Cyclothmia/HPD dual diagnosis

Hi. I'm a mod on the HPD forum, but am posting here on this forum as just another regular member. I have HPD and cyclothmia. I have had intensive therapy for the HPD and it's mostly under control now. Because of the intensity of the therapy and its emphasis upon the HPD symptoms I've identified more with that diagnosis and looked upon the cyclothymia as a kind of a secondary thing that was kept under control with meds. It's actually hard to see where one disorder ends and the other begins. There is a history of bipolar in my family and there have been two suicides.

I have probably had cyclothmyia since childhood and can remember my first depression at the age of six after I lost my grandparents. I remember becoming very withdrawn and insular and escaped into a fantasy world in school, often to the extent of being so lost in my thoughts I wouldn't hear the teacher talk to me. I've never had a psychotic episode although there was a time in my life when I became intensely involved in spiritual things. I wasn't exactly delusional but my interests bordered upon the obsessive. At that time I had intense levels of energy and functioned well, although I did make some rash decisions and entered into a really disastrous relationship on an impulsive whim, which later caused me great damage. I also felt at that time as if I could achieve anything and nothing at all perturbed me. After that period I crashed into a depression and became withdrawn and unmotivated. I've never really looked at the patterns of my moods before but can now see how they formed. After that hypomanic episode the highs have been less severe and haven't prevented me from functioning. If anything, they've helped me to get motivated in things and I find that I'm really creative and sociable during them.

I had a crisis about 20 months ago and had what is probably the closest I've come to a psychotic depression. I had feelings of dissociation and unreality and felt like I was on auto pilot, acting and speaking normally, but almost as if I was really detached from things. My memories of that time are quite sketchy it was at that time that I got my diagnosis of cyclothmia/type 2 and the appeasing type of HPD. I self harmed at this time, cutting myself, and have not done this before or since. My attention seeking behaviour at the time (ie expecting special privileges from my doctor, phoning him demanding to be seen, manipulating people etc and my obsession with my appearance, despite the depression, led them to also suspect HPD, which I knew I had as I had also suspected it in myself. I would constantly re apply my make up, change my clothes three or four times a day, look at my reflection, and act inappropriately provocatively. The HPD had always been the bigger problem in my life, and ironically it's thanks to my HPD symptoms - persistently insisting that I get treatment for it - that I found my fantastic therapist and was lucky enough to get the therapy I needed. I'm now self aware and for the most part have beaten the worst aspects of it, although I will always be a Dramatic Personality Type. I do have off days but I can recognise them and act
accordingly.

For the most part I ignored the diagnosis of cyclothmia. It only emerges periodically and for a great deal of the time I'm quite level. When I do feel the symptoms I go back on my meds. I take Epillim as I can't tolerate lithium and it works almost immediately. I try not to take anti depressants as they had a really big effect upon my sex drive and made me feel really strange if I forgot to take them for a day or so. I would get a sort of whooshing in my head and feel as if I was walking on a ship. I'd also get a sort of physical agitation, constantly tapping my foot, or rubbing my hands. These withdrawal type symptoms made me concerned about the possibility of addiction and I would really only take them as a last resort, if I got really depressed. I tried Seroxat, Citalapram and another one I can't remember and they were all pretty much the same.

I've noticed a definite seasonal pattern in my depression. I'm quite high in the summer. As soon as October comes I begin to hibernate. I don't always feel depressed per se, but I have no motivation to really go out of the house. I'm in the beauty business and things are going badly at the moment due to the recession so I'm never there and both salons are up for sale due to debts. That's not the issue, it's a separate concern, but I'm relieved in a way as it means I don't really have to go in much, and I want to change direction anyway. I'm quite happy to stay indoors and not do anything. It's a sort of depression but I don't feel sad or hopeless at the moment. If my mood does slip I'll go back on the meds. My sleeping patterns are really strange. I don't need much sleep, and this is unusual as it's usually a symptom of feeling high.

Does anyone here have a dual diagnosis, especially a personality disorder? HPD and BPD are quite similar in some ways and I was reading about a correlation between BPD and the bipolar spectrum, and that Dramatic Type personalities who are extravert and larger than life are more prone to developing bipolar type disorders. It can be hard to separate the two disorders sometimes. Because I've been in intensive therapy I've concentrated more upon the HPD symptoms, and not really examined the cyclothmia/type 2.

In my case, the evidence points to just cyclothymia. But I am at a point now where I feel it's under control enough to see if there are other problems too. From what others post here, dual diagnosis isn't all that unusual. If your bigger problem is under control now, you may also be at a point where you can find out exactly how much the other problem affects you and what you should do about it. If something bad happens to you and you feel sad about it, that's normal. If the sadness aggravates histrionic disorder, it could look like a second problem on top of the first when it really should be looked at as a complication. A good question to work on with your therapist is whether the histrionic disorder is causing the depression. If it causes you problems in your dealings with other people or at work, of course you'll be depressed about it.

One thing that could be making things harder for you is going on an off meds according to how you feel. Some meds really need to be in your body at a sustained level for a long time for you to really know how well they work. If the unpleasant effects are too much, that's something to talk to your doctor about so you can make a more informed decision about whether the tradeoff is worth it.

Hi. The histrionic disorder doesn't cause the depression, but the depression can aggravate the histrionic disorder. For the main part, the HPD is well under control. I've done extensive therapy, worked deeply upon childhood issues, learnt how to recognise my patterns, identify the traumas that caused the HPD and re learn from scratch healthier patterns of thinking and reacting. I've had psychodynamic psychotherapy and also CBT, and both have helped tremendously. I've learnt to gain insight into myself and my thought patterns, and as I confronted my issues, dealt with the pain from them and challenged my responses, noticed a gradual but very definite change in my personality. I have become a calm person and much more rational. It's very much an ongoing process and I learn something new about my reactions every day. I've got a naturally enquiring mind and this has helped me to question everything about myself. What I have noticed is that the cyclothmic moods are much less responsive to outside events and they feel different to the HPD moods, which were for the best part exagerated over reactions to events. The cyclothmic moods occur out of the blue and they feel different, less rooted in reality and have a dream like quality about them, as if I'm not well. When I do have an attack of them, then the HPD can kick in and be triggered. If it's a reaction to a stimuli it's HPD and the moods are intense but short lasting and they don't stop me functioning. If it occurs out of the blue, it's cyclothmic and the moods feel deeper, last for weeks at a time and don't shift so much, they remain static. Whenever I have an illness of any kind, cyclothmia or flu, the HPD symptoms can kick in. The HPD symptoms are much easier to be aware of and control. I have an insight into them. When it's cyclothmic, the changes are much more intense and I have less insight.

I think one of the reasons I was reluctant to take my meds is that I've been in a kind of denial about the cyclothmia. Because I am quite level between attacks it's a lot less disabling than the HPD was and so therefore it's been easier to forget I had it. I was treated by both the psychiatric services and the psychological services with different approaches. The attitude seemed to be that as soon as I became level with the cyclothmia, it was safe to treat the HPD and they paid less attention to it. Because I had therapy every week for the HPD there seemed to be much more of an emphasis on that. Now that the HPD is well and truly under control, and I'm thinking more rationally, I'm becoming aware of the impact of the cyclothmia.

You're right about taking the meds. The psychiatrist reluctantly let me come off the antidepressants as long as I took the mood stabilisers and I am going to get a repeat prescription for them tomorrow to prevent a winter depression setting in. I've been discharged from psychotherapy but am still under the care of the psychiatrist. I don't see her so much now, but see a nurse when I go for my appointments. She has a lot more time and has answered a lot of my questions.

Thanks for your help, and I'm glad that your cyclothmia is under control.

Hi hon

Sorry I am late in on this. I have a query of BPD as well as BP1 which is being discussed atm and I believe quite a lot of ppl with BP/cyclothymia have a PD as well. I dont have evidence for that, it is jsut anecdotal but it is something I have noticed.

Please feel free to post here or in bipolar, which is more active as much as you want and we will try to be supportive and help you out.

Hugs

Cracked

Hi Masq!
Welcome here!!! Wow, though I knew you had HPD, I was not aware of your dual diagnosis! I already thought you were a wonderfully, amazingly, strong person, I'm now more in awe of your dedication to your wellness. I'm not dual diagnosed with BPD, but in addition to Cyclo have always had the dx's of Generalized Anxiety Disorder (GAD) and Adjustment Disorder. While untreated for the Cyclo, the other dx's actually worsened the Cyclo. Since having been put on mood stabilizers in addition to the AD's, I now find that it was likely the other way around... the untreated Cyclo greatly enhanced and even likely triggered severe episodes of the others. I think, in my unprofessional opinion, that (well, at least for me) Cyclo is my primary affliction and the others are tertiary. Having the primary issue under control allows me to control the others and, like you, make me more able to separate that condition's symptoms from other things. One thing I was almost immediately able to differentiate between after medications was the difference between my Cyclo moods and my monthly hormonal mood swings. With the Cyclo moods under control I was able to more clearly identify when my hormone surge kicks in each month and work with my pdoc to tweak meds to try and bring the hormonal moods more under control.

I hope you find the Cyclo and BP forums a source of support. These forums are a bit more laid back than the one you're used to frequenting, so that may help

Many many hugs to you!!!
Kosh

Oh, PS- I noted you wrote that your moods seemed to be a bit tied to the seasons. Have you ever spoken to your pdoc about maybe looking into Seasonal Affective Disorder (SAD)? Or even Mood Disorder NOS. (The NOS isn't a general "don't know what to dx them with" kinda dx... it's actually used to broaden the spectrum of treatment meds/therapies for ppl who are exhibiting symptoms from more than one specific mood disorder).... just a thought.

Hugs,
K

Thanks Cracked and K. Yes, I have wondered about SAD and am looking on e bay for a light box. My friend has one and it has given her a whole new lease of life in the winter. I am back on my meds as I can't go through another winter feeling bad. I could feel the depression begining to kick in the other day when I developed a sinus and ear infection.

You should be able to hire a lightbox initially to see if it works for you before forking out for one. WOrth trying?

Hugs

Cracked

That's a good idea. It would prevent an expensive mistake if it doesn't work. I have a north facing window in the lounge and it gets really gloomy in there in the winter.

I have that too and I rented a light for a bit - cant remember where from tho - anyhow it worked but it was too much to buy one

Hugs

Cracked