It's all just the bipolar talking

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At times, when I think about my need for MtF SRS (male-to-female surgery), which does not seem like it will be fulfilled, my stomach burns. Last year, I was very agitated about that. Now, I'm thinking that my psychiatrist considers that strong need to be a manifestation of bipolar disorder. It goes back to when I asked her if she considered my transgenderism to be based on obsessiveness and she said not necessarily, but she did consider the anger I had over surgery to be obsessive. I was obsessed around that time with the idea of poking my eyes out, which she attributed to my bipolar disorder. So it seems that she considers that need to be obsessive, and she considers that obsessiveness to be bipolar.

Now, I'd be all for that invalidation if it weren't for one thing, as I find invalidation to be the only thing that helps with the burning stomach. That thing is the fact I thing the bipolar diagnosis is probably BS and is based on the idea that agitation means bipolar. I've written elsewhere how she considered my memory of the delusional mood, a phenomenon she denied the existence of, to be necessarily a manifestation of hypomania. She seems to be part of a group of doctors that has a very broad view of bipolar disorder and wants to search under every nook and cranny for anything remotely like it, as evidenced by a diagnosis handed down after only 15 minutes, without asking follow-up questions. (Sure, testing was also used, but I saw the results, and there wasn't anything in the testing that couldn't be explained by ASD/schizotypal traits + anxiety + depression, with maybe some borderline thrown in. Also, testing shouldn't substitute, I read, for a good thorough diagnostic interview, especially for such a time-based disorder like bipolar disorder.) Because of this, I'm getting a second opinion, as finding out about this stuff makes me question the whole diagnosis and treatment plan. Also, there's the fact my life isn't much better than it was.

The doctor I'm seeing for my second opinion has written on his blog about the "Everything is bipolar" craze, so I'd be interested to see what he says I have.

Another person who likes to blame things on bipolar disorder is my dad. I've yelled at them a few times over the past year, some relating to no respect for my transgenderism and some relating to money over surgery. He says in the issues over money that I was acting evil, but that wasn't me talking, as I am not my mind; rather, it was the bipolar disorder talking. He says that I should just forgo psychotherapy, which he has zero faith in, and work on making sure my medication is right, because it's all about the brain chemicals. He then says I should just work to be stable for 2 years and not move to make any major changes to my living situation.

Well, my parents are all I have in people I am close to, and you don't bite the hand that feeds you, am I right?

I've got bipolar II, and my experiences don't sound like yours at all. Of course, everything is relative and I'm not a doctor, but getting a second opinion sounds like a good idea to me. I think most of my problems are due to Asperger's , but the bipolar exacerbates them and creates a disruptive (and sometimes destructive) ripple. But again, my experiences are different. It's a cycle of severe, soul-sucking depression and impatient agitation with rash decisions.

My personal opinion about this situation is:

1) Also scientists still haven't sorted out complitely how personality disorders represent in autism, that's why they are getting dx just very carefull to avoid over-dx. Scientists know it seems to represent differently and the standart tests to detect personality disorders don't work well for autistic ppl because of some overlapp in some areas. That's why it is the best, if someone thinks to have both to go to an autism expert.

2) Many disorders who were kind of "new" or have been befor overlooked had their "hype". Starting with schizophrenia in the 50s and 60s, followed by borderline personality disorder, ADHD, ASD and Bipolar. Some psychiatrists stuck to one hype. I personally think it's a good thing to get avare of a disorder who got mainly overlooked in the past, but it has also the danger that in this "hype" time some ppl get over-dx. I remember the 90s and beginning of 20s century were ADHD had it's hype in my country and it was in many newspapers and so on. Also general pediatritions got interviewed, claiming they could dx ADHD within 5 minutes. Now you don't hear thing like this anymore, children are getting screened more carefully and also other disorders get considered more.

3) I also belief that you need at least one hour to sort out the possibilities what a patient has. Especially when also comorbidities are supposed to get dx in addition to a disorder you usually even need more than one hour.

4) A problem I noticed over the years seeing all kind of different psychiatrists, that most psychiatrists stick to their first opinion about you. The problem starts when this opinion is not quite correct.

5) To get a second opinion is always a good idea, when you are not sure or think your psychiatrist might be wrong. But I also know out of past experiences that this can lead to the fact that your current psychiatrist is not at all happy about it or you even have to look for a new one when she finds out. I just wanted to mention this, in my case it didn't stopped me from getting a second opinion when I felt terribly miss-dx.

Last edited by Raziel on 21 Oct 2013, 6:35 am, edited 1 time in total.

Yeah, I've noticed that to. Psychiatry, FTW. And after all, there isn't really any tests for bipolar. Which is somewhat in it's "hype" right now, especially in children. The number of children lately that have been diagnosed with Pediatric Bipolar Disorder (Which isn't even in the DSM, and claims that bipolar people eat more protein than other people) is really over the top. You'll even come across pdocs who will diagnose anyone with any signs of depresison as "bipolar".

I think one way of trying to discern whether you may have bipolar disorder is to consider the extremes of your mood (a.k.a. how happy and excited you get when you're at your most happy, verses how sad and empty you get when you're at your most depressed) and also consider whether your mood is mostly within an average emotional range or whether in fact most of the time you're either at one extreme or the other. Like- are you the kind of person who is extremely overhappy/hyperactive/overjoyed or extremely depressed? do you tend to feel intense emotion most of the time?

Honestly, I don't know. I don't have anything to compare it to except my own experience. Hopefully, when I go to get my second opinion next week, my doctor will do a good job of answering that question.

Also, if so, can't strong emotional intensity also be a sign of borderline pesonality disorder, or even just the autism? The doctor I'm going to is big on borderline, and even does psychotherapy for such patients despite being a psychiatrist, so he's likely to take a serious look at that. I kinda doubt I completely have borderline, though.

Yes, it is quite possible to misdiagnose bipolar as borderline and vice versa. However they are two quite distinct disorders, best thing to do is to look at the symptoms unique to each.

For example, for a while I thought maybe I had borderline, but my psyc confirmed I definitely didn't. As borderline is a personality disorder, it is characterized by stability in symptoms - if you're borderline then the emotional swings are part of your personality and not occurring more suddenly after "onset". Plus borderline is characterized by instability in personal relationships and mood swings are triggered by external events and not randomly occurring.

Sounds like a lot to sort out. Thankfully, the doctor I'm going to seems to like to do a thorough history, unlike my present doctor.

Well, I spoke with the doctor for the second opinion and he says that based on what I've told him and the records he's gone through (including the hospital records), I do not have bipolar disorder, or any serious psychiatric illness. He does not think I have ever had a major depressive episode, either. He says he thinks neither the lithium nor the antipsychotic have been doing me any good and that if I wanted to I could discontinue them, but that I may also want to speak with my doctor about what he said and work something out.

He says the issues I've been having, including the agitation back in October and the suicide attempt, were related to the autism spectrum disorder (which he says I've partly outgrown) and the gender dysphoria (viz. my frustration over not getting surgery), with anxiety.

He says regarding the thought disorder I exhibited as a child, that that could be a manifestation of the developmental disorder. As for the psychotic episode at 14, he considered that really atypical considering my history. He says he wonders if it wasn't that I just got too much into the video game. He says it likely wasn't bipolar disorder and had that been schizophrenia, coming on at that age, it likely would have been severe. He says either way, it is clear that today I do not exhibit any serious psychiatric illness, be it bipolar disorder or schizophrenia. He says he does not consider the various attenuated psychotic symptoms I've had since then to be important for diagnosing.

He says he's somewhat surprised that my doctor would diagnose me with bipolar disorder, because he knows her. He was the director of the psychiatric residency she took, so he knows her. He says the diagnosis likely had to do with the hospital she worked with and the need for reimbursement.

He says if I want I can see another psychiatrist in the office whose son has Asperger syndrome and knows a bit more about autism spectrum disorder for a 3rd opinio, and I took up his offer.

Now I'm wondering. Should I go off the psych meds now? Perhaps I should call the office and ask again to make sure.

First call to make sure, because even if they are unnecessery the problem with many psych meds is, that you have to go off step by step - carefully.

He tells me if I wanna stop 'em, I could just stop taking them. He says you don't have to come slowly off the lithium and I'm taking such a low dose of the Zyprexa I don't need to come off that slowly, either.

He leaves it up to me if I want to wait to speak to my psychiatrist.

I don't know what to do at this point.

Keep on them until you've got a third opinion. There must have been a reason you were DX'ed as bipolar and psychotic in the first place. Sorry if I sound suspicious of this...just I am of psychiatrists who suddenly tell you theres little wrong with you. And I went through that. And there was something serious wrong with me.

There is no evidence that when I was psychotic when I was 14 that I was suffering from a mood episode, and actually there is evidence against a mood episode, as I've discussed with both the psychiatrist I got a second opinion from and my psychologist. I was not diagnosed with a mood disorder then, and I have not been psychotic at any other time. Nevertheless, of all the issues with the second opinion, I agree the least with this (i.e. that it wasn't necessarily a sign of a psychotic illness). Still, it was not the main focus of the interview.

As for the bipolar issue, that was diagnosed at age 28 based on increased agitation and edginess on an antidepressant, which is not a valid practice. There is no evidence, either from the records or self-report, I have ever sufferred a major depressive episode, a mixed episode, a hypomanic episode, or a manic episode. I agree with the second opinion on this.

A major reason why I agree with the second opinion is that he was much much much more thorough on the history taking, whereas with the first opinion I was diagnosed after only 15 minutes. Looking back, I find that pretty outrageous, especially for diagnosing such a time-based disorder as bipolar disorder. As I wrote above, he said that the bipolar diagnosis was likely handed down so the hospital could get reimbursement, as something like autism spectrum disorder or gender dysphoria would be much less likely to.

"Psychotic features" were added to the diagnosis, but those were based on reports of brief, infrequent psychotic-like experiences, like a whisper here or a suspicion that those people talking to each other are talking about you. He did not consider them important to diagnosis, and based on what I read, "attenuated psychotic symptoms" cannot really be used to diagnose anything by themselves, which seems to agree with him. More evidence of diagnostic upcoding by my psychiatrist.

Another outrageous thing that I suspected and he confirmed was with my second hospitalization. I had suffered dyskinesia and akathisia for a second time on Saphris, even with Benadryl, which left me very unnerved. I talked to my psychiatrist at the time, telling him I was afraid to keep taking it, and he responded saying to just stop taking them, so I did. Nevertheless, I was very afraid of hell at this time. The experience of akathisia was hell, and I feared having to suffer a similar experience in hell. So I converted. Nevertheless, I was still very afraid of death and hell so I checked myself into the hospital. My psychiatrist wrote in some of the notes that I was experiencing manic psychosis. However, as the doctor I got my second opinion from read the actual direct observations of my behavior during the hospitalization, even the observations written by the doctor, he said there was no way I was experiencing manic psychosis. As he explained to me, manic psychosis is not subtle: It doesn't take a magnifying glass to find. In addition, I remember a nurse tell me on the first night I was in the hospital (paraphrasing): Why are you even here? You seem so well. I got plenty of sleep every day while I was there, my behavior was generally appropriate, I never exhibited the characteristic flight of ideas or pressured speech, the nurses noted only one day in which I had an irritable mood, and no one ever observed an elated or euphoric mood. So where was this manic psychosis? More evidence of diagnostic upcoding.

I'm also kinda pissed, because in retrospect that hospitalization was probably not even necessary, but now I'm in debt to the tune of 2000~3000 dollars for it.

I'm pissed overall with my first doctor's sloppy diagnostic practices, and I'm looking to jump ship. And bipolar isn't what I have.

EDIT: In addition to this, I am getting a third opinion, from another doctor in the second doctor's office who has more knowledge about the autism spectrum.

Oh okay, a friend of mine took Lithium and she went off it very slowly.
With the meds, it depends....

If you go off the meds now without talking to your current psychiatrist, it's possible that she is pissed and you have to look for a new one. It depents if you wanna risk that. You could also wait and talk to her about stopping psychiatric medication and what the other psychiatrist said and if she still "forces" you to take them it's propably better anyway to change, but maybe you can sort things out with her and she realises that this psychiatrist you went to is propably right, but to do that a third opinion might be a good choice. Unless you wanna change psychiatrists anyway...



Both can happen of course, but I was also once terribly miss-dx and the reason for it was that the psychiatric clinic I was, had no real experience in autism nor in gender identity disorder and that I had a traumatic anxiety reaction at the same time (I was put in the locked ward and I had severe claustrophobia so I freaked). Autistics don't always react the way like neurotypicals do.
Of course if beneficii isn't quite sure, a third option would be a good choice, but I think it's upto her.

Yeah, too less time for diagnosis is one of the mainreasons for miss-dx next to too less knowledge in some disorders (like ASD, gender identity disorder etc.) and arrogance of some psychiatrists and of course not being able to admit for being wrong.

My last psychiatrist told me the day she kicked me out (I got a second opinion):
"I didn't thought reading the psychiatric reports would be necessery"



Yes that's why especially Borderline Personality Disorder as a diagnosis is so popular in my country, because insurences pay pretty well to treat it and also there are many treatment options for it in my area you can just attend if you have this diagnosis.



I'm sorry to hear that.



good.

... sadly in my city is noone who has real experience in ASD.
I was dx in the past by a German autism expert with HFA, but now got re-dx with ADD + autistic tendencies. So I'm a bit uncertain and because there are just view autism experts in my country, to go to a good one to get another opinion I would propably have to wait about a year.