Bipolar C-PTSD vs. Bipolar

Sadielady3

MyPTSD Pro
I've been wrestling with something since Friday and thought maybe I'd post it here to see if anyone has any input or thoughts. I've been going through a lot lately. I have been having intense episodes of vertigo, which has kept me out of work (I'm a teacher) for over a week now. Dramamine seems to help some but I still have episodes that are bad enough that I have to sit down or lay down. I'm supposed to see an ENT specialist on June 8th but I've been in and out of Urgent Care the past week and have had numerous tests run including a CT scan and an MRI of my brain. None of the tests are coming up with anything but it is Urgent Care and they are just trying to rule out life threatening stuff.

I saw my therapist on Friday. He thinks the issue is psychological. He also now thinks that I have bipolar disorder. Technically, my current diagnosis is major depression disorder with a secondary diagnosis of anxiety. Both my therapist and my psychiatrist agree that I have PTSD. I personally think I have C-PTSD but I know that diagnosis is more controversial. I honestly don't care what the chart says that I have, only that I'm getting treatment that will help me to improve as much as possible. If bipolar is correct and getting on meds for it helps, I'm all for it.

I don't think I have BD because I don't have manic episodes at all. My husband agrees with that- in the five years we've lived together he's never seen any mania. There's also no family history that I am aware of for BD. I knew all four of my grandparents and none of them likely had it based on my memories of them. My mom is a narc with some anxiety issues while my dad had OCD (hoarding disorder) and possibly some depression. I've never seen any manic episodes with either of them either. My brother seems to have escaped all of the mental health issues and seems fine. The only thing I can see on the checklist which could apply to me in terms of a manic episode is that I do become goal oriented when I'm not depressed but I still sleep and take breaks from whatever I'm working on. I'm just more focused than when I'm depressed on actually completing tasks.

I do think that my depressive periods are triggered by emotional dysregulation. I will know at this point exactly what is bothering me and why I shouldn't even be bothered by it. In the past, my therapist has noted that I have traumatized parts. I think what's happening, although I can't say for sure, is that one of the parts is triggered and I can't stop the feelings. Then I spiral into darkness, despite rationally knowing that everything will be fine.

I personally think my T could make a better case for DID (somewhat likely) or even BPD (not terribly likely but possible). I did read a few articles that say it's not uncommon for people with C-PTSD to be misdiagnosed as having bipolar disorder. So I thought that maybe someone here has been through this and might have some insight.
 

ruborcoraxxx

MyPTSD Pro
Didn’t go through this personally, but my father had a suspicion of bipolar for years. That’s what they tried to diagnose once they didn’t know anymore. I’ve never seen him manic and have lived with that person for years. For me and now with the distance, it looked like he has PTSD, specs of narc-like personality disorder and massive depression disorder. He’s got it all, pills, shock therapy, ayahuasca… At the end no diagnose worked because he simply wouldn’t follow the guidelines or do anything sustained to confront his problems. So he isn’t a good example of successful diagnose. But also I might be biased in this analysis as I resent that person to death and went no contact.

There are two types of BP. One with manic episodes, others with hypomanic episodes (mania but less intense, for some, just "being normal" moments). It desperately can look like BPD, and both happen to be these sort of we-don’t-really-know-but-it-isn’t-good diagnoses. BP can be very real in the sense of being a pure mood disorder that fluctuates on its own rhythm and in that sense it’s distinct from the emotional volatility typically found in BPD and PTSD. So good news in the sense it’s supposed to respond well to medication. Which isn’t necessarily the case of BPD as the dysreg comes from … too many things. It can also be co-morbid.

Honestly I’m no professional but for having several close friends with BPD I’m very doubtful that BPD is even a thing in itself, I think it’s a coping style of forms of PTSD. But the tools designed for managing BPD are rather wonderful, not just for people with disorders but even in general. I find DBT superb. So who cares how it’s called apart from the people devoted studying this. I’ve almost been diagnosed with BPD too but I don’t think I fill enough conditions to be a good candidate. Pdoc 1 thought I had some form of BPD and Pdoc 2 really thinks I don’t as my personality baseline is too consistent and I managed to keep most of my friends so far. So f*ck knows.

I have no idea for all the physiological part. High levels of anxiety can trigger a lot of shit. Tinnitus and dizziness are quite common beasts. I have horrible headaches.

I’d just wait with your doc and try what they’re suggesting. And stick to it for a while. I think it’s better to be consistent and take it easy and not flip flop through too many theories, treatments and trials at once. Otherwise you’ll be unable to tell what’s environmental, what’s idiopathic, what’s caused by the medication, what’s caused by the trauma. It would be needed to make a correct differential diagnose. If the BP option isn’t ruled out or in, no way to know.
 

Sadielady3

MyPTSD Pro
@ruborcoraxxx Thanks. I always forget how difficult mental health diagnoses can be due to overlap. I talked things over with a friend who has convinced me that it doesn't matter if my current vertigo issues are psychological or physical and that I need to call it a day on finishing the school year (only 12 days left). If the rest makes it go away, then great. I have the sick time and maybe I need to just worry about taking care of myself right now.

I'm mostly scared about being misdiagnosed because of medications. Every time I've been put on an SSRI I've wound up attempting suicide, nearly attempting suicidal, or hospitalized due to a psychotic break. Psych meds really scare me. I'm willing to try different therapy modalities. I'm currently in a CBT therapy group but am interested in trying DBT at some point. My T noted on Friday that he doesn't know anyone who works as hard at their mental health as I do. I genuinely want to be as healthy as possible. But meds scare me.
 

Friday

Moderator
Diagnosing comorbid disorders is incrediably difficult, as not only do symptoms overlap (like PTSD & Bipolar can look identical // are frequently misdiagnosed as each other // as panic attacks & disassociation -or depression- can look like bipolar manias & depression) but they ALSO effect one another. 2 symptoms converging to create a 3rd totally different appearing symptom.

If your doc is suspecting a bipolar comorbid? That ALSO means you’ll need to rule out ADHD. Because those 2 disorders share so many symptoms (they’re considered “sister disorders”) that often the only way to determine which one you’re dealing with, is by a med trial. As stimulants kick people with bipolar disorder into manias, but calm/soothe/sharpen/regulate ADHD; meanwhile the antipsychotics, mood stabilizers, and antidepressant cocktails tuned for people with bipolar disorder usually have the opposite effect on people with ADHD. (To oversimplify a smidge, since labeling is often politics/marketing rather than scientific... People with ADHD tend to kick into psychosis with antipsychotics, become far more dysregulated on mood stabilizers, whilst antidepressants up the ante to suicide. <<< This is why med trials are nearly always with short acting stimulants, rather than cocktails that take months to work and more months to wean off of. IE If the best guess is wrong? You lose 4-8 hours of your life, instead of 3-6months.

But when you’re dealing with something like PTSD + __________? (Or MDD+________ ; or several other possible comorbid disorders) A straight up Bipolar -v- ADHD med trial rarely works // isn’t to be trusted as much as if those were the only disorders under consideration. Because you have symptoms from the PTSD that are going to be affected. Someone with bipolar disorder in a dysregulated depression may rise up out of the depression, meanwhile someone with ADHD may be kicking into a panic attack at the least startle, much less a chemical jolt. <<< So a good diagnostician is going to be looking at your historical reactions to things. Does coffee make you jittery & chest tight & stay up half the night? Or do you have a paradoxical reaction to stimulants? If you’ve taken antipsychotics, mood stabilizers, or antidepressants in the past? Ditto. Paradoxical effect or just “not tolerated” / standard sooo NOT the right drug, that most people have when trying to find the perfect cocktail for their neurology.
. Every time I've been put on an SSRI I've wound up attempting suicide, nearly attempting suicidal, or hospitalized due to a psychotic break.
^^^THIS^^^ for example... could be EITHER paradoxical, or not. Why? Because most people with bipolar disorder become too depressed to kill themselves too quickly... if you look at this >>> -U <<< that line in the center is where most people attempt suicide. On both the way down AND the way up. So the suicide attempt could be either ADHD paradoxical med effects, or a depression being raised too slowly to move out of the danger zone. And the psychotic break? Could be either ADHD paradoxical med effect or bipolar disorder being raised out of the danger zone for suicide too quickly and it springboards right into a manic episode culminating in psychotic break.

***
So my best piece of advice, if you’re looking at bipolar -v- adhd? Find a treatment team veeeeeeeery familiar with both disorders AND since the PTSD diagnosis is already very solid, a team who is ALSO familiar with how trauma & trauma related disorders effect both disorders. Yes. It’s a very small niche. But an important one to be really secure in.
 

Sadielady3

MyPTSD Pro
@Friday I hadn't even thought about throwing ADHD in the mix. I was tested for that formally back in September and there were zero indicators that suggested that it was my problem. In fact, it was the fact that I definitively didn't have it (and most people who know me were surprised I was even being tested for it) that led me to realize that I have trauma, after a few web searches and seeing that trauma can look like ADHD. No test is perfect though but it seems unlikely with really definitive results. As a special educator, if I saw results like that on an assessment for a student, I would be moving on to something else.

Because most people with bipolar disorder become too depressed to kill themselves too quickly... if you look at this >>> -U <<< that line in the center is where most people attempt suicide. On both the way down AND the way up. So the suicide attempt could be either ADHD paradoxical med effects, or a depression being raised too slowly to move out of the danger zone. And the psychotic break? Could be either ADHD paradoxical med effect or bipolar disorder being raised out of the danger zone for suicide too quickly and it springboards right into a manic episode culminating in psychotic break.

This I did not know. Perhaps I am a lot more depressed than I ever realized. I'm generally pretty functional- I hold down a full time teaching job and still do interact with people socially on occasion. I am unsure if I was passing through the danger zone or if there's something else going on there but it is possible. Seeing that I'm going to be off for the next couple of months, might be a good time to see if I could maybe push through.

I am more interested in bipolar vs. C-PTSD. I honestly think that whatever is wrong with me is based in trauma because I've had an awful lot of that over my life. According to the internet, some people with bipolar have a history of trauma though too. I guess as long as I can be kept safe I can go along. I just know I have a history of not being safe on meds in the past.
 

Sideways

Moderator
I still have a question mark over whether or not I have Bipolar Disorder. That was my first diagnosis.

Now? My primary diagnosis is (complex) ptsd and DID. Depressive episodes come and go, and it's possible that those episodes are part of Bipolar Disorder.

There's a history of mood disorders in my family. One of my sisters also has a question mark over her mood diagnosis. It's possibly Bipolar Disorder II. In her case, her hypermanic episodes aren't clear - she has what is more in line with Mixed Episodes.

It's relevant because we have decades more success with our mood disorder medication than with ptsd medication. And if there is a mood disorder present of some kind? That element of what's going on for you may respond really well to medication.

DID is much harder to diagnose. On average it takes 7 years in treatment to diagnose a person with DID. And the route to that diagnosis is very often via other, incorrect diagnoses. Comorbid disorders get very complex, very quickly. The nuances of how your particular case presents is something you're most likely going to come to learn about over time, with a therapist who can help you monitor what's going on, and tease out the subtle differences, in order to find the best treatment pathway for you.

My personal experience? Coming to understand my mental health is more of a marathon than a sprint. Anyone who suggests they can do a comprehensive assessment and give you a correct diagnosis that has been right all along, and will still be correct in 5 years, when they've had a chance to monitor the cyclical nature of these illnesses? Is overselling what psychiatry is currently capable of.

That's not all bad news though. Take what you know from your past, monitor your present, and see it as an opportunity to get to know yourself better, and find what works best for your own unique presentation.
 

Friday

Moderator
In fact, it was the fact that I definitively didn't have it (and most people who know me were surprised I was even being tested for it) that led me to realize that I have trauma,
As a special educator, if I saw results like that on an assessment for a student, I would be moving on to something else.

Yep, yep! It’s much the same with psych testing... if you find out at a later date through (or after) the testing process with a kid that they’re dyslexic/dysgraphic? Results of previous written tests are going to need to be tossed, or at least re-evaluated with the new understanding on board. Ditto verbal tests, with hearing loss or auditory processing disorders; or an undisclosed TBI with any kind of testing; etc. Which doesn’t actually mean the results will change, just that the potential is rather high.

As Bipolar/ADHD share so many symptoms... it’s strange that you weren’t definitively ruled out for both back when, or that if you were, that they’re looking at either one without the other, now that they know to look for the effects of trauma skewing the presentation.
 

Sadielady3

MyPTSD Pro
@Friday My psychiatrist hasn't weighed in on any of this yet. She may well say that since the testing for ADHD was really negative in all of the subcategories that bipolar isn't a good diagnosis. She may suggest a different test. I'm not sure. I'm mostly scared of what meds she might prescribe and, although I always have a choice not to take my meds, I would be compliant. It's a scary prospect for me. This conversation has been helpful though because at least I know that it's a process. No one's ever been that interested in diagnosing me before so this is new for me. And, to be honest, bipolar just sounds scary to me. I associate it with my ex who used to beat me and treat me horribly. I don't see that person in me so to be placed in the same box with potentially scary meds has been hard.
 

ruborcoraxxx

MyPTSD Pro
@Friday My psychiatrist hasn't weighed in on any of this yet. She may well say that since the testing for ADHD was really negative in all of the subcategories that bipolar isn't a good diagnosis. She may suggest a different test. I'm not sure. I'm mostly scared of what meds she might prescribe and, although I always have a choice not to take my meds, I would be compliant. It's a scary prospect for me. This conversation has been helpful though because at least I know that it's a process. No one's ever been that interested in diagnosing me before so this is new for me. And, to be honest, bipolar just sounds scary to me. I associate it with my ex who used to beat me and treat me horribly. I don't see that person in me so to be placed in the same box with potentially scary meds has been hard.
On this, I understand but don't worry too much. My ex had CPTSD BPD and suspected ADHD and bingo these 3 are also girating in my papers. Nevertheless the only thing you'd prove by having the same diagnosis is that you can have the same but not do the same. If all people with the same problems did the same things, it would also be much easier to diagnose and it likely would be the jobs of courts and not of medicine.

I understand it's scary for the medications too. The most important is to report everything to your pdoc and not to wait for your report, so they can work with you and stop if you're willing to throw yourself out of the window.
 

Mach123

MyPTSD Pro
Hi I just want to say I hope you feel better. I never got stable on psych meds but I believe in them if the feelings are severe. I don’t know the answer, but feeling suicidal and stuff ? Probably worth a try. I was diagnosed BP in the early days and I was a couple years on different meds but that doesn’t work on me. Cannabis now is all I use . It’s not perfect .
 

grit

Not Active
I was listening to Iain McGilchrist on podcast over the weekend about the divided brain. As I listened I was thinking about my own recovery and the implication of what he was saying. Your post reminded me of the same thing.

I think you, above all, know what is it that is troubling you. If you can have all these diagnosis, then maybe all these diagnosis lose meaning. If you feel one more than the other, who else in the world could argue about that with you.

I think one thing that I find really hard to pinpoint is what is the baseline really...who has the perfect baseline that is standard for everybody else in all cultures, all humanity and all situations? and that is the reality. The reason reality is harsh as the saying goes is because the baseline is something common but all things common - it is too common....even you hearing a doctor giving you yet another diagnosis you are somewhat a decent baseline then to even hear it! But baselines have to have contexts!

You are struggling with something, you feel there are gaps and pockets of blindness/dissociation etc, and your left brain as this author was saying is trying hard to put in category but your right brain is beyond categories and also much more powerful than the left brain...and when both are competing for authority, a shutdown is possible - dissociation and if one has dissociation for a long time (like I did) then the spectrum is huge from missing cues on people's faces to full blown splits of personality (which the latter when not managed and coped properly (or unaware of), one cannot function in relations especially working where others are not attuned).

As I read your post, I could not help but notice, you may be outsourcing your own inner intelligence to others or professionals and they are diagnosing you with their own judgement and value based on whatever symptom you bring that day. So now it may be that, time is being spent categorizing what they think and what you think rather than spending time (as you suspected) listening to your body that left you long time ago because you were experiencing unbearable trauma against your body. We may give names to the trauma to use language and categorize it so we can talk about it intellectually, but the it gnaws at the body still...and language or diagnosis hardly ever touch the body that was traumatized enough to dissociate.
 

joeylittle

Administrator
@Sadielady3 - I do think your psychiatrist weighing in will be useful. It doesn't mean they'll be right - but there's some stuff you mentioned in your history that it would be good to unpack with the psych.

Every time I've been put on an SSRI I've wound up attempting suicide, nearly attempting suicidal, or hospitalized due to a psychotic break.
Any diagnosis is informed by the ways a patient reacts/has reacted to various medications. If you haven't already - make some notes on the specifics with each of these bad reactions to SSRI's that you had. Medication name, what was going on before you started it, how long you were on it and when the problematic reactions were occurring. What you are describing as a psychotic break could have been a med-precipitated manic episode....or something else, depending on which SSRI was involved.

Bipolar has multiple subtypes - their names and definitions have changed markedly over the years - and it's very difficult for the sufferer to assess any of them.

In a nutshell:
  • Bipolar 1 is what most people think of as bipolar - there's mania, and there's depression, and both are clearly visible.
  • Bipolar 2 is harder to recognize - there's depression and hypomania. Hypomania has distinct criteria - the most important thing to remember is that it doesn't present as mania. It's not the same thing, and while it's easy to conceptualize it as 'light mania' or 'lesser mania'...that's not really it.
  • Cyclothemia is a bipolar subtype characterized by specific patterns in sets of symptoms, but can have mania or hypomania, and depression behaves differently that in the previous two subtypes.
  • Substance abuse/medication subtype - would apply if the episodes were triggered by alcohol or drug use, or a medication for a non-psychiatric condition
  • Finally everybody's favorites (lol) - Other specified and Unspecified.

Each of the above has to be differentially diagnosed - they need to be separated from other potential diagnoses that might better describe what the person is suffering from. In particular - as you've already noted - PTSD, Borderline PD, ADHD, and Depression are all invoked within the Bipolar symptoms, and so....that's just a lot of stuff to sort out.

Why it matters?
Unlike PTSD (or CPTSD), or some forms of depression - Bipolar does respond very well to the right kind of medication. While meds aren't always necessary, they are often necessary, and extremely successful. So - if that's what it actually is? You will want to be on the right medication. And the right medication won't f*ck up your brain, the way the wrong ones did.

Your psychiatrist should have the tools AND the knowledge needed to help sort through these multiple diagnostic options. If they don't? You definitely need a different psychiatrist. And if you have the feeling your psychiatrist isn't a good doctor - meaning, doesn't know their shit, and isn't dedicated to unlocking the key to your specific mental health condition? - start getting referrals.

Meanwhile - you can help them help you by making sure you aren't discounting things that might actually be symptoms...For example: I hear you saying that you've never been manic - but that belief might lead you to discount things you've actually experienced, that might be indicative of hypomania.

Onset and duration of your bad times, your sort-of-ok times, any weird times...with Bipolar, a lot has to do with duration and onset. You might not know what brought it on - but if you can make a timeline breaking down when your symptoms happen, that will be extremely helpful for you and for anyone on your treatment team.

What I can tell you is - it's one of the more difficult things to diagnose, when it's not extremely obvious. The biggest thing researchers have learned about it is, it's not always obvious - but it reacts to certain medications in unique ways, and if you can get the meds right, it's life-changing. (Very similar to ADHD in this way, which is why they are quite often compared)

There is Bipolar in my family history, and it took awhile before my psych (and by extension, me) was thoroughly convinced I wasn't dealing with some form of bipolar 2. Part of the confusion about it stemmed from how I was reacting to a few different medication types - in my case, it was that they weren't working at all like they should have. Finally - we went ahead and tried something that was either going to really help, or really trigger a manic episode. That was a little risky, but my psych knew I was good enough at symptom tracking, and we trusted each other enough to go on and try it. Turned out to be a medication that helped me with my depression, enormously - and did not bring on any kind of mania, which it really should have....and so - I got a good depression med out of it and knew pretty categorically that I wasn't any bipolar type. Useful! At the time of course, it was scary and I hated having to treat myself like a research rat...but you do what you need to do. Sigh.

Bottom line - I'd encourage you to dig into it further, and work with your psychiatrist - or, a different psychiatrist. Your therapist will know you very well, it's true - but they probably don't have the day-to-day medical experience to truly sort through a bipolar diagnosis...or if they are also a prescriber, maybe they do? I'm assuming they don't....

Diagnosis: take a village.
 
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