Disclosing That You Have a Mental Illness, part III: Friends and Family

friends

Credit to flickr.com user Oliver DelaCruz. Used with permission under a Creative Commons license.

[Part I | Part II | Part III | Part IV]

 

You know when and how to disclose your mental illness. But should you? We cover whether you should disclose to friends and family.

Pros and Cons

When you think about whether to tell people, think about what the consequences will be if you don’t tell them as well as if you do. Thinking this through can help you decide if you truly want to disclose your mental illness.

Disclosing To Your Loved Ones

Before you disclose your mental illness to your family and friends, there are several factors to consider. First of all: do you think your listener will understand? Will they be able to support you in the ways you need supported, such as advice, help with doctors or avoiding drinking, or emotional support? Not everyone is skilled at being emotionally available. Make a list of the people around you who have this skillset.

There are three possible outcomes to telling a loved one about your illness:

  1. He or she is completely comfortable with your disclosure, and nothing changes.
  2. He or she is incredibly uncomfortable, and takes steps to end the relationship with you.
  3. He or she says that he or she is comfortable with you telling them this, and proceeds to fade slowly from your life.

Obviously the first outcome is the best and most hoped for. While ending relationships are a concern, it’s entirely possible that he or she wouldn’t have been able to support you anyway, so it’s probably best that he or she disappears from your life.

Telling a loved one about your mental illness takes a lot of courage. Consult your list of people who can give you emotional support to decide whether it’s worth the risk to tell them.

Tune in next week for part four in this series: “Disclosing That You Have a Mental Illness, part 4: Your Employer.”

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Disclosing That You Have a Mental Illness, part II: How

disclosing

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[ Part I | Part II | Part III | Part IV ]

Are you ready to disclose that you have a mental illness? Read on to figure out how to tell your family, friends, and maybe even your employer that you have a disorder.

1. Prepare Your Listener

In order to best disclose that you have a mental illness, you need to prepare your listener. It’s sort of like writing an essay: first you tell him or her what you’re about to say, then you say it, then you summarize what you’ve just said. Preparing your audience is called “process talk.” Try this: “I want to talk to you about something I’m struggling with. It’s taken me a lot of courage to come this far. I hope you’ll support me.”

2. What You’re Dealing With

Next, you want to give concrete examples of what your mental illness is. Explain a situation or two where you’ve struggled, such as not being able to get out of bed for weeks, or going on multiple unplanned spending sprees when you’re manic, if you have bipolar disorder. Cementing your mental illness in your listener’s head will help them understand exactly what you’re facing every day. Consider providing educational materials such as articles or pamphlets about your mental illness. NAMI.org is a great online resource for the National Alliance on Mental Illness.

3. Ask for Help

Suggest ways your audience can support you. This can involve asking for more breaks or other accommodations at work or school, or simply asking a friend to understand why you can’t hang out as long. You can also ask your loved ones to help you find a doctor and follow through with an appointment, if you feel that your friend or family member will understand and be helpful. Set boundaries here, too: you know yourself best, and you need to explain whether you need advice or just need your audience to listen.

4. What to Share

You definitely don’t need to share everything. Plan ahead as to what you feel comfortable sharing about your experience. It’s perfectly reasonable to explain that you don’t feel like talking about something in particular. If you do feel there are good parts to your illness, like things you’ve learned, try to share those.

Explaining your illness to a listener is an intense experience, and a personal decision. Practice in front of a mirror or with a licensed professional, like a therapist, who may be able to answer any concerns you have. Keep in mind that you need to prepare your listener, explain your illness, and ask for help.

Tune in next week for part three of this series: “Disclosing That You Have a Mental Illness, part III: If.”

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Disclosing That You Have a Mental Illness, part I: When

mental illness

Credit to flickr.com user Jennifer Mathis. Used with permission under a Creative Commons license.

[ Part I | Part II | Part III | Part IV ]

How open are you about your mental illness? Have you been thinking about opening up to others? Read on to find out when to disclose that you have a mental illness.

When to Disclose

  1. When you’re well – You don’t want to wait until you’re in a dicey situation for the people around you to find out that you have a mental illness. Disclosing when you’ve got your illness under control will give the people you disclose to time to adjust to the fact that you suffer from a disorder.
  2. When you need people to understand – Sometimes, people who suffer from mental illnesses need special accommodations at work or school. Letting friends know the reason behind why you don’t want to hang out with them during a depressive spiral can prevent them from thinking you’ve grown distant. Telling people you have a mental illness is better when it serves a purpose.
  3. Not after a mass shooting – Unfortunately, people equate acts of mass violence with mental illness. The stigma is all too real. Disclosing your mental illness after someone who reportedly has a disorder commits an act of violence might cause the people you’re disclosing to to link your illness with the perpetrator’s.
  4. When you’re ready – Disclosing your mental illness to friends, family, or even an employer is an intensely personal decision. Write down exactly what you want to say, and practice your words, either in front of the mirror or with a licensed professional. Talking to a therapist about your concerns may help put your mind at ease.

All in all, disclosing your mental illness is a process, the start of which is completely up to you. Tune in next week for the second part in this series of three, “Disclosing That You Have a Mental Illness, part II: How.”

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Bipolar Patients More Than Twice As Likely to Have Suffered Childhood Adversity

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Credit to flickr.com user Zach Korb. Used with permission under a Creative Commons license.

A new study published in the British Journal of Psychiatry looking at more than thirty years into bipolar disorder research found that people with the disorder are 2.63 times more likely to have suffered adversity as children than the general population.

Adversity is defined here as emotional, sexual, or physical abuse, or the loss of a parent before the age of nineteen. While the loss of a parent did not raise the risk of a bipolar diagnosis significantly, people who were emotionally abused were more than four times as likely to have a subsequent diagnosis of bipolar disorder.

The study, run by researchers at the University of Manchester, gathered data from millions of patient interviews in nineteen studies between 1980 and 2014. The authors of the study believed that bipolar disorder had a similar link to childhood adversity like schizophrenia, and does not just stem from bio-genetics.

The hope that the researchers have is that specialized therapy plans can be put into place for people who have suffered childhood abuse, and that future diagnoses can take into account personal histories.

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Scientists Predict Who Will Respond to Lithium

Lithium is a salt which treats both mania and depression in a lucky thirty percent of people with bipolar disorder. But prior to the discovery of a new method to predict who will respond to lithium, people were playing roulette.

Now scientists at the Salk Institute can predict, with 92 percent accuracy, who will be a lithium responder. All they need is five cells and a test. They discovered that the neurons of people with bipolar disorder are more excitable when exposed to stimuli and fire more rapid electrical impulses than individuals without the disorder. This means that people with bipolar are more easily stimulated.

In an old study, the scientists found that soaking skin cells from bipolar patients in a lithium solution calmed the hyperexcitability–but only for some of them. The next study proved even more fruitful. The researchers soaked lymphocytes (immune cells) rom known lithium responders in lithium solutions, and found the same results–the hyperexcitabilty was calmed. But even though both responders and non-responders had the same excitability, the electrophysiological properties were different.

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Credit to flickr.com user The Javorac. Used with permission under a Creative Commons license.

The Salk team looked for electrical firing patterns in neuronal lines, measuring the threshold for evoking a reaction, and other qualities. Overall, the patterns in responders were completely different than in non-responders.

The scientists were able to replicate the results again and again, which means that this test is proven to work. Now a blood draw is all that’s needed to test whether a patient with bipolar disorder will respond to lithium.

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What to do if Your Child has Bipolar Disorder

So you’ve discussed your child’s symptoms with a pediatric mental health specialist, and have a diagnosis of bipolar disorder. What now? Thankfully, there are some suggestions you can take, and taking care of your child with bipolar disorder is similar to taking care of an adult with the disorder.

1. Pay attention to medications and therapy appointments

As a parent, you are responsible for making sure your child follows their treatment plan. Use whatever reminders you can to remember to give him or her the medication that he or she needs.  If your child must take their pills at school, then open a line of communication with his or her teachers and school nurse. Appointments with his or her therapist are also important. Make sure your child attends their appointments

children2

Credit to flickr.com user Cristyan González Alfonso. Used with permission under a Creative Commons license.

2. Monitor side effects

Some side effects of atypical antipsychotics, like weight gain and blood sugar changes, are awful in adults–and children do seem to be more prone to them. These drugs were originally formulated for adults, and few have been tested on kids. Ask your child’s psychiatrist what side effects you need to keep an eye on.

3. Work out agreements with your child’s teachers

Some children with bipolar disorder need more help at school, such as more breaks during manic episodes, or less homework. During especially bad episodes, your child may need to be removed from school until he or she stabilizes. Talk to your child’s teachers. Keeping an open line of communication is the best way to ensure your child has success at school.

4. Keep a schedule

Try to be consistent with mealtimes and bedtimes, as well as waking your child up at the same time every day. This will help keep stress in the home to a minimum. Try to be patient with your child as they adjust to new routines.

5. Go to family therapy, if needed

Taking care of a child with bipolar disorder may put a lot of stress on the family as a whole. Your marriage might suffer, and the child’s siblings might be jealous of all the attention he or she gets. Attending therapy as a family may help you handle these issues.

6. Don’t ignore threats of suicide

Suicide threats are extremely serious, even in young children who may not understand what it means. Talk to your children, and if they do have suicidal ideation, give them a safe environment. Remove all the weapons or pills from the house. And talk with their mental health specialists. Crisis lines are always open.

7. Communicate with your teenager

Teenagers may become irritated or resentful if they feel that you’re compelling them to be treated. Talk to them about why you’re giving them medication and taking them to therapy appointments. Educate your kids about their mental illness. Also, it’s important that your teenager avoid substance abuse, as the risks of developing a problem are much higher in teens with bipolar disorder. Alcohol and drugs can interact with medications poorly and worsen mood episodes, so it’s important that your teenager be made aware of the risks.

All in all, taking care of your child with bipolar disorder requires an extra level of parenting. But you can do it. There are steps you can take to help you.

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Bipolar Disorder in Children

Bipolar disorder affects people of all ages, including children as young as six. The disorder has periods of elevated mood, called mania, as well as periods of depression.

Common symptoms in children are:

  • Mood swings ranging from depression to irritability to elation, sometimes up to several times a day
  • Racing thoughts (while manic)
  • Hyperactive or aggressive behavior
  • Casual sex or spending sprees that are out of character
  • Decreased need for sleep
  • Inflated ego
  • Suicidal ideation in older children
  • Separation anxiety
  • Carbohydrate cravings
  • Difficulty waking in the mornings
  • Oversensitivity to emotional situations
  • Bed-wetting (especially in boys)
  • Obsession with gore or other socially inappropriate topics
  • Night terrors

 

children

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Symptoms in children look slightly different than those of adults. Children can be more irritable than adults during a manic phase, with less elevated mood, and are more likely to experience psychotic features, such as auditory hallucinations. As for depression, children are more likely to complain about physical pain. Between episodes, kids return to their normal mood. Something of note is that they cycle between these episodes several times a day, as opposed to weeks or months.

Some experts believe the disorder is rare and thus over-diagnosed; others believe the opposite, so there’s little agreement. It’s also difficult to diagnose the disorder in children, because symptoms can overlap with other diagnoses like conduct disorders or Attention Hyperactivity Deficit Disorder (ADHD)–which can occur in conjunction with bipolar disorder, making an accurate diagnosis even more tricky.

So, if you suspect your child has bipolar disorder, please speak with a mental health professional specializing in disorders in children. Ask your pediatrician for recommendations.

Stay tuned for next week’s post: What to do if Your Child has Bipolar Disorder.

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How to Apply for Disability Benefits for Mental Disorders

Sometimes people just need a little help. If you can prove that you have a disability that prevents you from working, you may qualify for Social Security Disability Insurance (SSDI) or Social Security Income (SSI).

Types of Benefits

SSDI is a benefit which offers monthly payments that requires you to have had a steady work history over the past decade. You must have a disability and submit an application to the Social Security Administration (SSA). You must also currently be able to earn no more than $1,170 per month, and your condition must prevent you from working for a year–either the past year, or the foreseeable future. SSDI needs you to have earned 40 “work credits,” where you earn and pay taxes on a minimum of $1,260 per month. You can gather up to four work credits per year. Twenty of them must be earned in the decade before the disability was diagnosed. Younger claimants may qualify based on their parents’ work history.

SSI, on the other hand, is a needs-based program. To qualify, you may not own more than $2,000 in assets excluding your home and one vehicle worth $4,500 or less. If you’re married, you may own up to $3,000 in assets. Your income must be below a certain threshold depending on where you live.

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Credit to flickr.com user Jason Truscott. Used with permission under a Creative Commons license.

Which Disabilities Are Accepted

The SSA publishes a “Blue Book” which describes the criteria required for disabilities to be accepted for benefits. Bipolar disorder and other mood disorders are part of this Blue Book, as well as schizophrenia, anxiety disorders, and intellectual disabilities, like autism. Unfortunately, illnesses like bipolar disorder or depression need a great deal of evidence to demonstrate that your condition impairs your ability to work, even after treatment.

Application Process

The process to apply for these benefits for a mental disorder is not that much different from applying for a physical disability. Your best bet in submitting an application is to visit your local SSA office. There, you can talk to a representative who will help you fill out the forms. If you’re not comfortable with talking to the representatives in person, you can call them. They will fill out the forms for you and send a medical release form for you to sign, along with a postage-paid envelope. They will also let you know what documents you need to send them in order to prove your disability, like medical records from up to a year before your disability diagnosis.

Medical Records

The SSA is obligated to help you find and submit all of your medical records, though if you submit them yourself, your case will be delayed less. List all of your treatment team and where they work on your application form, from counselors to psychiatrists. The SSA will have you sign an Authorization to Disclose Information (SSA-827) to obtain the required records from your providers. Your medical records should contain the results of any tests–like IQ tests in the case of intellectual disabilities–as well as treatment notes. Your doctor can also fill out an optional mental residual functional capacity (RFC) assessment form, which is the best thing you can do for your case, as it demonstrates your doctor’s opinion on whether or not you can function.

It is very important to provide evidence towards your disability, like diagnoses, treatment plans, prognoses, every medication tried, and how you responded to medication. In the best case scenario, your treatment notes will include details on how your disability impedes your ability to work.

ADLs

The representative will also have you fill out a survey about your “activities of daily living,” or ADL. The Function Report form (SSA-3373) makes you describe how your disorder impairs your daily life, including during social engagements, housework, shopping, transportation, and how you spend money. If you have trouble working with coworkers or following instructions, then you need to talk about that in your ADL.

Managing Expectations

Try not to get your hopes up that your initial claim will be approved. Over 60% of claims are denied at first, and over 80% of appeals are denied. That’s not to say you shouldn’t appeal! You definitely should. You may consider hiring a Social Security Disability lawyer to help you fill out your forms and represent you in your hearing with an Administrative Law Judge.

You can be disqualified from receiving benefits by not following your doctor’s treatment plan. It’s very important to take your medication and attend your talk therapy appointments during your application process.

Applying for disability benefits can be a daunting procedure, but it can be done. It takes effort and patience and communication with your treatment team. Make sure that you jump in feet first.

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Antibiotics Linked to Manic Episodes

Have you ever taken an antibiotic and felt more manic? There might be a reason for that.

 

antibiotics

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Researchers have found a link–not cause and effect, mind, just a link–between antibiotics and manic episodes in people with mental disorders. Robert Yolken and a research team at John Hopkins University reviewed medical records of patients treated for mania, major depression, bipolar disorder, and schizophrenia at the Sheppard Pratt, a psychiatric hospital in Baltimore. The scientists also surveyed over five hundred controls–people without mental disorders–about their antibiotic use.

 

What they found is shocking. In the manic patients, 7.7 percent were taking antibiotics, compared to 1.3 percent of the controls. This is a more than a fivefold increase in the odds of being in the mania group. However, only 4 percent of the people hospitalized for bipolar depression and 3 percent of the people hospitalized for schizophrenia were taking antibiotics.

Yolken’s team examined whether the place of infection, such as the mouth, skin, or respiratory system correlated with hospitalization, and determined that the site of the infection didn’t seem to matter.

There are several ways that antibiotic use could impact psychiatric symptoms. The infection itself could lead to inflammation. Or the antibiotic could kill off good bacteria, which could also lead to inflammation.

The research team is conducting more studies to see how this link works. For example, one study is examining whether suppressing inflammation in the gut will reduce the recurrence of manic episodes.

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Dans les souliers d’un bipolaire // In the shoes of a bipolar

Stephane, of Espoir Bipolaire, a new French blog, has kindly shared a guest post with us titled “In the Shoes of a Bipolar.” Stephane is translating some of the Bipolar Parent’s posts into French, such as 4 Ways to Educate Someone About Mental Illnesses. Scroll down to the bottom of this post for the English translation!

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