Bipolar Disoder Has Me Confused

By Kristina Randle, Ph.D., LCSW

I recently wrote in and had my question about my best friend thinking I had schizophrenia answered. First, I’d like to thank Dr. Kristina Randle for her help. I told my therapist and my psychopharmacologist everything and they’ve done what they can to help. I was diagnosed with bipolar disorder, because my pharmacologist thought I was having paranoid delusions, delusions of grandeur, and auditory hallucinations. But those are typically seen in schizophrenia, right? I’m not the doctor, though. She prescribed me Abilify, an atypical anti-psychotic, which I tried for two weeks before seeing her again and telling her the long list of side-effects. Now I’m taking Risperdal, another atypical anti-psychotic, which doesn’t seem to have the same side-effects, though I’ve only taken one half-milligram pill so far.

My question is regarding my diagnosis. Is it possible to experience psychosis and still have just a bipolar diagnosis? My family has a a history of both schizophrenia and bipolar disorder, so I wasn’t sure if they were just guessing because of my father, my closest mentally ill relative, having bipolar disorder. Also, my therapist doesn’t seem to think I have bipolar disorder, which I like. He thinks I’m just rather eccentric. My dad thinks that maybe the drug companies are influencing my pharmacologist into prescribing me all these expensive new meds. Thank you

A. You’re welcome and thank you for your followup response. Unfortunately, the diagnosis of mental health disorders is not an exact science. It is not uncommon for individuals to receive multiple diagnoses over the course of treatment.

Your therapist thinks you are eccentric and that may be true to some extent but if you are having delusions or hallucinations then you’re dealing with more than eccentricity. The term eccentric means unusual or odd behavior. It does not include having delusions, hallucinations or breaks with reality. When an individual has a break with reality then the correct terminology for this experience would be psychosis.

Your specific question is related to technical differences between schizophrenia and bipolar disorder. According to the National Institute of Mental Health, an individual with bipolar disorder can have extreme episodes of mania or depression that mimic delusions or hallucinations. For instance, an individual having an extreme episode of mania may believe that he or she is famous or possesses magical powers. In this specific instance, the belief of being famous or possessing special powers is associated with the mania and therefore technically part of bipolar disorder. An individual exhibiting the same delusions of grandeur minus the mania may be exhibiting a symptom of schizophrenia. The key difference between a schizophrenia and bipolar disorder diagnosis in the above example is whether or not mania caused the delusions of grandeur. Also, a diagnosis of schizophrenia would include a number of different delusions all occurring at the same time. As you can see, identifying one’s specific diagnosis is not always a straightforward process.

What’s most important is symptom relief and working with a mental health professional whose focus is keeping you stable. You mentioned that you are in counseling and that is very good. Medication alone, even for psychotic disorders, is not an ideal treatment. Generally medication is required but it should be only a part of the treatment. There are many effective treatments for psychotic disorders including cognitive behavioral therapy, social skills training, relaxation training, family therapy, psychoeducation and cognitive enhancement therapy.

I hope this answers your followup question. Please do not hesitate to write again with any additional questions and or to let me know how you are doing. I look forward to hearing from you. I wish you well. Please take care.

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Last reviewed: By John M. Grohol, Psy.D. on 10 Oct 2010

APA Reference
Randle, K. (2010). Bipolar Disoder Has Me Confused. Psych Central. Retrieved on August 21, 2014, from http://psychcentral.com/ask-the-therapist/2010/10/10/bipolar-disoder-has-me-confused/

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