Possible to have BP & Be So in Control?
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Q:  Possible to have BP & Be So in Control?

Dr Phelps,
Background:  My oldest child was always a difficult child since birth. We tried to get help but no one seems to want to make a dx, she has all the symptoms of  pedbp except psychosis. She has rages, is creative, smart, talks rapidly and changes topics often, sleeps too much or too little, sensory issues, intense carb cravings, intense desire to drink alcohol, never accepts the word no, odd silly laughing behavior, has trouble keeping friends, dresses seductively, makes embarrassing  sexual statements, becomes extremely motivated and other times just cant do anything, distracted sometimes, bossy, lies and believes her lies, destroys property, anxiety, has low self esteem and yet other times feels as if she can rule the world, and states that no societal rules apply to her. Her grandfather has bp. Age 11 dx with OCD, no parental strategies seemed to work. Age 15, sleeping a lot and cutting herself, put on prozac, one week later hospitalized for taking a knife to herself and threatening to kill sister, dx with bp, Lithium 450mg  bl .04, followed by pdoc that did not believe in labeling her, took her off lithium 450mg after one month, put on Lamictal, finally up to 200mg within 3 months, added abilify 5mg, she had more anxiety, put on Tenex, and one pill made her manic, back on abilify 5mg, one month later we go into office and my daughter tells pdoc she doesn’t need meds nor does  she have this. The dr believes her, takes her off meds, she becomes depressed again. Then behavior changes trouble with the law, drinking and drugs, hitting her parents, jumping out of moving cars, ends back in psych ward for taking handful of pills, released with dx of Adhd. I should mention she was an A student up until this year, she is now failing everything. Court wants her in to psych ward for full eval, she now has three counselors again, chemical dependence counselor, mental health counselor, and a MSW who comes to our home to resolve conflict, all recommended by probation officer. These counselors state they can help her without another admission. Went to see new dr who says she does not show classic signs of bp as she is not out stealing credit cards to go shopping. (btw we keep things locked up in our house, for that very fear) And that she is not engaging in weird sexual behaviors, nor was she talking a mile a minute while in the dr’s office. I should also mention that my other two children are fine, except for what they have had to endure from my daughter over the years and that her father and I are happily married, both with professional jobs, although stressed from so many years of dealing with my daughter.

Here is the problem, My daughter seems to only show this “bipolar” side to those that are closest to her, which basically is only our family. She is in complete denial and says there is nothing wrong with her no one is going to change her personality. The counselor (who has seen her 4 times now) stated that she would be able to see the bipolar. My daughter has confessed that she knows how to “play” all of these professionals, and when faced with them, she is very quiet, sweet, articulate, smart and in control young lady. Is this really possible for her to have bipolar and be so in control. I can not find any reputable literature on this, except for reports from other families who are going through this. Sorry so long.

Dear Tina --

Let's put it this way: I have definitely had patients who while hospitalized for mania, where their behavior prior to admission was very dramatic and enough to convince even skeptics that the bipolar  diagnosis was warranted, pull themselves together and act "normal" when being interviewed by someone who had the power to allow them to be discharged.  So yes, I do think that for short period of time, people can put a lid on their symptoms in a rather deliberate way.  Worse yet, they may not be able to recognize what they are doing in this respect, even after their manic phase is over. One bipolar specialist who has studied the issue of insight in bipolar mania, Dr. Nassir Ghaemi, has found that as many as 50% of people experiencing mania have no insight into this symptom.

A book that might be useful is called "I'm Not Sick, I Don't Need Help", by Xavier Amador. This book title sounds like it might be just the thing, but there is no magic in it, just some practical ideas that might help somewhat. It will help just to see how well recognized this problem is, and how many other families have been through it. An organization that has lots of experience with helping families manage when a loved one has an illness into which they have no inside at all, is the National Alliance for the Mentally Ill. Check them out at www.nami.org.

Dr. Phelps

Published July, 2007


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