delivering an assertive request, or denial to a request.

4. Ask yourself, "so what?" Is being right, or having things done perfectly really worth losing the relationship? Really? If it is, then go ahead and assert yourself. But the next time a task isn't done exactly right, ask yourself, "so what?" Is it really that important?

5. Learn how to skillfully ask for your own needs to be met. This requires skill in balancing your request with firmness and gentleness, being clear, and making it about you, not their deficiencies. Being able to clearly articulate the reward to them for granting your request is also very important.

6. Practice saying "no." Actually, being able to say "no" without apology can help strengthen your relationship. You will feel stronger and more satisfied, and your partner will feel like they can count on you to do the right thing, no matter how much they push against you.

7. Experience gratitude and show it. Make lists of the things you value and appreciate about those you love and express your gratitude to them for these specific things often. Very often.

8. Learn how to be a giving person. This is very different than being a resentful door-mat. What I am talking about is being able to observe needs in others, and meet them without being asked, and without expecting something specific in return. And also be a vessel to receive love.

9. Appreciate differences. We were made to be inter-dependent with others. Those of us with BPD really love being in relationships and are not usually made to be "an island unto ourselves." Celebrate this fact, and celebrate that we do really complete one another. Show this by liberally allowing others to make their own choices and be their own selves, and reap the rewards of the wonderful new things they bring to our lives.

10. Practice compassion and take a non-judgmental stance with others. If you really have these two things down, then true recovery is yours.

Borderline Personality and Bipolar Disorder Differences Part I: Diagnosis

Development/Nature of the Illness

Course/Presentation of Symptoms

Onset and Duration of Mood Episodes

Impulsive Behaviors Present Differently

Psychosis Presents Differently

Borderline Requires Symptoms beyond Mood and Impulsivity

Borderline Personality and Bipolar Disorder on the Same Spectrum?