Mental Illness

Bipolar and Mood Disorder management counselling

There are a range of different conditions often referred to as mood disorders or forms of Bipolar or “Bi-Polar”.

These issues are a major speciality of the senior practitioner (Stuart), who has also authored a number of professional practitioner training courses in this and related subjects.

(Different people use the spellings Bipolar, Bi-Polar or Bi-Polar. We deliberately use all of them on this webpage for the benefit of search engines.)

Depending on whether the USA or UK definitions are used, the type of mood disorder or Bipolar depression you are diagnosed with can vary, since the medical professions in each country tend to have differing ideas about an exact diagnosis.

In the USA, for example, most forms of mood disorder tend to be classified as forms of Bi-Polar, and you will either end up with a specific diagnosis of Bipolar I or II or be classified as rapid cycling, Cyclothymic or “Non-Specific” Bi-Polar.

In the UK the terms Bi-Polar I and II are common, but other forms are often instead classified as non-specific “Mood disorders” rather than specifically a type of Bi-Polar. 

This distinction is important for sufferers to understand since much of the self-help information in books and on the Internet originates in the USA, and thus uses their terminology.

What is Borderline Personality Disorder?

A further distinction is between a mood disorder of the Bi-Polar type which is considered to be clinical and a medical condition that frankly you are born with, or Borderline Personality Disorder (BPD), which is a condition that builds over time as a result of life events. BPD is certainly not something people choose to have, or have developed through any fault of their own, rather it occurs as a result of people going through various experiences in life that create an unusual development.

In the UK you tend to have a diagnosis or EITHER a Bi-Polar related condition OR BPD. In the USA there is a greater acknowledgement that often people have BOTH. This may occur for example when a person is “born with Bipolar” and thus has an unusual development, creating elements of BPD as well. It can also be argued that a person can develop BPD and then hereditary Bi-Polar can kick in at a dangerous time, e.g. middle age on top of this.

In practice, it is highly likely that Bipolar and BPS are essentially present in a substantial number of cases.

When Does Bipolar depression / manic depression occur?

There are classic “danger times” for Bipolar to show itself. Often until these times, the person may be perceived as “moody” or prone to “bursts of energy”, but otherwise seem quite normal. They may also suffer from periods of depression over time. These may not, however, appear to be strong or serious enough to warrant deeper investigation. Then at a particular time in life, the symptoms hit them hard, revealing full-blown Bipolar.

The lucky ones get help quickly, and the unlucky ones try to fight the condition, seeing the symptoms as merely what they have faced all their lives, just “really bad at the moment”.

Unfortunately often Bi-Polar asserts itself very dramatically, resulting in the sufferer ending up in a police cell for inappropriate behaviour (caused by mania) or in hospital (caused by severe depression). It may also be seen via “dual diagnosis”, most commonly where the person presents as having alcoholism and also has the underlying condition of Bi-Polar.

Classic times for the full onset of Bi-Polar are age 5 (according to USA early bi-polar studies, less recognised in the UK), Age 18, Age 30 (most common) and retirement age. Each of these also tends to be at a time of major life significance, and it is unknown whether the onset is due to lifestyle or biological factors. These are also approximate ages.

It is becoming recognised that there are more high functioning people who suffer long term with subclinical conditions (present but not full-blown and noticeable) than is realised by the NHS. Indeed I (Stuart) was accepted to complete a doctoral research project at a local University from 2011 to 2015 but sadly no funding was available.

How often do mood swings occur in Bipolar and other mood disorders?

There is also a common misunderstanding that Bi-Polar means that you have one or two major swings per year and are stuck in one or other state for the rest of the time. In BiPolar I and II there is indeed a tendency to remain for long periods in one state and to have one or more swings per year.

However, there are a large number of sufferers who do NOT have this pattern. For example:

– Cyclothymic sufferers: often nick-named “Bi-Polar Lite”, the changes are less severe but more frequent.

– Rapid cycling Bi-Polar: more acknowledged in the USA than in the UK, the changes are very rapid, often in weeks or days, in very rare cases in the course of a day.

– Where more than one condition exists, e.g. where BPD and Bi-Polar are both present and different mood state patterns co-exist

– Where hormonal influences such as the menstrual cycle influence mood state

– Where self-medication with prescription or non-prescription drugs, recreational substances, lifestyle habits and other environmental factors add yet more variables.

– Where inappropriate medication has been prescribed, perhaps because the diagnosis is not yet clear. (classically the sufferer is seen to have depression and given anti-depressants that may inter-react badly in a manic state)

Thus it is possible to have quite a range of patterns. If it makes it easier to understand, each of the above creates an effect like the tide coming in and going out. Some factors cause the tide to come in once a year, and out once a year.

Others monthly, others daily. Others, like taking alcohol create a sudden surge and then drop off the tide. If you have a number of factors all working separately but influencing the same thing (mood state) sometimes they cancel out (false calm), sometimes they amplify (tidal surge) and sometimes the effect is chaotic (whirlpool)!

There are also a number of conditions that appear more often for clients with mood disorders. It is hard to know whether this is caused by the condition, or simply exists in a high level of correlation. These include anger issues, stress issues, obsessive compulsions (especially obsessive thoughts), addictions, eating disorders, self-harm, post-traumatic stress effects, debt, and life issues.

If you have a diagnosis of Bipolar, Mood disorder or BPS already

It is often possible to learn to manage your condition better. This is not a cure or treatment, but it does offer you the chance to live more happily and in a more stable way.

A range of different therapies are possible, and these should be chosen according to the individual case. They do however include CBT (Cognitive Behavioural Therapy / Coaching), relaxation therapy, Counselling skills, life coaching, psychological therapy, Japanese Traditional Therapy, nutritional therapy, and exercise programmes.

You must remain in the care of your GP or medical specialist (or CMHT). This is not a substitute for the care and medication you are already receiving. It is well recognised by CMHTs, and by NICE official guidelines and standards that CBT and other management techniques are useful in the long term treatment or care of Bipolar and other mental health conditions.

If you do not have a diagnosis

You are welcome to attend a case history and case assessment session. We, however, are not able to provide a diagnosis. We are often able to assist you in identifying issues that you may not have realised as important. These can then be listed and presented to your medical doctor.

One of the first stages of identifying possible mood disorders is to create an “early warning system”, which in simple terms means monitoring and recording mood changes. This can then be very helpful in gathering evidence for your medical doctor and any specialist you are referred to.

We also use the CORE assessment forms that are pretty much standard in NHS use, and thus information can be quite useful for presentation to your GP. Most specialists are very happy for their clients to remain also seeing us for support since we work alongside them and never seek to replace or supplant them.

If you are suffering from severe depression or mania, or feel any urges to harm yourself or others, you should seek an urgent appointment with your GP without delay. We may still be able to assist you, but we will need you to seek medical advice first.

CBT Cognitive Behavioural Therapy as part of managing mental health

If you are suffering from any type of depression or mood swings, Counselling, psychotherapy and CBT may be extremely useful in managing your condition.

Please note however that these are only appropriate in addition to medical supervision, and you must stay in contact with your medical doctor. CBT is the main psychological therapy recommended by NICE guidelines. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -