Types of Bipolar Disorder & Related Disorders – Schizoaffective Disorder, Schizophrenia, Borderline Personality Disorder, Post-Traumatic Stress Disorder

Before a professional diagnoses any mental illness,

it is important that they know your medical history and any medical conditions or problems that could cause mood disturbance.

Bipolar Disorder is solely diagnosed by the presence of MANIA.


This means that a person experiences:

– Hallucinations: our brains experience things with our senses that are not really there. We hear things, see things, smell things, taste things and feel things that are not really there. IT MEANS THEY ARE REAL TO THE PERCEIVER…NO ONE ELSE CAN EXPERIENCE THEM.

– Delusions: are beliefs about things that are happening, have happened or will happen that are not and have not taken place based on the perception of others. IT MEANS THEY ARE REAL TO THE PERCEIVER…NO ONE ELSE CAN EXPERIENCE THEM.



Is based solely on the presence of:

1. Full-blown mania

– Full-blown mania is mania that disrupts your ability to function in work, socially, in your responsibilities and roles and contribute to productively to society.

– Full-blown mania puts yourself and others at risk for harm.

2. Mixed Episodes

– Mixed episodes are episodes that have BOTH mania and depression taking place during the same day.

3. Rapid Cycling

– Rapid Cycling is when a person has 4 or more cycles of mania and depression in one year.


Is based solely on the presence of HYPOMANIA.

Hypomania is a form of mania that does not significantly disrupt your ability to function.

You are still able to work without losing your job. You are still able to function in your daily responsibilities and social relationships.

Bipolar Disorder, Type 2 is diagnosed when a person IS NOT rapid cycling…meaning that they do not have more than 4 episodes a year.

People with Bipolar Disorder, Type 2 tend to struggle more with depression than with mania.

Depression tends to be more severe.

The depression may impair the ability to function to the point that it disrupts the ability to work, function in daily responsibilities, social relationships etc.


This is when a person experiences HYPOMANIA (mild mania) and MILD DEPRESSION and it cycles back and forth between episodes for a period of 2 years.

Neither the mania or the depression are severe enough to disrupt the ability to function in their responsibilities.


This diagnosis is for people who experience MANIA that does not fall into the other categories…

For example:

People who ONLY experience full-blown mania without depression. This may still be diagnosed as Bipolar Disorder, Type 1 by many psychiatrists.

ONLY experience hypomania without depression.


[box] These related diagnoses are NOT my first hand specialization based on my experience…I do not live with these disorders…I am sharing from my education and knowledge and experience as a therapist with working with clients)[/box]


Is a diagnosis given to someone who experiences Bipolar Disorder or Major Depressive Disorder or another Mood Disorder Not Otherwise Specified (NOS)

That experiences psychosis during time periods when they are NOT experiencing depression or mania.

With Bipolar Disorder, the psychosis ONLY occurs during mania or depression.


Is a diagnosis that is given when a person experiences delusions and hallucinations for a period of more than 6 months.

As with the majority of mental health conditions out there, schizophrenia can be treated with a combination of therapy and medication. However, the medicines used in the treatment of schizophrenia, such as Seroquel for example, can have side effects and therefore sometimes it can be necessary to try alternatives.

Seroquel Withdrawal Psychosis refers to the appearance of psychosis when the dosage of Seroquel is reduced, especially where the reduction is too fast, or without the necessary preparations.

Ultimately, if schizophrenia is well managed, by recognizing the signs of any acute episodes, taking medicine as prescribed, and talking to others about the condition, it is entirely possible to reduce the chance of severe relapses.


Is a diagnosis that is given when a person experiences delusions and hallucinations for a period of less than 6 months.


BPD is a diagnosis of the PERSONALITY.

This is is NOT KNOWN if it is a genetic disorder. It does not cause depression or mania.

This is a disorder MAY BE a reflection of our ATTACHMENT with our primary caregivers.

People who often have Borderline Personality Disorder struggled as babies and young children who do not know what to expect from their primary care giver.

It is common for people with bipolar disorder to have borderline personality disorder because their primary caregiver was bipolar and they were not able to know what to expect from them…

Example, children do not know if mommy will be happy to see them or sad to see them. They will get confused messages from mommy that say things like “Come here & go away”

Borderline Personality Disorder affects ATTACHMENT:

People often have an intense fear of abandonment or feel abandoned.

They put people up on pedestals one moment then knock them down the next.

Trust is very hard because they struggle with uncertainty and confusion about if their needs will be met.


This is diagnosed when a person experiences or witnesses a traumatic event that is a threat to their life and as a result, they experience extreme anxiety and paranoia, nightmares, vivid memories and flashbacks that looks like psychosis (they re-live the event as though it is happening right now)

Most of the time, seeing a therapist or counselor who specializes in post-traumatic stress disorder will help to relieve some of their symptoms of anxiety and paranoia. In some cases, people may even decide to try something like these edible marijuanas canada located, (if you live there) to see if this can help them back into a healthier mindset.

PTSD relates to bipolar disorder because it can resemble mania: irritability, emotional outbursts, impulsive behavior.

People experiencing PTSD may be misdiagnosed with Bipolar Disorder if not thoroughly assessed.

It is common that people with bipolar disorder also experience PTSD. Many people with bipolar disorder have experienced severe trauma that endangered their lives.


PTSD and Bipolar Disorder can be partners and look a lot like each other

Post Traumatic Stress Disorder (PTSD)

is NOT a genetic disorder like bipolar disorder.


It comes into our lives based on

HOW WE RESPOND to a traumatic event.


When PTSD partners with bipolar disorder, it can cause mania and depression without any specific triggers in your life.


PTSD itself is a trigger.


PTSD is a response to an event that causes intense fear, horror or helplessness in which there is an actual or perceived threat to our lives or serious injury of self or others.



Symptoms of PTSD



RECOLLECTIONS: images, thoughts, and perceptions that are recurrent and intrustive or distressing

DREAMS of the event

ACTING or FEELING as if the event were reoccurring…RELIVING the experience  (this can look like mania)

ILLUSIONS or HALLUCINATIONS seeing and sensing things that are not really there or happening

FLASHBACKS feeling as though you are re-living an earlier time.


How PTSD Looks in Real Life

PERSISTENT AVOIDANCE – avoid thoughts and feelings, conversations, activities and places associated with the trauma

NUMBING of RESPONSIVENESS – shutting down or not responding to any triggers of fear.

INABILITY TO RECALL important aspects of the trauma

FEELING DETACHED or ESTRANGED from others (causes isolation and the loss of relationships)

RESTRICTED AFFECT – inability or difficulty to feel and/or express emotion (this looks like depression)

EXPECTATION TO NOT LIVE A NORMAL LIFE.  (This can look like suicidality, mania or depression)


SLEEP DIFFICULTY -Difficulty falling and staying asleep (big problem with bipolar disorder)

IRRITABILITY-outbursts of anger (may look like mania)

DIFFICULTY CONCENTRATING  (can look like mania, depression, or ADHD)

HYPERVIGILENCE – obsession (this can look like mania)

EXAGGERATED STARTLE RESPONSE – responding to a small fear trigger as though it is incredibly scary to you.



PTSD is diagnosed when these symptoms begin within 4 weeks of experiencing or witnessing a traumatic event AND if the symptoms persist BEYOND 4 WEEKS.

PTSD is an ANXIETY DISORDER that has depressive and manic symptoms.

There are many people who have PTSD and are misdiagnosed with Bipolar Disorder.

There are also many people who have BOTH bipolar disorder and PTSD.



How to choose a therapist & What to expect in your first session(s) of therapy



In this article I will share with you the common practices of therapists in their first session(s) as well as give you some ideas of how to choose a therapist that could be a good fit for you.

We will explore:

Finding a therapist  •  Assessment   •   Confidentiality   •   Your first session    •   What to expect from therapy

Finding A Therapist


There are many ways to find a therapist:

  • Direct referral from a physician or psychiatrist.
  • Referral from a friend
  • Websites that are “Therapist finders”
  • Your own research


Do your research:

There are several different “Theoretical Orientations” that therapists practice from.   Many therapists practice from multiple modalities, but to be an educated consumer, it is important to have an understanding of a therapist’s emphasis because it will have a HUGE effect on how you do therapy together.

There are several theoretical orientations, I will share with you three main theoretical orientations of psychotherapy.

Psychodynamic theoretical orientation primarily focuses on problems in your past experiences, what happened in your childhood primarily in you key attachment relationships (ie. parents, siblings and any prominent relationships that served as building blocks in your life), and draws a connection with your present problems or issues and emphasizes feelings.  This orientation consistently asks “How does it make you feel?”

Cognitive-Behavioral theoretical orientation primarily focuses on how your thoughts affect your feelings and behaviors/actions.  This orientation believes that it is not what happens to you that determines your quality of life, but it is how you think about what happens to you and how you respond to it.

Post-Modern (Narrative Therapy & Solution-Focused Therapy) theoretical orientation is one of empowerment that holds the perspective that people have strengths, abilities and resources that once we develop our gift at using them, we have the ability to resolve problems in our lives now and in the future.

The focus of therapy is on the stories people tell themselves about problems and the effects of those stories on people’s lives. A post-modern therapist emphasizes understanding the problem, but focusing your attention and growth on what you want instead of the problem.

Postmodern therapists believe that “You are NOT your problems.  You are in a relationship with your problems.”  For instance, “You are not depressed.  You are affected by depression. You are an intelligent and capable person who happens to be affected by depression right now or is currently in a relationship with mania (mania is powerful and causes you to do all sorts of things).”

The therapist does not take the stance of “the EXPERT”, instead you are the expert of your life (you are the only one who has lived it) and the therapist uses their expertise to collaborate with you and share a process with you that may help you develop your strengths and abilities.  This form of therapy is highly collaborative and transparent.

I could go on and on with post-modern therapies….

YES…I am biased.  My foundation and training is as a Post-Modern therapist.  However, I have integrated Cognitive therapy and Psychodynamic therapy into my practice and use anything that works for my clients.




Most therapists will want to collect a significant amount of personal information about you in order to do a thorough assessment.

It is important that we have an accurate medical history so that we can make necessary referrals to be able to rule out any medical cause for dysfunction in your life.

It is also important that we have an understanding of your current symptoms – their onset, duration, intensity and history (have you experienced them before).  This is how we diagnose (make sense of a problem you are experiencing) as well as determine if it is in our scope of practice and competency to be able to help you.

We want to know about your support system both for your own safety and so we can provide resources and referrals.

We will ask you about medication history, drug history, suicide attempt history and abuse history.

Often times people are not honest about this from the get-go because it is very hard to share this history AND it makes sense to fear judgment, stigma, shame etc.

There are many therapists who will not take on new clients who have current drug use or have a history of suicide attempts or current suicidality because it is NOT in their scope of competence and requires more availability and urgent care.

In your first few appointments, your therapist will likely explore this information with you in a formal assessment.



Confidentiality & HIPPA Agreement


In California, it is the law that in your first appointment the therapist goes over with you “Confidentiality” and the ‘HIPPA Agreement”.

Everything that is shared in therapy is held CONFIDENTIAL, but there are exceptions to confidentiality that you MUST know.

  • If a therapist suspects current or previous CHILD ABUSE (physical, neglect, sexual, emotional), we are legally mandated to report it to Child Protective Services.
  • If a therapist suspects current or previous ELDER or DEPENDENT ADULT ABUSE (physical, neglect, sexual, emotional, financial), we are legally mandated to report it to Adult Protective Services.
  • If you tell your therapist that have the intention to HARM a specific identifiable person, we are mandated by law to make reasonable efforts to warn that person and notify the police. (In California)
  • If you are suicidal (you have the intention to commit suicide and a plan to carry it out AND therapeutic interventions are not working) it is our ethical responsibility to contact the psychiatric emergency team (PET team) to have you hospitalized, even if it is against your will.



In Your First Session

Now that all of the legal and ethical stuff is out of the way

It is all about the relationship


Things for you to pay attention to to determine if you have a good fit with your therapist.

  • Do you feel comfortable in the therapist’s presence?

In my opinion, the therapist is NOT supposed to be intimidating. You can expect yourself to have walls up when you first meet and to feel anxiety.

A therapist’s presence should feel good, provide containment and feel safe once you build trust.

  • Do you like the therapist?  Do you respect the therapist?

It is important that you like your therapist’s personality and respect them.  No therapist is a perfect person who lives by everything they say all of the time (or even much of the time)…nonetheless, it is important that you VALUE THE WAY THEY THINK.

  • Do you feel that the therapist gets you?

I cannot express how important this is!  If you share things that are very important to you and the therapist doesn’t acknowledge it and asks a question that changes the topic to what they think is important…THEY DON’T GET YOU.

I am adamant about this because there are so many people who refuse to go to therapy because they have had this experience. I was one of them.

I believe that a good therapist will check in with you and make sure that the conversation is useful for you and that you want to be having it.

  • Do you believe the therapist can help you?



It is pretty common for people in their first session to “dump” out all of their feelings and experiences with the therapist.

The challenge with this is that it feels good in the moment, but the trust is not there in the relationship so it makes most people feel so vulnerable that they won’t come back to therapy.

Trust is not something you automatically give your therapist. Trust must be earned.

I recommend honoring your boundaries and taking your time in therapy.  Your boundaries and walls are there to keep you safe.

I believe we should change our boundaries and walls only when we have something of more value to replace them with.  In your first session, you have not created that something of value yet.



What To Expect From The Process of Therapy


  • Therapy will open up wounds in order for them to better heal and it will be painful at times.
  • Therapy will affect the way you think and feel about yourself and your life.
  • Therapy will affect your behaviors and actions.
  • Because you are growing, therapy will affect all of your significant relationships.


I hope this is useful.


To choose me as your therapist, if you reside in the state of California, please contact:

Robin Mohilner

(310) 339-4613

email: thrivewithbipolardisorder@gmail.com


What is Bipolar Disorder?

Bipolar disorder is a highly misused name whose sole purpose is to describe common and shared experiences and behaviors that occur in a significant percentage of the global population.

To appropriately receive this name (or as it is often called, “label”) one must have evidence of the presence of one single manic (severe) or hypomanic (less severe) episode.

how do you recognize mania?

  1. a person must have a distinct period of at least 1 week in which they experience persistently elevated, expansive or irritable mood

  2. at least 3 of the following symptoms

  3. mood disturbance must be severe enough to cause impairment in ability to work, relationships, social activities


  • elated mood – ecstatically happy with or without reason; bouncing off the walls with happiness.
  • expansive mood – covering a wide area of mood; mood swings.
  • irritable mood – angry; easily lashing out

Notice if mood is abnormally elated, expansive or irritable from how mood normally is.  Mood may swing between the extremes of elated and irritable as well as other emotions. Mood  may shift without any situational triggers or circumstances.  Emotion may be expressed in an out of control way.

If a person exhibits these moods, it does not mean that a person should be diagnosed with bipolar disorder. However, it does mean that bipolar disorder could be a reasonable possibility.


During the period of mood distrurbance 3 or more of the following symptoms must be present to a significant degree

Inflated self-esteem or grandiosity

  • perception of self is not in touch with reality
    • exteme (significantly greater than normal) sense of self-importance and specialness
    • arrogance
    • It is common for people to believe that they are not from this planet or are chosen by God.
  • profound sense of spirituality, ability and purpose

    • sense of invincibility, omnipotence, mastery and control
    • incredibly heightened intellectual and overall brain activity due to changes in the brain during mania
    • connection to the world around them; believing they can change the world by doing ________________.
    • perception of having special powers, gifts and abilities

This (and the ability to persist towards goals) is often the reason why people do not want to take medication.

Not needing to sleep (or unable to sleep)

  • significant decrease in need for sleep.
  • Difficulty falling asleep and staying asleep.

If a person is having difficulty sleeping and/or does not have the need for sleep, this is an early warning sign of mania for a person living with bipolar disorder.

Medical problems must be ruled out when a person is experiencing sleep difficulties. This symptom alone cannot result in the diagnosis of mania. However, it is a very important symptom that must be monitored.

Can’t stop talking

  • pressure to talk
  • more talkative than usual

This is not about a person’s need to talk about themselves or be the center of attention.  They are simply flooded with so many ideas that they can’t stop talking.

Obsessed with a goal (goal-directed activity)…unable to stop.

  • unable to stop persisting on a goal (work, school, sexually)
  • neglect things like eating, showering, sleeping, family, friends etc to work on a goal

This is not Type A personality. This behavior is significantly different from how a person normally behaves.

Excessive involvement in pleasurable activities (impulsivity)

  • high potential for  painful consequences
  • often times impulsivity is expressed by spending lots of money frivolously (trinkets, clothes and unnecessary items) and goal oriented ways (investments, business, homes etc); however the investments are often not things that would be chosen by them normally.
  • sexual impulsivity – it is very common for people experiencing mania to have an intense and often insatiable sex drive

There is a difference between impulsive personalities and mania. A person experiencing mania is acting impulsively in extreme ways that they would not normally behave otherwise.

Flight of ideas or racing thoughts

  • these are thoughts that move so fast that they cannot be expressed or only make sense to you.
  • it is often having multiple thoughts at once that get jumbled together
  • these thoughts can be obsessive. You just can’t stop thinking them.

These racing thoughts often exist in people with bipolar disorder even when they are not experiencing mania.  Mania exacerbates them.

Easily Distractable (particularly by ideas or tangents,  this symptom is related to racing thoughts)

  • attention is easily grabbed by unimportant and irrelevant external stimulus

Similar to ADHD, yet ADHD does not have the mood component and distractibility occurs during the manic episode unless it is also a diagnoses.


can occur during mania and depression

  • delusions – refusal to accept that their perception and experience is not real to other people in spite of evidence that contradicts their perception and experience.
  • hallucinations – having sensory experiences (seeing, hearing, feeling, tasting) things that is not real to other people and rejecting that possibility in spite of evidence that contradicts their sensory experience.

Psychosis that takes place within a manic episode is common for mania.

However, when psychosis occurs outside of a manic episode, the diagnoses is schizoaffective disorder.

Note: Symptoms are not due to substance use or a medical condition. Medical conditions should be ruled out by a physician.


Answering Readers Questions: March 23, 2011

I highly value curiosity and welcome questions that can be generalized to be helpful to a lot of people.

Every thing that I write here is my opinion based on two things, my personal experience of living with bipolar disorder and my experience of helping people live with bipolar disorder both professionally and through out my life.

Here are the questions I have received recently:

  • What do you mean by “I am living with bipolar disorder”?

  • What are an M.A. and MFTi? (The letters that come after my name)

  • Can you treat bipolar disorder with just medicine or do you need therapy as well?

  • What does lithium do?

What do you mean by, “I am living with bipolar disorder”?

CLEARING UP CONFUSION: I, Robin Mohilner, was diagnosed with bipolar disorder as a teenager. I do not write from the perspective of living in a home with someone diagnosed with bipolar disorder.

I do not own “bipolar disorder” as my identity.  It is not who I am.  I try to refrain from saying, “I am bipolar.” That gives bipolar disorder the upper hand in my life.

By having the attitude and mindset that “I am living with bipolar disorder.”, I have the upper-hand.

I am in a relationship with bipolar disorder. I experience it as separate from me.  It affects me and I affect it (powerfully).

It does not control me, but when I’m not paying attention to our relationship, it temporarily gets the upper hand and I lose my power and control.

When I’m not paying attention, bipolar disorder loves to take me on emotional rollercoasters.  It loves when I am nervous or uncomfortable because it gets the upper hand and off I go unknowingly breaking unspoken social rules and impulsively speaking before I think or it makes me think so fast that it’s difficult to get words out of my mouth.

On the other hand, I have spent fifteen years developing a strong upper hand.  I get how bipolar disorder works.  I know how to prevent and contain my episodes.  I know what bipolar disorder needs and wants.  I am skilled in the art of stealing its power and fuel so that it cannot control my life.  My passion is to develop this in others.

The key is that I exercise my “paying attention” muscle everyday.  This keeps me living with bipolar disorder instead of being bipolar.

What are an M.A. and MFTi?

This question addresses my professional credentials.

M.A. refers to the Master’s Degree that I have earned in psychology, specifically in Marriage & Family Therapy, with eligible certification as an Art Therapist.

I earned my Bacherlors degree from U.C. Berkeley in Psychology and my Masters Degree from Phillips Graduate Institute in Marriage and Family Therapy.

However, earning degrees does not make me a therapist.  I have spent years paying my dues, which will explain the MFTi.

MFTi stands for Marriage and Family Therapist Intern. For the past five years I have practiced as a therapist under the license of supervising therapists.

I have successfully completed all of the hours of experience that I need to become a licensed therapist; however, I am currently patiently waiting (it’s a long wait) for the state of California’s Board of Behavioral Science to approve my hours of experience and grant me permission to take two challenging exams.  When I pass these exams, I will be officially a Licensed Marriage & Family Therapist (LMFT).

Can you treat bipolar disorder with just medicine or do you need therapy as well?

You CAN do anything you want. Nonetheless, bipolar disorder is complex and it affects a person’s complete way of being in the world.

Bipolar disorder is a reflection of the way the brain functions. It affects both how people think (very fast), feel (passionately) and how people respond to things that cause excitement, stress, fear and basically any human emotion.  There are both profound strengths (example, many experience high levels of intelligence and creativity) and weaknesses (example, having no intuitive clue about what is socially appropriate).

Bipolar disorder affects people’s self-esteem, relationships and quality of life.  Medicine does not change that.

Medication only reduces depression and mania.  Bipolar disorder is more than just an episode.

Therapy helps one navigate through the complexity and develop their awareness of how they are affected by bipolar disorder and utilize their own strengths, abilities and skills to construct their preferred way of being.

What does lithium do?

Scientists still do not know how lithium works.

Nonetheless, they do believe they have found two ways that lithium affects the brain.

One way they believe the brain is affected is at the level of the axon in neurons. Neurons are the brain’s cells that do all of the communicating.  Scientists believe that lithium affects the myelin sheath on the axon (the part of the neuron that message travels down). It is believed that brain’s affected by bipolar disorder have deteriorated myelin sheath and lithium may help reconstruct it.

Another more recent finding on the effect of lithium is that scientists have found that lithium may build  brain structures that are deteriorated in people living with bipolar disorder. Some of these early findings show that scientists witness change in areas such as the amygdala (seat of emotions in the brain) anterior and posterior cingulates (seat of impulsivity, awareness of unspoken social rules, center of inhibition that are all diminished in people with bipolar disorder).

If this was helpful, feel free to send me general questions and I will do this on a more regular basis.


5 Actions to help someone who has lost touch with reality

When someone has lost touch with reality the words to describe this experience, “psychosis” and “psychotic” often scares people. One automatic response to those words that many people have is “crazy”.

Reality is simply created by people agreeing on shared sensory experiences.

Psychosis simply refers to someone experiencing things with their five senses that other people are not able to perceive.

The five senses:

  • Sight

Some people see people or things that others do not see.

Some people see sounds or smells represented by shapes and colors.

  • Sound

Some people hear sounds or voices that others do not hear.

Some people feel sounds with their body or taste sounds that other people cannot.

  • Touch

Some people feel sensations in or on their body that other people cannot feel.

Some people can touch something that others do not perceive.

  • Taste

Some people taste flavors and textures that others do not taste.

  • Smell

Some people smell pleasing and displeasing scents that others do not smell.

What most people do not understand is that the EXPERIENCE of these sensations is very real.

When other people do not agree or share in these sensory experiences it does not make it any less real for the person who does.

These sensory experiences are taking place in a person’s brain.

What MAY be happening during these sensory experiences is:

  • There could be a communication problem in the sensory centers of the brain
  • Communication error between the sensory centers of the brain and the cerebral cortex (thinking part of the brain).
  • The messages coming from the five senses may get jumbled by the time they reach the sensory centers.

When someone is having these experiences, the goal is not to “snap them out of it”.

Instead, goals are to help loved one’s by:

  • assessing their safety in regards to harm to self and/or others.
  • meeting and supporting them wherever they are in their experience
  • helping them regulate if they are willing.

Five actions you can take to help someone who has lost touch with reality.

1. Do not challenge or try to disprove their experience

Instead, BE CURIOUS.

Some ways of being curious:

  • Ask them to tell you what they are hearing or seeing etc.
  • Ask how it affects them – behavior, thoughts, feelings etc
  • Ask how they feel about it
  • Ask them if they believe it is a problem or if there are ever times when it is problematic.
  • Ask them how it helps them.

This assesses for safety and prevents agitation.

If what they are experiencing is causing them to want to do harm to themselves or others, hospitalization is necessary immediately.

It is not helpful to tell someone who is experiencing psychosis that what they are experiencing is not happening.  Doing so often causes agitation for the person and isolation.

2. Bring their attention to their body

There are several activities you can do to help someone bring their attention into their body.  However, when someone is experiencing psychosis, you do not want those activities to be based on imagination.  The activities should be physically based:

  • Breathing: have them notice their lungs filling.  Some people may not respond well to listening to their heart beating it could cause some to become agitated.
  • Wiggle the toes, rotate the ankles, raise and lower the legs, or massage their own legs. You can do the same with fingers, wrists, and arms.
  • Put feet flat on the floor, sit with good posture and breathe
  • Rotate neck clockwise and counterclockwise.  This can be done with the chest as well.

What these activities do is engage the sensory organs and sensory centers in the brain to the present moment in the body.  This may help someone regulate their brain by focusing on the physical senses.

3. Focus on breathing

Breathing is consistently important in everything we do.

Ask them to take at least seven deep breaths, into their belly, and slowly release them.

Breathing deeply helps regulate the brain.  Its like pressing the restart button.

4.  Redirect them to thinking about a time & place where they felt good

If they are agitated, ask them to tell you about a time and place where they felt good (or whatever emotional state they are needing).

Ask them about sensory things like what they saw, heard, touched, tasted, smelled etc.  This may help regulate the sensory areas of the brain.

5.  Containment

If your loved one is a willing participant to be close to you, ask them if you may hug them.  Ask them if you may give them a long tight hug.

This type of hug is not one in which you pat them on their back or rub their back.  This type of hug is one in which you hold them tightly, without squeezing, and simply breathe deeply together.

This form of containment and breathing is very calming and may also be a “reboot button” for the brain.


Uncovering reasons why people refuse to acknowledge and support their loved ones living with bipolar disorder

So many people have shared with me the pain that they experience from their loved ones who reject them or refuse to acknowledge that they are living with bipolar disorder.

In this blog, I will do my best to expose some of the things that may cause people to reject and deny support to people living with bipolar disorder.

My goal is to uncover the pain that people are going through when they don’t respond the way we would hope.  I hope that those reading this will have a greater understanding about painful responses from the people you care about who aren’t able to be there for you yet.

To reach this goal, we are going to break down the complex responses:

  • Denial
  • Insecurity & Fear
  • Shame & Guilt


Denial broken down into pieces:

  • Rejection

“This is not happening. My daughter is not experiencing mania, she’s just moody.”

“This is not happening. My son is just going through a lot of financial stress.”

“My husband can’t be bipolar. He is the provider for our family.”

“My wife is not bipolar, she has a drinking problem. That’s all.”

  • Awareness

“This cannot happen to me. I could never have imagined this.”

“People with bipolar disorder are crazy…they’re insane…my _______ can’t be bipolar.”

“This can’t be happening, I know everything that goes on in my family. I would know if this were happening.”

  • Possibility

“This is not possible. This doesn’t happen to me.”

“It can’t happen. No one in my family or anyone I know has ever had it. It’s not possible.”

  • What is

Declaring that the evidence, experiences or facts that support what is happening is not true.

“It’s not true.”

“This is all lies.”

“None of the doctors we’ve seen know what they are talking about.”

The message I want you to notice and take home about the denial response is that it is a reflection of where the person is able to be right now. It is a mental and emotional place that is self-centered and experiencing a great deal of fear and pain.  It is not a reflection of you.

Insecurity & Fear

Insecurity broken down into pieces:

  • What are people going to think of me…

“What will my friends think of me if they know that my child is bipolar.”

“What if people think I did something to my child that caused them to be bipolar.”

“What if people think I was abusive.”

  • I failed…

“I must have done something wrong raising my child.”

“I wasn’t a good enough parent.”

“I am a bad mother.” “I am a bad father.” “I am a bad sibling.” “I am a bad spouse.”

  • What does it say about me…

“Does this mean I am bipolar?”

“If I were a better parent, my child wouldn’t be suffering with this.”

  • I don’t know what to do…

“I don’t know how to help my (loved one).”

“I don’t know what to say or how to act.”

“What if I make them worse?”

The message I want you to notice and take home about the insecurity and fear response is that it is a reflection of the person’s fear and insecurity AND it has nothing to do with you.

Shame & Guilt

Shame and guilt broken down:

  • Its my fault…

I did this to my child. My child has my genes.”

“I wasn’t there for him/her when s/he needed me.”

“I didn’t teach them good coping skills.”

  • I am embarrassed…

“I am embarrassed that my child is bipolar.”

“I am embarrassed that my spouse is bipolar.”

“I’d be less embarrassed for my child to be a drug addict than mentally ill.”

The message I want you to notice and take home about the shame and guilt response is that it is a reflection of the person’s beliefs and fear of other people’s opinion AND it has nothing to do with you.


Reasons why people refuse to acknowledge and get help for Bipolar Disorder

Many people find it incredibly difficult to acknowledge and accept that they are living with bipolar disorder….let alone be willing to get help.  They have really good reasons.

Here are some perspectives people have shared with me as well as my own experience that I have overcome in order to get to be who I am.

I share this is so that people who want their loved one to admit they have diagnoses can understand where their loved one is coming from.

  • “This way of thinking and being is normal for me. I have always been this way. Why should I need a doctor, medication and therapy to feel “normal”. This is what I know. Nothing is wrong with me.”
  • “I’m not hurting anyone but myself. I don’t care what people think about me.”
  • “This is who I am. I don’t want to change.”
  • “I don’t want to be controlled by medication. I don’t want to be a robot……I am afraid that if I take medication, I will lose who I am.”
  • “Struggling with the ups and downs is something that I know how to do well. I don’t know what I would do with myself.”
  • “I am so scared of medication. I have heard stories of people not being able to feel and think. I have heard stories of people not able to be who they were. That really scares me.”
  • “I can’t believe that the most wonderful, beautiful, life changing experience didn’t come from God and is considered as a disorder…I can’t believe that it means there is something wrong with my brain.”
  • “I don’t want to be treated as though I am crazy.”
  • ” I don’t want to find out that there is something wrong with me.”
  • “Society has a problem for not valuing and putting to use your creativity, brilliance and energy. I have something to offer just the way I am.”
  • “Moses saw a burning bush and said God was talking to him…AND he’s a prophet. Why is it that when I see God and we talk that I am crazy?”
  • “I love mania.”
  • “I don’t see it as a problem.”

Underlying Fears:

  • “What if no matter how hard I try, I can’t be “normal”?”
  • “What if I can’t be fixed?”
  • “I am broken.”
  • “I don’t belong. No one will accept me.”
  • “My life feels over.”
  • “I don’t know who I am.”
  • “No one will love me.  I am not loveable.”
  • “I am so scared of myself.”

No one can be forced to see that they are living with bipolar disorder. No one can be forced to take action and receive treatment.

Have compassion and empathy.

People usually do not seek out treatment unless it affects their functioning on the following levels:

  • They feel out of control of their mind and body.
  • There loved ones do not feel safe being around them.
  • They are at risk for self-harm or a danger to others.
  • They are not able to function in their work.
  • They are not able to be the partner they want to be in their romantic relationship due to their behavior and emotion.
  • They are having difficulty maintaining friendships due to their behavior.

Sometimes people are not able to see that this is taking place.  They are so deep in the mania that they can’t see what is happening.

Therefore, it is important for loved one’s of a person who is allegedly experiencing bipolar disorder to share their concerns and help them develop their awareness.


5 Ways to help someone who is manic or rapid cycling

Before we get started, I want to help everyone understand why in my writing I use the terms “we” and “us”. The key reason for doing this is because stigmatization, judgment and the fear people have of people living with bipolar disorder can be very isolating and create a great deal of self-shame and self-fear. I use “we” and us” to remove stigma, judgment and fear in order to create belonging and acceptance. I also use “we” and “us” so it is very clear that I am writing about an experience that I belong to as well.

This blog is in response to someone asking for help to better be able to help her loved one who is struggling with rapid cycling…and I’m broadening this to include both rapid cycling and mania.

#1 Thing you can do to help the one you love is by taking really good care of yourself – emotionally, mentally, physically, your health etc.

It is incredibly hard to help someone who is experiencing mania or rapid cycling. The reason why hospitalization exists, besides being at harm to ourselves and others, is to slow us down. Hospitalization removes whatever supports mania and medically slows us down and forces our bodies and mind to stop running a million miles a minute and rest.  Being forced to slow down can feel like death or simply horrible.

The goal of this blog is to help intervene before hospitalization is needed.

This blog is about how to help someone you love slow down and gain some control during mania or mixed episodes without hospitalization. It is not easy.

A gem I have gained from my experience from experiencing mania is how powerful the mind-body connection really is. When my mind and emotions are going a million miles a minute there is no rational way to THINK myself out of this process. However, my body can only go so fast.  I learned that if I can slow down my body and gain awareness and control in my body that it has a profound affect on my mind.

What I hope to share are some tools that can be helpful to the ones you love that I have learned from experience and professional education that have been successful in slowing down mania or cycling and building awareness and control.

Help loved ones gain control of their mind through their bodies by:

  • Shifting our attention to our breath.

    When we focus on our breathing it brings our attention away from what is taking place around us and in our minds. Our attention goes directly to expanding and contracting our lungs.  Our attention goes to breathing as deeply into our bodies as we can and releasing our breath.

    By focusing on our breathing we experience control. Our awareness decides how deeply we breathe. We have the power to control our breath which can either slow down our body or speed it up.

    GOAL: Breathe deeply and slow down the breath which will regulate the rest of the body and the mind.

    How you can help:

    Don’t judge, label or say things like “You’re out of control. You’re manic. You’re crazy etc”

    Instead say something like, “I’m feeling scared/sad/down/lost/frustrated etc, will you hold my hand (or sit beside me) and breathe with me?”

    • Creating a safe place for us to contain ourselves

    When we feel out of control in our bodies, a long tight hug really helps.  There is something incredibly containing about a hug that is grounding for a person who feels out of control.

    The hug not only helps us stand, but it also helps us to emotionally center ourselves. We feel emotionally connected, present and a hug is an act of love.

    GOAL: Hug your loved one until they let go, don’t let them go. By hugging them they feel safe, wanted and loved. This containment creates self-control in both their body and mind.

    How you can help:

    Simply say, “I want to hug you, may I give you a hug?”

    • With your words

    When we are manic or rapid cycling we don’t respond well at all to words, we are not able to be rational…especially when sentences start with the word “You…”.

    GOAL: To not make us feel bad about ourselves, when we are manic or rapidly cycling and are out of control…we already feel bad about ourselves.

    How you can help:

    Make “I” statements. Start your sentences with the word “I”. For example, “I feel scared when…” “It concerns me when…” “It’s problematic for me when…” etc.

    • Giving us space.

    When you can’t express how you are feeling, it is incredibly frustrating when someone keeps asking you “What’s wrong?”, “How are you feeling?”, “Are you okay?” etc.

    GOAL: Give us space so we can ride out the emotional rollercoaster.

    How you can help:

    Help your loved one create a space when they are okay that feels safe to them. This space will be where they go when they experience an emotional rollercoaster.

    • Forgiveness

    Mania, depression and mixed episodes cause us to express ourselves and emotion in ways that are very hurtful.  We often feel ashamed of what we do and say. We are often not kind in how we treat the people we love during these times of incredibly emotional rollercoastering. We are so disappointed in ourselves and feel so much pain for how we treat those we love during an episode.  Forgiveness is a gift that we need to receive.

    GOAL: Help us heal and recover by forgiving us for the pain we cause.

    How you can help:

    If you remind your loved one that you know that how they are behaving is not who they are…that it is the mania or depression. Let them know that you love them and that the mania or depression is hurting you.

    Don’t let bipolar disorder be an excuse for bad behavior. Help your loved one see the difference. Therapy can be very useful to build this awareness.


    Part 2: Tearing Down Stima to Understand Diagnoses with Compassion – Behavior Perspective

    In Part Two of this exploration of compassionately understanding diagnoses we will explore the perspective of behavior and changes in needs and interests.

    Behavior & Changes in Needs & Interests

    Bipolar Disorder – when experiencing mania

    • Decreased need for sleep

    In my opinion this is the number one detector that a person is experiencing mania. When we are having difficulty sleeping we are vulnerable to mania. This is a call to action for self-care or medical support.

    • More talkative than usual, rapid speech and a pressure to keep talking

    This is such an uncomfortable feeling to not be able to stop talking. When I talk about this with people we laugh about the endless times we’ve stuck our foot in our mouths because we talk way before thinking. Our words get so jumbled and we wonder if we are making sense. Nevertheless, we don’t dare ask anyone if we make sense, we just keep talking to fill the silence and hope they don’t notice.

    • Increase in goal directed activities, risk taking or pleasure-seeking behaviors. Ex. spending money, heightened sex drive and risky decisions

    This is where we really pay for our actions. No one cares if you spend way more money then you have when you are manic, the banks want their money back. When we invest all of our savings into everything from building a business/investments to saving the world and we fail…its gone. Our partners probably won’t mind if we spend more time on https://www.sexmature.xxx/ than usual, but I highly doubt they will be okay if we go and have sex with as many people as humanly possible. If we jump off of a cliff because we truly believe we can fly…we pay with our life or our quality of life.

    Then there are the consequences that often go not talked about…

    The loss of respect people have for us.

    The loss of trust and safety people hold for us.

    The loss of trust, safety and respect we feel for ourselves.

    We lose our dignity as a consequence to these behaviors and it is incredibly painful and so difficult to recover from.

    Schizoaffective Disorder

    Same as bipolar disorder or major depressive disorder or any other mood disorder, except that psychosis is experienced when not in a manic or depressive episode.

    I like to think of psychosis is similar to the “Telephone” game. When the message starts in the brain each time it gets passed along the message is changed so that when the message gets to the end of the line its a completely new and different message.

    When this “Telephone” game happens, the brain tells stories in the form of messages about things your eyes see, your ears hear, that you touch, smell and taste that you haven’t actually experienced. However, these experiences are very real to you because they are taking place in your brain.

    In many circumstances the experience of these messages wouldn’t be problematic for a person. We all have experiences where we think we see something and then realize it wasn’t there. What makes it problematic is when:

    • the message that we received is harmful in some way. It could cause us to be fearful, cause self-harm or harm to others, or be very painful.
    • We don’t have the ability to realize the difference between what we think we saw, heard, touched, smelled, or tasted from what is taking place around us. It puts us out of touch with our environment and that could be dangerous for our safety and survival.

    Borderline Personality Disorder

    • Frantic effort to avoid real or imagined abandonment

    I have so much compassion for this behavior when I am able to put in perspective everything a person would have to go through that could cause them to have this incredible fear. They are simply doing their best to be loved and there is no way to know how to do be loved when your primary caregivers didn’t provide consistent and predictable etc nurture.

    • Extreme idealization or devaluation treatment of interpersonal relationships

    I can only imagine this as a very painful and difficult behavior for all people affected by it to deal with. Based on observation, people affected by borderline personality disorder tend to idealize someone when they are experiencing forms of love such as kindness, acceptance, approval, affection etc and devalue a person when they make a mistake, disagree, aren’t fully available, don’t receive their needs when expected, aren’t 100% able to be supportive etc.

    No one will ever be perfect = 100% consistent in saying and doing the right thing and meeting your wants and needs. People are often not even be able to do that most of the time. This is painful for everyone. But I can imagine how deeply it would hurt for someone living with borderline personality disorder. I have so much compassion for the need to be loved and to have the fear at any moment the love that they receive will be abandoned. Therefore, the slightest change in the act of love could trigger that frantic fear of abandonment.

    • Impulsive actions that can be risky and cause self-harm

    I can’t say that I have an answer for this behavior. My curiosity looks at it from the perspective of attention seeking behavior to get needs met OR maybe a way to release emotion based fear and pain by causing physical pain. Either way, I believe these behaviors could be self-soothing in some way in an attempt to get needs met by the primary caregiver.

    Maybe it is a way to say, “Notice me! Love me! I need you! Take care of me! I’m so confused and scared and I don’t know what to do about it.” My heart goes out to people who weren’t able to receive the care that so many of us take for granted.

    • Recurrent suicidal behavior: threats, gestures, attempts or self-mutilation

    I wonder if this pattern is an attempt to get the attention, acceptance, approval, love and nurture that they deserve and need to receive…that we all need to receive. In many circumstances people do not want to die, but they may feel dead to the people they need to receive care from OR they may need to feel that their life is of worth to others. There is no right answer to explain this painful behavior.

    It is important to understand that not all of the characteristics or symptoms of borderline personality disorder will be experienced and expressed. These are tendencies that have been observed over periods of time.

    Part Three will explore these diagnoses from the perspective of Thought Processes and Sense of Self