Q: Is it possible to exhibit bipolar (and other) behaviors only because I
think about psychological disorders too much and unintentionally "fake it" to
qualify for a diagnosis? |
Sorry to bother you, but this is one question I didn't see covered in your
History: I'm 22, and for the past 6 years ago I've had alternating diagnoses of
being bipolar, borderline, or just brilliant and bored with life (and therefore
prone to create needless drama).
During high school I definitely felt like my moods controlled me, and I was
certainly depressed and maybe hypomanic (i.e. cutting, being bulimic,
overextending etc), and since everything happened naturally my "sickness" seemed
I didn't receive help until college, however (my parents were pretty oblivious,
but the college officials weren't). By that point, I was (knowingly) delusional
at times, taking handfuls of over-the-counter pills, etc, and acting so 'off'
that my roommate seriously thought I was a cocaine addict (um...no). Through it
all, though, I knew how weird I was acting, and what made me MOST agitated was
the constant question, "Am I faking all of this, or is it real? But how could I
be faking this--but would I be having these thoughts if I WEREN'T faking it?"
I would obsessively pore over psychological journals trying to diagnose myself,
and I never knew whether I exhibited a behavior because it was authentic or
because I knew I needed to exhibit it in order to qualify for the pet diagnosis
I wanted to convince my psychiatrist of. This is especially true because if I
take enough "time out" I can typically "talk myself down" and avoid acting out
(though I can't change my mood).
Now that college is over, I'm more stable day-to-day, but my life is still a
mess, even though I've received "the psychological seal of approval." Among
other things, I'm about $20k in debt from spending lavishly during "up" times, I
convinced my (now ex) boyfriend to propose to me (and became
depressed/claustrophobic and broke off the engagement a couple weeks later,
moving 1000 miles away), impulsively joined the Marines (and was kicked out
within 2 weeks), and in general make grandiose/regimented plans for my
future/eating habits one week (only to be so depressed that it's hard for me to
get out of bed and do anything but gorge for the next week).
To outsiders I somehow look okay, but in reality? Obviously something is wrong,
but maybe I'm not bipolar or bpd at all, and I'm just using those disorders as
excuses so that I don't have to grow up? But is that even POSSIBLE? Should
"trying to be normal" really be that difficult? If you have any thoughts, Dr.
Phelps, I'd love to hear them, because seriously, this question drives me even
crazier than my behaviors! Thanks!
Dear Carolyn --
A couple of thoughts. One way to approach this would be to connect with a good
psychotherapist and ask this question there, expecting that the "answer" would
emerge slowly in your work there, as you kept examining the kinds of examples
you present in your summary here and those which occur as you go along. In other
words, it may be much easier to let an outside observer try to answer this
question for you than to figure it out yourself.
Which leads to the second thought: "overthinking" is a recognized symptom of the
bipolar thought process. Many times it can look like "obsessive-compulsive
disorder", except that the usual themes in OCD are about harm, or completing
things correctly, whereas yours is sounding rather different in what you have
written here. So it could be that the instrument you are using to try to solve
the problem is part of the problem itself. When my colleagues put it thus: if we
threw you a ladder to get out of the hole that you are digging, you would
probably use it to dig with.
Thirdly, you describe numerous outside observers who have already, and rather
consistently, come to the conclusion that there is something wrong with your
behaviors that warrants mental health treatment. So simply on the basis of what
you have written here, it seems more likely that they are correct then that you
are "faking it". However, except for the distress that it is causing you,
questioning whether there really is a underlying mood problem to explain your
struggles, or whether you might simply be able to overcome those struggles by
changing your behavior, is a worthy question. On the other hand, asking
questions like that is supposed to lead to improved outcomes, not worse ones,
and thus it appears that you may have exhausted the utility of this question and
are ready to move on to other strategies.
Interestingly, in this respect, I just came back from a bipolar-specialty
meeting in which a research team described their project, just getting under
way, testing a psychotherapy approach with no medications at all, for Bipolar
II. In other words, the psychotherapy approaches for bipolar disorder are just
getting better and better and may decrease the need for medications at least
somewhat, if not completely. Again, this suggests that a good psychotherapist
might be an important component of whatever treatment approaches you put
together at this point. If you invite your providers to point out to you if they
ever think that you are "just faking it", and to keep a rigorous examination of
that potential in mind as your treatment proceeds, you can potentially "offload"
that concern onto their shoulders and focus on carrying out their treatment
recommendations. From what you have written, I think that is an exciting
prospect and I hope you might be able to engineer something like that soon.
Published September, 2007