DX: Bipolar I

Awhile back, I wrote a post about my frustration with what I considered to be a “wastebasket” diagnosis (bipolar not otherwise specified), wishing Dr. Awesomesauce would pick a number and settle the question for good. I was in bipolar limbo; I remember the Vocational Rehab counselor who asked if I was BP 1 or 2, and trying to explain what the hell NOS meant in the larger scheme of things. He was confused, and for that matter, so was I.

But now all that’s past history because I received my definitive diagnosis in the hospital. Funny how a depressive episode and not a manic one got me “upgraded”……if you can call it that. I totally skipped BP 2 and went straight to type 1.

I have mixed feelings about this. I’ve actually long suspected I had the more severe version of the disease because some of my manic episodes have been pretty wild. No, I’ve never walked down Main Street naked, but I did cause a lot of disruption on the job at times when I was working, and there have been a couple of instances when I was so out of control that I nearly had to be hospitalized. Still, I was able to continue my dalliance with denial, almost convincing myself that my case wasn’t really all that serious. And sometimes I’ve even talked myself into believing I wasn’t bipolar at all.

That’s over with now. If nothing else, this diagnosis establishes once and for all that I really do have a major mental illness and I can’t screw around with it anymore. It’s not something I can’t live with or learn how to handle better, but I have to give it a lot more respect than I used to.

If you’re not bipolar, you may be wondering what the difference is between bipolar 1 and 2. On the surface, it’s fairly simple: it’s the degree of mania one experiences. People with bipolar 2 have hypomania rather than full-blown mania—they are often more talkative and productive than usual, they tend to increase their activity and have grandiose ideas about what they can accomplish, and they can become hypersexual, which obviously can be a strain on relationships. On the other hand, they may be more irritable and angry, which is called dysphoric hypomania, and thus quite unpleasant to be around.

People with bipolar 1, on the other hand, have “classic” manic symptoms, many of which are exaggerated versions of the behaviors seen in hypomania and can be very dangerous. We can have hypomania too, either by itself or as a prelude to mania. Most of my own manic episodes have been preceded by a hypomanic state, which is the part of the disorder so many of us yearn to hang onto. I looooves me some hypomania and wish I could live the rest of my life in that condition; unfortunately, there’s no medication or therapy that allows us to keep the hypo without either going off the deep end into depression or sailing off on a manic high.

Not that it keeps us from trying. I myself have been known to drink a half-gallon of coffee and/or manipulate my medications to keep a budding hypomania going; trouble is, I usually don’t stop there, but keep zooming—straight into the danger zone. Only the thin edge of dignity has prevented me from taking actions that would embarrass me forever or put me in danger of incarceration. Otherwise, my manic state usually results in loud arguments in front of restaurants (in the pouring rain, no less), wild shopping sprees (I spent us into bankruptcy twice!), psychosis (gotta love seeing cats running under the linen carts in the ER), even threats to kill people (thank you, Wellbutrin).

Which is why I wasn’t sure if my manic episodes rise to the level of bipolar 1, but apparently the doctor who diagnosed me saw enough in Dr. Awesomesauce’s notes to label it as such. At any rate, it’s settled now, and it will never change because this is not the kind of illness that goes back to a lower level once the patient is better.

I would be lying if I said the label doesn’t hurt a little bit. No one grows up thinking they want to be bipolar 1 (or any other kind) when they get older. But it’s also a good thing because there is no more dancing around it, and God knows I needed to accept this as a permanent part of my life. And at long last, the confusion is over.