Is There any Link Between My Manic Episode and This Emergence of Phobias - or Could This be a Separate Anxiety Disorder?
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Q:  Is There any Link Between My Manic Episode and This Emergence of Phobias - or Could This be a Separate Anxiety Disorder?

Dr. Phelps, 

A few months ago I had my second manic episode (the first in almost 7 years).  I had  psychotic mania and was hospitalized for it.  During the later stage of the episode I became very paranoid and was afraid people were trying to hurt me.  It took about 6 weeks to fully recover from the manic episode.  However, since this time I've developed  several phobias and my anxiety levels have been higher than usual. I'm afraid of getting lost, afraid of elevators and being around large crowds of people.  Is there any link between my manic episode and this emergence of phobias - or could this be a separate anxiety disorder? I've always been a bit anxious and was slightly phobic about elevators and crowds before, but its reached a new level - especially with the getting lost fear.  Please let me know your opinion.  



Dear Noelle --
Fortunately, you used just the right word in your request: "opinion".  I do indeed have one on this issue, but unfortunately there is very little to go on in the way of research about this, to my knowledge. 

In my practice, I have many patients who would strongly endorse your story as descriptive of their experience as well.  There is some connection between bipolar disorder and anxiety symptoms.  I wrote a lengthy essay about the two on my website (e.g. anxiety as a bipolar symptom is a part of that essay, but it is far too short to satisfy your question). 

As you may have learned, there are psychotherapies for anxiety, and in my experience they are valuable whether a person has bipolar disorder or not.  Agoraphobia can ironically include both being in the middle of an open place alone, as well as being in a crowd of strangers (and might in that respect capture that fear of getting lost: the common thread throughout is a fear of being isolated with no one who would come to your aid if you needed it).  So that captures a part of the problem.  Social anxiety (officially called "social phobia") captures another part of the problem.  Both of these have a strange and interesting relationship with bipolar disorder.  Unfortunately, often when mood symptoms are completely controlled, and these can still be prominent and troublesome.  But the good news is that psychotherapy can help address them.  Not perfectly every time, not as fully effectively as when people don't have bipolar disorder, I think; but still valuable. 

I hope you find an effective approach to the symptoms soon --

Dr. Phelps

Published August, 2008


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