Misdiagnosed as bipolar? Just ASD?

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I was diagnosed with "symptoms of bipolar," in other words, my psychiatrist wasn't confident that I was full-out bipolar, but I had enough symptoms to warrant a prescription for valproic acid and a label of Bipolar-NOS. However, I wonder if I actually need this medication, or if my ASD, anxiety, and prior diagnosis of ADHD are contributing to bipolar-esque symptoms. My psychiatrist thought that I probably do not have ADHD, but it is worth noting that I was diagnosed with this as a young teenager and was on Concerta for awhile, which I tapered myself off of due to the extreme anxiety it induced. I'm looking for some perspective from other autistics to find out if these symptoms are typical of people with autism (or anxiety/ADHD), or if they are indicative of bipolar. Here are the issues I'm experiencing:

-restlessness: I have a hard time sitting still, constantly pace around, and always need to fiddle with something with my hands. This happens because I am nervous, but even when I am not having an anxiety episode I still can't sit down.

-impulse control: sometimes, although not always, I have problems regulating my impulses. For instance, I am really not supposed to drive, but I sometimes get random urges to go down a highway at 70 miles per hour. I often make decisions which are short-sighted. For instance, I'm a college student, and on the last day of the add/drop period I completely changed my whole academic schedule, which put me too far behind to recover. I don't know if this is hypomania or ADHD.

-changes in mood and energy: I am either very enthusiastic (bouncing up and down on my bed, skipping around the house, making up silly rhymes about my pet), or very lethargic (I can't bring myself to get up from my bed, I don't have the willpower to exercise anymore, I sit on the couch and overeat, and I can't get myself started on necessary projects). I know the hyperactivity and rhyming is often associated with hypomania, but the hyperactivity could also be indicative of ADHD, and some autistics frequently engage in wordplay. I don't know if my mood swings are indeed bipolar, or if my ADHD diagnosis is still valid and I perhaps have the new-found development of depression.

It's worth noting that the hyperactivity and lethargy have worsened over these past few months. I was always hyperactive as a child, but I think it has become more manifested in public lately. I used to be able to keep myself together in public, but people have noticed my hyperactivity at work (before my leave of absence), and in class. It's quite possible, however, this is just because I've become more outgoing over the years; I used to be so shy and withdrawn as a child that no one would have ever thought I was hyperactive, because I didn't engage with people. I don't recall having problems with severe lethargy before, although I have experienced intermittent depressive feelings ever since I was 16 years old. I always wondered if this was just situational depression, since there usually is a trigger and the depression doesn't last for more than a couple weeks, but what gets me worried is that I am now experiencing suicidal feelings on occasion, and that the depression won't lift. For instance, I was placed on an involuntary leave of absence from my job back in September, and I still feel very much depressed--it's like I can't recover. I might have a few good days where it isn't so blatant, but then it returns again. The odd thing is, however, that the hyperactivity isn't gone. I might wake up, full of energy and optimistic for my day, then three hours later, I feel as if there is no hope. I tend to experience at least 2-4 fluctuations in my mood throughout the day. I may go through several days where I feel at my baseline, just a bit hyper, but then I have a few depressive days.

-Poor concentration: I have such a hard time sitting down to read a book, which used to be one of my favorite things to do. I find that I can still memorize lists of information, but anything that requires global processing demands too much executive functioning at this time. Sending a simple email or focusing on taking laundry out of the dryer is difficult.

-Pressured speech: Many, many people have told me that I talk incredibly fast, and often so, incredibly loud. I go through hours, sometimes days, at a time where this isn't a problem, but then suddenly I can't control my speech anymore. I tend to get loud and fast when I am either really excited/passionate about something, or I am in an anxiety-inducing situation, although there is certain times this happens without any trigger. Seldom am I aware that this is an issue, unless someone brings it to my attention.

Possible flight of ideas: I have been told that I am very tangential and quickly change topics. Sometimes the new topic bears no relationship to the topic I was previously discussing. This is a tricky symptom to attribute to one disorder, because it could be connected with autism, ADHD, and/or bipolar.

Inappropriate laughter: I frequently laugh in situations that are not comical. For instance, I tried calling the local library, and I was unable to complete my call because I was laughing too hard--nothing the librarian said was funny by any means. Whenever I fall (I have low muscle tone issues), I tend to laugh afterward. My theory is that this is because I am highly embarrassed. My laughing is not just chuckling for thirty seconds, but it often escalates into 5-10 minutes of uncontrollable laughter punctuated by tears. I don't know if this is due to my anxiety or if it is more likely caused by hypomania.

Here are the bipolar symptoms I don't have:

-heightened self-importance: I definitely have low-self esteem overall.

-decreased need for sleep: even when I am very hyper, I still crash at the end of the day. In fact, even though my hyperactivity increased last month, I found myself needing more and more sleep. I used to be able to subsist on 4-6 hours of sleep, but now I find that I need 7-10.

-poor financial choices: I am exceedingly cautious with money. If I spend $2.50 on a coffee, I feel like I have made a poor financial choice. It is worth noting that I have been spending a bit more lately (by more, I mean getting a $1.10 Snickers bar when I pass by a vending machine), but I think this is to quell my depressive feelings. I sometimes feel so blue that when I see cheap food, I buy it just to distract myself from feeling so hopeless.

-irritability: my mood changes from enthusiastic to depressed, but no matter what kind of mood I'm experiencing inside, people tend to think that I am pleasant. Several people have told me "I've never, ever seen you angry!" I am not prone to fits of rage or outwardly manifested moodiness. Is it possible to have bipolar without any irritability?


So, what are your thoughts? Do I fit the criteria for bipolar, or am I just displaying a cocktail of autism, ADHD, anxiety, and depression symptoms?

you could be describing me---or any number of people on the spectrum. i am diagnosed with bipolar but the consultant who was an international expert in bipolar said that ADHD, anxiety and autistic traits are the rule rather than the exception in bipolar. and that ASD labelled people very often have mood problems too and ADHD symptoms as well. these are qualities of the brain which seem to dance well with each other genetically.

we will all express our brain-state uniquely, whatever mood or attention problem might beset us. none of us really fit the diagnostic manuals and their Lists to an exact fit. sometimes the doctors try hard to make people fit their expectation of a given category of disorder but we all we're all just not that simple.

you sound to me like you need to look hard at what is actually disrupting your ability to live well and peaceably enough. the depakote might or might not be right for you, even if you are bipolar. if moods are swinging into disatrous manias, depakote helps some people maintain a more even existence. but it isn't the right med for everybody, in terms of controlling mood or dealing with side effects. trial and error, that's the lot left to those of us who do need meds to get by in life but who are very sensitive to side effects and find getting an acceptable treatment tricky. still, i have a med regime that has been working pretty well for a long time now so it is possible, don't give up.

OTH, if you can live without meds and find yourself without undue suffering day to day (or causing others undue suffering) than modifiying your behaviour through better lifestyle choices and utilizing the tools of therapy such as Cognitive Behaviorial Therapy or some other one, may be enough to meet your needs.

if you are able to pursue other consultants for their opinion of your mental condition(s) than I advise strongly doing so. don't tell them to begin with anything but your symptoms and the way your life is with you, see what they say. then admit you have been diagnosed before such and such and see what they make of this. tell them how desperate you are to know what is really what and how to proceed and make the best of your life.

try not to feel that you are strange for having so many different possible labels. as my pdoc (the best one) said, the bipolar and ASD can in themselves encompass other problems like attention disorder, anxiety, depression, impulsivity, and so on. so it may be that ASD and bipolar say it all. or you may just need ASD and ADHD to get the picture right on paper and get the right treatment. but if you do have bipolar, as i do, the ADHD can't be treated with a stimulant (in most cases) as it makes our moods worse (irritability, agitation, anxiety etc). Pity, but that's the way it is. so i use lots of non-med tips to help with the ADHD part of my make-up.

hope this helps a bit. let me know if i can try to answer anything else.

sammieramsea

I was misdiagnosed with bipolar (which started as bipolar I, then backed off to bipolar NOS) about a year ago. I was frustrated at being unable to get sex reassignment surgery and had meltdowns in my house due to that, and they seemed to get worse on Prozac, so by "raging on Prozac" I was diagnosed with bipolar. I recently got a second opinion and the doctor says that I have leftover ASD along with gender dysphoria and anxiety; he got me off the medication. I know now that I need to work on the ASD and the gender dysphoria.

I'm kinda pissed at the original doctor, because she diagnosed me after only a 15-minute interview and (according to the second doctor) really equivocal psychological testing results.

I'd say if you're really unsure about your diagnosis and the treatment doesn't seem right for you, try getting a second opinion, while also making sure the doctor you go to isn't like an Akiskal clone or something.

You're looking at bipolar as the symptoms not as the intense highs and lows that create those symptoms.

People with ADHD and bipolar are both impulsive but hypomania/mania is more the reason for the poor impulse control than the what is in in ADHD. ADHD emotions can be more intense than usual but they don't come as episodes.

Do you go through periods of depression and then intense highs (or just feeling over confident and creative)?

I have can have both low self-esteem and overconfidence. Not usually together. Well, sometimes but it's very rare. 4 days one way, 4 days another, though I am a rapid cycler. Yes, more rapid than that.

I used to think I have the hyperactivity associated in ADHD (which started only 3-4 years ago) but it came in episodes of an intense highs, with a lot of energy, racing thoughts, impulsive actions (like being more outgoing) and even delusions. Then I would crash into a deep dark pit of despair full of regrets about all those foolish things I had done and said during my manic episode and then get stuck on one or two issues about myself that I would usually be able to brush aside.

If you can't relate to that then it's possibly not bipolar. I'd get a second opinion.