Bipolar disorder and bipolar personality structure, also known as manic depression and manic-depressive structure, are something we are more likely to encounter in therapy than appears to be the case at first glance. Bipolar is predominantly characterised by swings in mood—from manic to depressive. However, contrary to common belief, neither the intensity of swings nor their frequency are deterministic of bipolar.
Diagnosis of bipolar
Some of the main issues related to bipolar, especially when we talk about bipolar personality structure, are the difficulties associated with its diagnosis in during the course of therapy, especially in psychotherapy or counselling.
Because depression is one of the main elements of bipolar, it can quickly be mistaken for regular depression. However, what differentiates bipolar depressive state from regular depression is not the intensity or their frequency, but the quality of depression. (Related article: Difference Between Bipolar and Depression)
The other difficulty in diagnosing bipolar is the fact that depressive states often do not last long, which defers the focus of therapy to other issues or even results in considering the depression as successfully treated.
Further to that, one of the main characteristics of bipolar is the element of client’s psychological denial when presenting problems, which can also mean the denial of the significance of the problem. Clients can therefore interpret depression associated with bipolar as just “one of the low mood periods” and the therapist or counsellor, if not attentive, can easily be misled.
Bipolar disorder or bipolar personality structure
Bipolar or manic depression does not need to manifest itself as a disorder. This means one does not need to fit the official criteria of bipolar disorder as diagnosed according to DSM (Diagnostic and Statistical Manual of Mental Disorders) in order to be considered bipolar. Client can have majority of symptoms but not all, or the symptoms can be less prevalent or prominent and hence not considered a disorder. But obviously this does not mean that there is nothing to attend to.
In such case we talk about bipolar personality structure, which has the traits of bipolar disorder, but does not fit all criteria needed for diagnosis. Diagnosing bipolar personality structure is often harder than in the case of the disorder because symptoms are more latent. The mania does not present itself as actual “mania” and the depression—combined with denial from the client, can often be misinterpreted as low mood.
Characteristics of bipolar
When diagnosing bipolar disorder we can also rely on characteristics of manic states as indicator of the condition. However, this is rarely the case with bipolar personality structure, since true manic states are rarely present. That’s when we need to rely on client’s developmental presentation and the quality of their depressive states.
One of the main determinants will be that the client will usually present high emphasis on competition and competitiveness—socially, professionally, and also in relationships. Doing, accomplishing, working, performing are considered as important values of someone presenting with bipolar. Hence, such clients can often also be confused with suffering from burnout.
When in depressive period, this tendency to do and perform can result in agitation out of not being able to or accomplish anything. Procrastination is also a possible indication. At the same time the person can be hard on themselves for not performing in their tasks.
Another characteristic of bipolar is grandiosity associated with client’s feelings, thinking and behaviour. This is usually evident from over-emphasising and dramatising language in therapy room.
Treatment of bipolar
When considering treatment of bipolar in psychotherapy or counselling, we need to be aware that proper diagnosis is the first determinant of success. Given that most bipolar clients will go into therapy when they are suffering from depression, the first crucial point is not to misdiagnose.
When a client presents with bipolar there is a high risk they will want to leave therapy once out of depressive period. That is when therapy will usually end and the client will not have the chance to resolve the underlying presenting problem. It is, therefore, important to address this in the relationship between the therapist and client as soon as the problem is apparent.