Nature vs. Nurture: The Causes of Bipolar Disorder

What causes bipolar disorder? Scientists aren’t actually sure, but are taking into consideration several risk factors, such as genes, brain structure, and environmental causes.

Genes

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Genetic studies of twins have shown promising results with regards to bipolar disorder. According to a a study by Berit Kerner, “The heritability of bipolar disorder based on concordance rates for bipolar disorder in twin studies has been estimated to be between 60% and 80%.” However, if one identical twin develops Bipolar I, the rate of the other twin developing it is roughly 40%, compared to fraternal twins at 5%. Parents have a 10 to 15% chance to pass bipolar disorder to their children if one parent has the disorder, compared to 30 to 40% if both do. This means genetics play a crucial role in the transmission of bipolar disorder.

Brain Structure

Recent evidence suggests that the structure of the brain may contribute to people developing bipolar disorder. MRI studies have found the over-activation of the amygdala, which processes memory, helps decision-making, and controls emotional reactions. People who are manic showed decreased activity in the interior frontal cortex, which assists problem solving, memory, language, judgment, and impulse control. Certain psychiatric medications work on neurotransmitters, suggesting that these messenger chemicals play a significant role in the function of bipolar disorder, but no one knows how exactly they’re responsible.

Environmental Factors

Stress is a significant predictor of bipolar disorder in people who are susceptible to the disease. Life events such as childbirth, trauma, job loss, or grief over a death in the family may trigger a mood episode. My mania and subsequent psychosis was set off by the birth of my first child, Nolan, but my second child’s birth did not trigger anything. However, substance abuse, hormonal issues, and altered health habits can also spark the illness.

Many factors set in motion the development of bipolar disorder. With more research, scientists will discover the roots of the disease, and possibly be able to prevent it in the future.

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What is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a chronic mental illness characterized by swings between depression and grandiose moods. Over five million people live with the illness. The disorder often runs in families, affects women and men equally, and appears around the average age of twenty-five.

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To fully explain bipolar disorder, we must first look at the two “poles” of the disease: mania and depression. Mania includes racing thoughts, elevated mood, over-excitement, a lack of a need to sleep, irritability, impulsive decisions, and sometimes delusions. Depression includes feeling sad or sluggish, overeating, insomnia or over-sleeping, severe lack of energy, trouble making decisions, and possibly thoughts of suicide. People with bipolar disorder can swing between these two states over periods of days, weeks, months, or even years. Rapid cycling occurs when four or more mood episodes happen over the course of a year, which is difficult to treat. Four episodes per day is called “Ultradian Cycling.”

Mixed episodes occur when symptoms of mania and symptoms of depression happen at the same time, increasing the risk of suicide. It is very difficult to treat a mixed episode, as most medications do not treat both sets of symptoms at the same time.

Children with bipolar disorder tend to have tantrums that last for hours, and possibly turn violent. Thirty percent of kids who have a major depressive diagnosis will eventually receive a diagnosis of bipolar disorder. During mania, kids tend to have trouble sleeping, be irritable, and speak quickly about a variety of topics. Depressive episodes see children complaining a lot about stomachaches or headaches, have no interest in fun, and possibly think about death or suicide.

There are three types of the disorder: bipolar I, bipolar II, and cyclothymia.

Bipolar I

Bipolar I is diagnosed when a person suffers from manic symptoms longer than seven days, or severe enough to require immediate hospitalization. Depressive episodes often last two weeks or more. Both states prevent normal function, and require treatment in order for the individual to fully live their life.

Bipolar II

Four times more common than Bipolar I, Bipolar II is characterized by both depression and hypomanic (“below mania”) episodes, but not full-blown mania.  Often productive, persons with Bipolar II are rarely hospitalized.

Cyclothymia

Cyclothmia is a tricky diagnosis with manic symptoms less severe than Bipolar I and depressive symptoms less severe than Bipolar II. Impact on productivity varies; some individuals may be hyper-productive with little impairment, whereas others are manic or severely depressed for most of their lives. Cyclothimics may have periods of stability, but those last less than eight weeks.

There are several risk factors under consideration. Genetics may play a part, though studies of identical twins have found that one twin may develop the disorder while the other twin does not. Brain scans show that the structure of the brains of sufferers of bipolar disorder have differently sized portions of the brain compared to healthy people. Family history seems to contribute as well, as those who have a family history of the disorder tend to develop it more often than those who do not.

Treatment for bipolar disorder requires a range of psychotherapy and mood stabilizing drugs like lithium and Depakote. Electroconvulsive therapy (ECT) is also used, with mixed results. Several illnesses are comorbid with bipolar disorder, such as Attention Deficit Hyperactivity Disorder (ADHD) or anxiety-related illnesses. These related conditions make it difficult to treat the underlying bipolar disorder, as stimulants used to treat ADHD can sometimes trigger a manic episode. 

With treatment, people with bipolar disorder can lead productive, healthy lives, managing their illness as it comes.

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6 Strategies for Parenting with a Mental Illness

When my mother was a little girl, her mother would disappear into her bed for months at a time, punctuated by periods of restless energy and action. My grandmother was so scatterbrained, she would forget the birthdays of each of her six children. The house was extraordinarily chaotic, what with my grandmother constantly replacing furniture from auctions and worrying about money. She was never diagnosed, but her behaviors were hallmarks of mental illness.

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Parenting while mentally ill adds extra challenge to people’s lives. Often, children of parents with a mental illness can feel anxious due to the chaos in the household, or unloved because their parent may be emotionally unavailable. Here are some tips for maintaining a healthy relationship with your children despite facing mental instability.

1. Get Treatment

Treatment helps a mental ill parent function properly. Being able to get out of bed in the morning to take your child to school on a regular basis requires you to manage your disorder. Mental illness is nothing to be ashamed of. There is help available.

2. Try to Stick to a Routine

Providing structure for your kids helps them grow into healthy, well-adjusted adults. Unpredictable behaviors in a parent disintegrates a child’s sense of safety and make it difficult for children to learn self-care routines. Even though enforcing structure may be difficult, abiding by Taco Tuesdays ensures that your children will have a rock in what may be chaos otherwise.

3. Talk to Your Kids About Your Mental Illness

Arming your children with age-appropriate information helps them realize that it’s not their fault that you suffer from a mental illness. If you keep them up to date with what’s happening with you, they can learn what to expect when you’re having a down day. They’ll also learn to separate you from your disorder, which can help them feel loved.

4. Create an Emergency Plan

Should you need to be hospitalized, your kids will need someone to pick them up from school and feed them dinner. If you have a partner and treatment team, create a crisis plan with them to ensure that your children won’t be affected negatively if an emergency sidelines you. Make sure that you communicate that plan to your kids.

5. Maintain Relationships with Adult Role Models

If you can’t provide a healthy role model for your kids, make sure they have someone in their lives who can. Consistency is key in this: you want an adult that will be there for them no matter what’s going on in their lives. If you have a supportive partner, that’s half the battle. If you’re a single parent, try to find a good friend or two–probably a parent themselves–who will help.

6. Remember That You are the Parent

Your children should not parent you. They are too young to take on that kind of responsibility, and that fosters an inappropriate relationship. Prioritize taking care of yourself. Put your oxygen mask on first, then care for your kids.

Following these six strategies can help mitigate the effects of your mental illness on your kids and encourage them to grow into healthy adults. Making them feel loved is paramount to their happiness.

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How to Talk To Your Kids About Mental Illness

“Mom, are you crazy?” my eight-year-old son, Nolan, asked after reading over my shoulder while I worked on my book. My memoir, Committed, is about my stay in a mental hospital one week after Nolan’s birth, and the page he read demonstrated a particularly erratic behavior from me.

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“No, honey,” I said. My heart sank. I was not ready to have this conversation yet, but Nolan’s question made me think otherwise. “I do have bipolar disorder, which is a mental illness.”

“What’s bipolar disorder?” he said.

“Bipolar disorder is when I sometimes feel depressed–like nothing in the world matters anymore,” I said, patting him on the arm. “But it also means I feel super energetic sometimes, and can’t control myself very well.”

“Will I get it?” he said, his eyes widening.

“I don’t know,” I said. “You might. It comes when you’re a teenager or young adult. But there are medications available to help manage it, so don’t worry.”

“Oh,” he said, giving me a hug. “I’m sorry you have bipolar disorder, Mama.”

And that was that.  The dreaded conversation–the start of many–was over.

Arming your kids with age-appropriate information about your mental illness can help them feel secure. If you talk to them about your disorder, they will know what to expect when you have a down–or up–day. They’ll also learn to separate you from your illness, and from any negative feelings that might occur. If you don’t talk to then, they’ll invariably draw their own conclusions, which can make them feel unsure about you and their position in the world.

Here are some tips for talking about mental illness with your kids.

1. Keep it Simple

Children only need to know the basics of mental illness: it’s not contagious, they are not destined to have a disorder, there are treatments available, etc. Another important factor that goes into talking about mental disorders with your kids is stressing that it’s not their fault. They can’t make their parent better, nor should they try. They can only support their mother 0r father by checking in on them, watching movies with them, and generally being their awesome selves.

2. Reassure Them

Explain to your children if they ask that they might get your disorder, but reassure them that there are treatments available and that you’re getting help yourself, if you are. Tell your kids that you still love them, and no amount of mental illness will change that.

3. Know Your Child’s Maturity Level

All kids are different, and mature at different rates. Preschoolers will only want very basic information about why you’re sad. Preteens will want more information, so give them as much as you think they can handle. Teenagers will often turn to their friends when seeking information about things that bother them, so make sure they’re well-informed.

4. Address Their Fears

Ask your children if they have any worries now that you’ve brought up the topic. Reassure them that their needs will be met and that you’re not going anywhere. Repeat information if they appear confused. It may be helpful to bring their fears up with a mental health professional, so you can make a plan to address them.

5. Make Yourself Available

Make sure you don’t end the conversation there. Children will have questions as they grow, and it’s important that you be available to answer them. Explain to your kids that they are always welcome to ask questions of you about this topic.

Talking with your kids about mental illness can be tough. But if you’re open to it, they’ll appreciate your candor and feel more secure knowing what’s going on with their parent.

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The Price of Mental Health

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The price of mental health is steep. According to a 2013 report by Health Affairs, Americans spent in excess of $201 billion on mental disorders, outspending diabetes, heart disease, and cancer. The National Institutes of Mental Health (NIMH) estimates that mental illness cost a loss of earnings of $193.2 billion in 2002, and the number is only growing with time. In 2006, mental disorders were 6.2% of the nation’s spending on healthcare.

However, despite costing the American public so much, mental disorders don’t receive much in comparative funding for research. The National Institutes of Health (NIH) estimated that the organization would spend $396 million on mental illnesses in 2016, compared to $1 billion for diabetes research.

To make matters worse, a whopping 50% of Americans with mental disorders can’t afford to be treated.  Only a paltry 38.2 percent of the estimated 45.6 million people with mental illnesses were treated for them in 2011. Half of those not accessing mental health services cited that the costs were too high as their reason for avoiding treatment. That number, roughly 14 million Americans, includes both the insured and uninsured.

Periodic blood draws, psychiatrist visits, medications, therapy–the costs of mental health care add up fast. I know of someone who had to stop taking lithium because she couldn’t afford the blood draws to monitor it, putting her at risk for lithium toxicity.

But there are ways to receive mental health services at a lower price. Ask your therapist or psychiatrist about sliding-scale fees. Try out support groups, many of which are free and can be found in your local library. If you’re near a university, call their psychology program to see if there are any therapists in training willing to take you on. You are worth exploring these options.

How much do you spend on mental health?

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What is Postpartum Psychosis?

Postpartum psychosis is a rare condition which includes symptoms of racing thoughts, delusions, hallucinations, the sensation of things “crawling” under the skin, mood swings, paranoia, and confusion. It occurs shortly after giving birth, in the first two weeks postpartum.

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Psychosis affects approximately 1 to 2 mothers out of every 1,000 births in the U.S. The risks include previous history of psychosis and bipolar disorder, even though roughly half of the women who encounter it have no risk factors. According to Wikipedia, “25 to 50% of women with a history of mental illness experience postpartum psychosis; around 37% of women with bipolar disorder have a severe postpartum episode.” The risk of having a second psychotic episode is roughly 30%. The condition is not recognized in the DSM-5, but is used by doctors worldwide.

Unfortunately, there’s a 5% suicide rate and a 4% infanticide rate lumped together with psychosis. Each woman who undergoes postpartum psychoses breaks from reality. The delusions she endures are quite real to her. However, not all delusions and hallucinations tell the mother to commit harm to herself or an infant. Sufferers require immediate twenty-four hour monitoring and, in most cases, medication, to come out of the fugue.

During my episode, I was lucky enough to have a therapist who helped me commit myself to the University of Washington’s mental ward, which was the only available bed in the city at the time. Because I hadn’t slept in a week, the doctors there prescribed Olanzapine to knock me out for the first twenty-four hours, and then Depakote to help tame the postpartum mania.

I couldn’t sit still; I felt like I was going to burst right out of my skin from all my restless energy. The urge to nurse my newborn, Nolan, was intense. I tried to suffocate myself with wet towels when I found I couldn’t do it. I suffered a single hallucination in the showers: a voice roaring at me to stand up.

If you are suffering from postpartum psychosis or know someone who is, immediate treatment is essential to make a full recovery, which takes roughly six months to a year. The mood swings and delusions can last anywhere from two to twelve weeks. It is not your fault that this happened. You can recover from this.

Have you suffered from PPP or known anyone who has?

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How Mental Health Affects Personal Hygiene

Hygiene is extremely important for health and morale-related reasons, but mental health conditions can negatively affect self-care. Keeping up a routine of frequent bathing can be difficult for many people suffering from bipolar disorder, unipolar depression, schizophrenia, and dementia. Teeth and hair brushing are burdensome for the mentally ill; indeed, getting that done on a daily basis is hard for me as well.

During my stay in the mental hospital, patients had to request that they be let into the shower, which was locked. The nurses required us to be dressed by eight a.m., but didn’t require oral care or hair brushing. As a result, my normally-straight hair became ridiculously tangled, to the point that I described it as a mass of Brillo pads piled atop my head.

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Self-neglect is one of the major symptoms of depression, and can easily be tied into mania as well. Body odor, soiled clothes, and poor oral hygiene are all signs of something going very wrong in a person’s life. Loss of motivation, a lack of self-worth, and social isolation all contribute to poor hygiene.

One way to help remind yourself to wash is to have soap and other supplies readily stocked. Fresh towels, even if it’s difficult to do laundry, are essential to cleaning oneself. People who care about you can help keep you on task as well by asking if you’ve had a shower lately. And you don’t need to bathe everyday. Showering every day strips the oils from your skin and hair, drying them out. So just get a bath in when you can.

Hygiene can be hard to maintain, especially if you’re in the throes of a mood episode. But it’s crucial to managing moods. Best of luck engaging in self-care!

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The Prevalence of “Nuts”

One of my strongest memories from the mental hospital, explained in a scene in my upcoming book, Committed, is what happened when I used a poor choice of words in front a group of the other patients. I commented on the awful food at the hospital, saying, “Doesn’t that just drive you nuts?”

All of them flinched. The effect of my words was immediately apparent: I had wounded them. I apologized profusely, and then my roommate said something I’ll never forget: “Don’t worry, we’re used to it.”

It took me a few moments to realize what, exactly, they were used to: the prevalence of “nuts,” or, rather, the misuse of words that could apply to them. “Nut” is defined by Merriam-Webster as “a foolish, eccentric, or crazy person.” Words like crazy, nuts, and psycho are often misused, and stigmatize people who actually suffer from mental illnesses. I admit that, now, every time I hear the word crazy in public, I, too, flinch. There are so many more precise words to be used rather than just defaulting to the standard “nuts.”

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Just like people don’t use the word “retard” to describe mental handicaps anymore, I contend that “nuts” is equally harming and ablest. “Crazy” and other terms usually don’t refer to actual psychotic people, but are used to dismiss the way people–mostly girls and women–feel. When “crazy” is used to describe irrational, frightening behaviors, it wounds people who suffer from mental illnesses by making them feel as if their disorder is out of control. These words have power, and that power is used to isolate people by making them feel abnormal–in a bad way. Mental illness is not the reason behind all bad behaviors. Plenty of neurotypical people can be jerks.

Here is a great list of words to use instead of insane or psycho, such as “naive, mistaken, confused, misled, misinformed, uninformed, [and] ignorant.” The author, Jennifer Kesler, also points out that a job or weather cannot be “schizo” or “bipolar.” Only a person can be those things, and saying they have bipolar is more correct than “is” bipolar, because you don’t want to define them by their illness.

Many people who suffer from mental illnesses don’t feel hurt when this language is misused, and even call themselves crazy. But others do feel attacked by it. I don’t mean to police language, but if one can avoid harming people who feel this way, then why not?

Have you been called crazy before?

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“How Do You Define Mentally Ill?”

“What do you mean he’s mentally ill?” the woman said. “He just needs to get his act together!” I was sitting in an Olive Garden the other day, and overheard part of a conversation from a very loud patron. I tried to ignore her, but she said something that caught my attention: “Well, how do you define mentally ill?”

Hearing that made me think about what a good question it was. How do you define mental illness? Mental disorders are more prevalent than heart disease, cancer, or diabetes. Twenty-five percent of American adults and thirteen percent of American children are diagnosed each year with a mental illness, per the National Institute of Mental Health (NIMH). The causes of mental illnesses are still unknown, though recent research points to genetics as well as environmental stressors.

According to the Mayo Clinic, “Mental illness refers to a wide range of mental health conditions–disorders that affect your mood, thinking and behavior.” Generally, these illnesses cause dysfunction in your life. Examples include schizophrenia, eating disorders, bipolar disorder, phobias, unipolar depression, and many more. These conditions are classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th. Edition (DSM-V). Published by the American Psychiatric Association, the DSM-V is considered the guide to mental health issues. It covers five dimensions of mental illness:
• clinical syndromes, such as bipolar disorder
• developmental disorders and personality disorders, such as autism and borderline personality disorder
• physical conditions
• severity of psychosocial stressors
• and highest level of functioning in the last year, which is a measure of the mentally ill person’s ability to meet life’s demands on an annual basis.

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But how does society define mental illness? There are stereotypes of the disordered person ranging from unpredictable to slovenly. Countless news stories report people with mental health issues as violent, while research shows that they’re no more violent than the general population. In fact, they are more likely to be the victims of violent crime. Thesaurus.com even lists “crazy” as the second synonym for violent.

What’s even worse is how society has treated the mentally ill. In Ancient Greece, physicians used to drill holes in people’s heads to let the evil spirits escape, and ostensibly cure their disorders. Institutionalism was rampant from the 1800s to the 1950s, and some patients were even chained to their beds and left in filth. It was as recent as the 1930s that lobotomies and malarial infections were the leading treatments for the mentally ill.

So, when the woman in the Olive Garden spoke about her friend’s husband, putting him down for suffering from mental health issues, I was irritated with her. People who endure these grueling conditions and their families have enough to deal with without others questioning their diagnosis.

Most people with mental illnesses are aware that they can sometimes be inappropriate or different than others. Mental disorders are not something you can just will yourself to cure. They require treatment ranging from talk therapy to medications, and some are even treatment resistant. Many people who do not receive treatment are unable to cope with their lives, which in turn causes them to not be able to keep the house clean or hold down a job. Many more can control their mental illness, or mitigate symptoms—with treatment.

Treatment has come a long way since the insulin-induced comas of the 1930s. But it’s not far enough. Communities have been slow to offer housing support and life skills training for the mentally ill who were deinstitutionalized in the 1950s. People who suffer from mental health disorders need more care than society has been willing or able to give.

Better funding for research into disorders would be a good start. The National Institutes of Health (NIH) estimated that the organization would spend $396 million on mental illness research in 2016, compared to $1 billion for diabetes research.

But what can individuals do for those of us who suffer from mental illnesses like bipolar disorder? Be kind to the mentally ill. Learn about various diagnoses and the stresses that trigger them. Advocate for better housing options and more funding for research. With these efforts, concerned people can make the world a better place for those with mental health conditions.

How do you define mental illness in your life?

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Pregnant While Bipolar

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Going through pregnancy while bipolar is tricky. Bipolar disorder symptoms can worsen during pregnancy. According to WebMD, “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions compared to pregnant women who do not have bipolar disorder.” As I’ve stated before, depression can lead to low birth weight in newborns, and stopping medications abruptly can harm both the bipolar sufferer and their unborn child. Manic episodes can contribute to poor decision making, such as smoking cigarettes or drinking while pregnant. And there are several medications which treat bipolar which can harm infants both in utero and while breastfeeding, contributing to neural tube defects as well as others.

People with bipolar disorder who wish to become pregnant need to closely monitor their health, even more so than people without mental illnesses. Especially because there is a clear link between bipolar disorder and post-partum psychosis.

Thankfully, there are steps you can take. There exists medication that can be safely taken during pregnancy which treat depressive and manic episodes. Lithium needs to be closely monitored, as it can cause a rare heart defect in the first three months of pregnancy for about 1 in 2000 births. Talk therapy poses no risk to the baby. Added structure during the day can contribute to good sleep habits, which can be disrupted during pregnancy. Sleep is a serious factor in whether a bipolar sufferer will succumb to a mood episode, so it’s important that a pregnant woman gets enough. Exercise, which is crucial in maintaining good mental health, will aid a pregnant woman in controlling her moods.

If you are planning a pregnancy, talk to your obstetrician and psychiatrist to make a comprehensive plan. Your treatment team will help you. Good luck!

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