Cyclothymia or Character Flaw?

Hi everyone,

I have been reading voraciously your postings here, thank you for your courage and honesty! I am at a tail end of a down cycle so I guess I am on the way up now. Still very tired but I feel a smile breaking out and am starting to make plans again. This depression came after surprise! a really great, awesome period where I got into school to pursue my lifelong dream and negotiated an arrangement with my boss so I can go to school and work full time. Yay 14 hour days! And just as things were getting really good and I felt on top of things, I started getting irritated, pursued by intrusive negative thoughts about my life and my relationship until I blew up at my boyfriend over something ridiculous (not the first time). I didn't really blow up actually, but the intensity of what I was feeling and the way I communicated was very negative and I was boiling inside. And we generally have a very positive, supporting relationship. The "episode" lasted two days, where the paranoid thought stuck in my head and kept repeating itself over and over. I couldn't sleep. I dropped 2 kg overnight (I am of normal weight). The next day it felt like the thought burnt a hole in my brain, exhausted, felt like I was coming down of drinking a gallon of redbull. The "hangover" lasted another 2 days. And then the remorse, the depression and the inevitable, "Crap, I did it again" thought.

It's been almost 5 weeks now and I am waiting for my P.Doc appointment. For some reason in this town, the P.Doc's are booked months in advance. Never had one before except in college once when I asked to be put on anti-D's and the nice lady said "why don't you wake up early before class and take a 15 minute walk for 2 weeks and then come back and see me." I was furious and stormed out. What I should have said, "Lady, if I could get out of bed early enough to go for a freaking walk in the morning I wouldn't be here talking to you." Anyway... but looking back I can trace this up/down pattern to childhood. I always blamed myself for not having self control or not persevering when I finally get up the courage to do something I have always dreamed of doing. I would get such amazing creative ideas, get motivated, get the ball rolling and then something would happen and I would feel wrung out, despondent, feeling like an idiot for even trying because it would never work out anyway and I would let it fall apart or break it up myself. I thought I was lazy or had some character flaw, but I am starting to think that no matter what I do, this ride will always go down just when I feel like I am on top of things. Sound like cyclothymia to you? I've mentioned to my previous counselor that I might be bipolar. She didn't think so. But usually, getting out of bed to see her was enough to break the cycle of debilitating depression and the times when I came to see her full of plans and ideas and creative zest she welcomed it as recovery. But I can see where others can't. I don't let people see me not being able to get out of bed on the week-end, keeping the shutters down so no one can see in and no light disturbs me, piles of clothes and dirty dishes piling up in the kitchen.

Anyway, let me know if any of this rings a bell for you. I did all the online diagnostic tests, the bipolar spectrum test, and two or 3 others and all point to a medium to high probability. I guess I am worried that the Doc will not understand and just say I have some depressive tendencies and anxiety and send me on my way again. The talk therapy helped but then I moved to a different country two years ago and the pendulum started swinging stronger. Or maybe I just notice it more as I don't have as much of a support structure here. I should mention, I am clean and sober for several years as alcohol and what not definitely made things much, much worse in the past.

I look forward to your comments and blessings on your recovery.

V8

Standard disclaimer: We can't diagnose you here, but you probably know that and aren't looking for exactly that anyway.

It certainly seems possible to me that you have cyclothymia. Who knows what the pdoc will think? These forums abound with users who have had trouble finding a pdoc who understands and is helpful. Even when you have the most helpful doctor, the first diagnosis can be wrong. And then, if you need meds, there's trying to find the right ones.

If you know something's wrong, seek the help you need. It's okay to tell the pdoc what you think it could be. But it's important for you to listen to other possibilities. In the ideal doctor-patient relationship, you and the doc look for the evidence that it is whatever you or the doc suspects it is as well as the evidence that it isn't. But even while that's going on, you should focus on getting better. That's what ultimately matters, no matter what name the problem has.

I'm sure you do have something you could call a character flaw. So do we all. It certainly does affect everything from how well you respond to therapy to the effect a medication has on you. If it's something you want to improve, wrap that into your therapy. It's part of who you are and the journey you're on is about getting to know that person better.

Good luck.

Thanks, Dark in the Light for your response.

I agree that there is a lot of work to be done personally no matter what the official diagnosis is. It shouldn't be a cop out.

So just wanted to update on how the PDoc appointment went:

I had my first ever PDoc appointment last week over the episode described above. I have been paying attention to my mood cycles and have seen a definite up and down wave going through so naturally I thought I was bipolar, in fact kind of convinced.

***Trigger Warning***

But when I met with the PDoc because of my history of eating disorder, being molested as a teenager, drug and alcohol abuse and another traumatic sexual experience as an adult, naturally she says BPD (Borderline).

***End Trigger Warning***

I have been sober for many years now and am back in therapy after the last episode, which was relatively minor but the feeling in my body was not. It took me days to come off it and I have had "aftershocks" of feeling raw and exposed. During the episode itself I felt frantic, a thought got stuck in my head and I felt as if I drank 30 cups of coffee. Also, I don't meet the required diagnostic criteria for BPD right now. My question is, do people recover from BPD and is it similar to cyclothymia or BP2?

The reason I ask, is that back when I was "out there" drinking/drugging and having an eating disorder for many years, I can see how I would qualify for BPD. But for the last few years, I have been fairly stable, I take extraordinarily good care of myself, I have lasting friendships and I can connect with people. These "mood episodes" are triggered by something that reminds me or makes me feel like I am stuck back in a traumatic experience and therefore maybe I am dealing with cPTSD now compounded by some kind of mild bipolarity rather than BPD.

Unfortunately, by the time I was able to meet with the Doc it had been over 6 weeks since my episode and I am feeling stable and "normal" so all she had was history to go off. I have a long distance relationship that bothers me but I certainly am not frantic about it, I'm cool with it. I am cool with a lot of things until I am triggered by something minor when I am on an energy shift wave already (3 days) and then I can lose it because the spoon is on the wrong side of the coffee cup (not really, but just trying to come up with an example) and then I get depressed for a couple of weeks. And then it's back to normal, better, even better, irritable, triggered, inappropriate anger episode, agitated depression, repeat.

Anyway, let me know your thoughts.

Thanks!

Since you describe such serious personal issues, I hope your first visit with the pdoc isn't your last. You and the doctor barely know each other. Getting the wrong diagnosis at first in psychiatry is par for the course. The patient is eager for an answer and the doctor is eager to provide one. But the patient doesn't know yet what all to bring up and the doctor hasn't figured out yet what all to ask about. It takes time to get there.

Meanwhile, the doctor should be giving you advice on things to do to help make things better. Next time you see her, you can tell her how they worked. If the problem reacted like PTSD, that would be evidence that it's PTSD. If the problem reacts like bipolar, that would be evidence that it's bipolar. The reaction may be one that doesn't provide a clear answer. That's frustrating, but it may provide more clues. And in any case, it will provide more information for you about what works and what doesn't.

Stick with it. What counts most is that you get help and the help works. The name of the problem is just a name. The essence of any problem that bothers you enough to seek a pdoc's help can't be described by just a word or two or three anyway.

I don't know much about borderline personality disorder. There is a forum for it on psychforums, so I would suggest you visit it. Look above in the blue tabs for "personality". As much as I would rather not send you away for the answer, I believe you would be heading to the answer you're looking for instead of doing without it. I just don't know how it compares to bipolar and cyclothymia or how it may change over time.

Bipolar and cyclothymia do change for many people. It can become better or worse. Some people say they get it under control or it goes into remission. And others have suddenly bad bouts after a long time of mild symptoms.

I hope you're on the road to getting better. Don't let the bumps along the way get to you.

Thanks again for your response. Reading it, at first I was like, what serious personal issues? I am just having an mini panic attack every couple of months these days, no biggie . But then I see that's not what you meant. Like I said, that stuff was in the past but it leaves a scar, a filter through which to see the world. I am doing deep trauma work with a therapist now. I also made another appointment to see the PDoc again in a month. What I had asked for was anti-anxiety meds and sleep aids for if I feel the whatever coming on but because of past history the options are limited and she didn't want to do anti-d's in case in triggers mania. You are right, the session was 20 mins long so it is difficult to relate everything in that moment especially since now I am feeling "normal." I am almost hoping that I go into hypomania so that when I see her again in a month someone will finally believe me.

Dark in the Light, can you tell me, how does a bipolar/cyclothymic react? (You said: "Next time you see her, you can tell her how they worked. If the problem reacted like PTSD, that would be evidence that it's PTSD. If the problem reacts like bipolar, that would be evidence that it's bipolar.") Just so I have something to compare to.

Anyway, that being said, I am exploring the BPD forum as well but frankly, I just don't relate. 5-10 years ago, when I was doing drugs and battling my eating disorder, yes, maybe, but now that stuff feels like it was in the past and now my head just does it's own thing sometimes.

violet8 wrote:Dark in the Light, can you tell me, how does a bipolar/cyclothymic react? (You said: "Next time you see her, you can tell her how they worked. If the problem reacted like PTSD, that would be evidence that it's PTSD. If the problem reacts like bipolar, that would be evidence that it's bipolar.") Just so I have something to compare to.

It's hard for me to answer, because I'm not a psychologist or psychiatrist myself. I just know that the various methods of handling problems have different effects from person to person and a pdoc can use that information for clues.

Guessing here: maybe if you're advised to stick to a routine and it helps even things out (sometimes part of successful cyclothymia treatment), that would be a different outcome than expected for someone with another issue in which the lack of routine isn't what's jumbling things up.

Another guess: if a bad reaction is triggered by going to a place where something bad happened to you, a bipolar regimen of careful eating, good exercise, and adequate sleep may not do much at all to prevent anxiety from bad memories next time you go there.

Just guesses. Like we often say on these message boards, let the real experts diagnose you and explain it. The pdoc should eventually be able to say, "I think you have ____ because you ____ but you don't ____. It's not _____ because_____."

That definitely resonates. When my routine is broken for whatever reason, travel, sickness, construction noise, change of season, but mainly travel it's like I've been knocked off my feet and have to learn how to find balance again.

Today for the first time in over a month, I woke up full of energy before my alarm clock rang. So this is my first signal that I am fully out of the depressed cycle. Throughout the day the clarity of thought has returned, I am connecting different subjects, have ideas circling in my mind, feeling alive and frankly a bit more frisky. To me, this is how I wish I could feel all the time. And I know this will continue for a bit until I start getting really creative, thoughts and fragments of ideas will circle my mind and I will find myself unable to sleep because I am composing multi-dimensional symphonies in my mind complete with orchestra and 3-D visuals. That part I reaallly enjoy and then energy will shift, my body will feel tired but my thoughts will race on until every mechanical noise will feel like nails on my brain, the street lights would be too yellow or shining too bright into the apartment, tinnitus, visual snow and the awesome 3-D visuals will start turning into incoherent dust again. And then I fall...

Anyway, Dark in the Light, I really appreciate how gently you steered me to the BPD forum. But I missed my chance to make a joke, and say "Oh No! Even the bipolars don't want me!" J/k it is certainly helpful to look at all the aspects as perhaps there is more than one thing going on. Appreciate your responses.