How To Rule Out Bipolar Disorder?

Question: Hello Dr. Sheppe, hopefully I am messaging at the correct location. I believe I have been suffering from BPD since around 19 or 20. I was first diagnosed last year. I was first diagnosed with Bipolar Disorder this year. I have dealt with anxiety and periods of depression since 15 or 16.

I am glad to be working with you as well!

There are so many issues I would like to work on, I don't know where to start. I guess I just feel so empty right now. I've been trying to do some self-help because I know something is wrong and I can't see a psychiatrist in person right now. Right now I'm depressed. What usually happens after depression is that I have a period where I feel okay. Then at some point I start to overspend, make impulse decisions, and I end up making a huge mess of my life that ultimately leads back to depression and the cycle repeats. I am tired of the cycle repeating.

I also have issues with friends. Sometimes I like people, other times I hate everyone and I just want to be left alone. I have pushed a lot of people away.

I was diagnosed with BPD after I had a breakdown that lead to me being hospitalized. At that time I was exhibiting every single BPD symptom. For the most part I still am.

My current mood is alright. I feel on the verge of mania, but I don't currently have access to medication, so I'm trying to keep calm. I've been off medication for about a year.

My biggest issue of all is that I don't know who I am, or what I want to do. One day I want to be a lawyer, the next a teacher, then a doctor, then an artist, etc. It changes almost daily.

Thanks to my impulses and spending I have lost three homes, a car, my driver's license, gone to five different colleges in three years (no degree from any), ruined my credit, covered both my arms in tattoos, and almost ruined my marriage. I want to change so bad. I NEED to change.

Some of my past delusions have been believing that I had the key to winning the lottery. I even went house shopping daily. Another delusion was quitting school because I was going to be a rock star. I got two full tattoo sleeves, and bought guitars that I didn't know how to play. A lot of my delusions involve me spending all of my money, because I'm going to get some more. I don't know where the heck I think I'm getting more from, but I truly believe in that moment that I can just get more money.

The reason I stopped medication in the first place is because my parents made me feel ashamed to be on medication. They don't believe in mental illness, so I was ashamed when they found out, so I stopped the medicine. Another reason I stopped, is because my husband told me that I wasn't myself. He said I seemed empty. I didn't feel the same. While on medication I was able to get a job and be productive for the first time in my life. A couple of months after I quit the medicine, mania hit, and on impulse I quit my job. By that time I no longer had insurance, so I don't even have a doctor that I could talk to about a prescription. I am now on state insurance, and waiting on a three month long wait list. Since being on this waitlist I have almost lost another home. My husband had to take my credit cards. I thought about going to the ER and telling them that I felt like I was approaching a manic phase, but I'm not sure they could help me.

My parents influence my life heavily. I just want to make them happy, but I feel like I just keep disappointing them. The harder I try, the more I think I fail...

So you do believe that I have both Bipolar Disorder and BPD? Do you know which type of Bipolar Disorder? When I was diagnosed before, no explanation was given I'm still so confused about that diagnosis.I thought this might help:

When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
I started to know that something was off when I was about 18 or 19. I had become very reckless. I dropped out of college to form a band, even though I had never played an instrument in my life. I would get tattoos whenever I wanted to. I would spend money as soon as I got it. I started experimenting with drugs because I felt so numb, and I just wanted to feel something. This was all extremely uncharacteristic because I have always been the type of person to follow the rules. Afraid to do anything that anyone would disapprove of. I used to be a devout Catholic, but it was also around this time that I gave up on religion.

How frequently do your moods change?
I deal with a various amount of emotional changes daily, but for the most part, the cycle goes like this: I start off doing pretty good. I tell myself that I'm going to enroll in school and get a job. I'm going to study hard, and I'm going to be productive. A few months later I find something else that I'd rather do, so I drop out of school to be an interior decorator, or wedding planner, or whatever it is at that moment. I even post job ads to plan events. Then I start to spend money like crazy on stupid things, until there is none left. Then comes depression. I tell myself that I'm a failure, and that I've ruined my life, and that I will never amount to anything. A few months or so later I'm feeling good again and the cycle repeats.

Do you ever have suicidal thoughts when you're feeling down?
Yes, but I never make plans to do anything for real.

Do your symptoms interfere with your daily life or relationships?
Yes, my mania has caused me to lose three homes, ruin my credit, lose my driver's license, steal from family as well as strangers, quit jobs, drop out of multiple schools, and it has severely strained my relationship with family.

Do you have any blood relatives with bipolar disorder or depression?
Not anything that anyone has ever been diagnosed with. I do believe that my dad suffers from depression occasionally.

What other mental or physical health conditions do you have?
I have been diagnosed with Borderline Personality Disorder.

Do you drink alcohol, smoke cigarettes or use street drugs?
Not anymore.

How much do you sleep at night? Does it change over time?
Currently I'm getting about five hours. There are times when I only need two, and times when I need nine.

Do you go through periods when you take risks that you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?
Absolutely. When I'm no longer manic I become so embarrassed by my actions that I have had to end friendships because of it.

What, if anything, seems to improve your symptoms?
Medication has helped me to improve.

What, if anything, appears to worsen your symptoms?
I suppose stress.

What are your symptoms? When did you first notice them?
One of my symptoms is anxiety. I am always nervous and worrying. My thoughts are a mess. I am very anxious about my life and where it's heading. I have no idea what I want to do, and I frequently change my mind when it comes to careers. I try to choose based on my likes and dislikes, but I can't think of any likes or dislikes that I actually have. I also have a fear of death and often induce panic attacks when I think about it. I hate going to sleep at night because of this fear, so I perform a ritual every night to calm myself.

I also get depressed quite often. I sit around and see how little I have accomplished and it discourages me. I often have no motivation to get up and shower. I spend most of my days laying around in bed. I have no motivation to find a job, or do anything really. I want to do things, but actually doing things very rarely happens. I don't know who I am or what I want and that creates more sadness.

I also lie frequently. I lie to my husband about bills being paid. We will have enough to pay them, but I will spend the money on something else instead. Then when we get a late payment notice I convince him that they are mistaken and that I will take care of it. I usually don't take care of it, I just buy myself more time until I can fix the situation. I have also lied in the past about having a job. I didn't want my parents to know that I didn't have one. I have even convinced my husband that I had an online job when I really didn't. I would always make up some excuse as to why I hadn't been paid yet, ultimately ending in me "quitting." I lie to my parents a lot. I make up things that I'm doing so that they don't know how much of a failure I really am. I tell them things are fine when they really aren't. I have also stolen money from them in the past to buy expensive things. I like to buy expensive things for my husband. It started when we were dating. I just like to make him happy. He doesn't know that I was stealing. Most of the times I will know we can't afford something, but I will tell him we are fine financially so that he can buy what he wants.

The most disturbing symptom is feeling empty. I don't even know how to fully explain it, but I feel like I'm simply existing. Not living, just existing. I'm just here because I was born. I have no purpose, no aspirations, no motivation, just existing.

I have experienced most of these symptoms since 17 or 18.

How are these symptoms affecting your life, including your personal relationships and work?
As far as work I have only had one job. I loved it at first, but about a month in I became bored. I was able to switch departments, and I though that would help, but I soon became bored with that as well. I convinced myself I should just quit even though I really couldn't afford to. Working there had become unbearable in my mind. I just went in one day and decided to quit. Didn't really give it much thought until about a month later when I was on the verge of becoming homeless. I haven't really looked for a job since then because I feel the result would be the same.

When it comes to personal relationships I don't really have any, and sometimes I like it that way. No one to judge me or tell me what to do. I'm in control. But then there are days where I long for a girlfriend or two to go shopping, or get our nails done. It would be nice to share secrets with someone, but I don't trust people to keep secrets. I don't have any good experiences regarding keeping secrets. In the past when I have had friends I grew bored of them and would try to push them away. I became annoyed by everything they did and wanted to replace them with someone else. The cycle would repeat itself.

I feel like the way I am currently will effect my children, and that's the main reason I want help now. I don't want them to be a confused adult like I am.

My relationship with my husband is alright. I can be mean to him at times. I also hate being away from him. He went on a business trip for four days and I felt like I was dying. I literally did nothing but count the days until he would be back. The same thing last month when he went on a business trip for a day. I constantly sent him text messages asking what was going on. When he didn't respond I would freak out and send him even more messages, some accusing him of ignoring me.

When it comes to my parents they only know what I want them to know, so they don't really know me at all.

How often during the course of a normal day do you experience a mood swing?
Almost constantly. My thoughts dictate my day. I can be content one minute and irritable the next. I frequently become anxious in the evenings, and when I am content it is usually during the middle of the day. It is rare that I am truly happy, and when I am it is often short lived.

How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
Daily. I will go out of my way for people and they will not do the same. Doing things for others is the one time I am motivated, and it always backfires. I feel unappreciated and ignored on a daily basis. I suppose it happens because I allow it to.

How well do you manage anger?
I am incapable of being angry with anyone other than my husband. I am afraid to show anger to others. I fear they will disappear if I do, or cut me off. With my husband I can be quite nasty with the things I say and do when I'm angry. In the past I have even physically attacked him.

How well do you manage being alone?
Sometimes I just want to be alone and control myself instead of letting myself be controlled by others. If I am alone for too long though it becomes a problem.

How would you describe your sense of self-worth?
I don't think much of myself. I think I look weird, that I'm not smart, that I am a failure, and that I will never amount to anything. I somewhat despise myself.

Have you ever felt you were bad, or even evil?
I have a tendency to be cold, so there was a time when I thought I was a sociopath. Then I realized I was far too sensitive to be a sociopath.

Have you had any problems with self-destructive or risky behavior?
I spend far more than I should. I spend money I don't have, and will do anything to get the money to spend. I also am a binge eater. I have been for some time. I am very impulsive, and have two arms full of tattoos to prove it. I have 16 tattoos and I now hate each and every one. Yet I still want more.

Have you ever thought of or tried to harm yourself or attempted suicide?
I have a history of cutting that I recently resumed. I have thought about suicide, but never seriously.

Do you use alcohol or recreational drugs or abuse prescription drugs? How often?
I went through a phase of using drugs because I wanted to feel something. I'm just so hollow. I became pregnant, so I stopped. I wanted to resume after pregnancy, but I no longer had a connection by then, so I just gave up.

How would you describe your childhood, including your relationship with your parents or caregivers?
My mother was extremely emotionally and verbally abusive. She would make me feel lower than dirt with only a few words. My dad would just sit there and let it happen. I remember hating him for that. He is a functioning alcoholic. I always wanted to please my parents, but I feel like I never did, and never will. My mom was also physically abusive, but it wasn't a daily thing. Maybe once or twice a month. Her tongue was her greatest weapon.

My grandmother babysat me a lot. I loved it at her house. She loved me just the way I was. She never made fun of me or judged me. She tried to teach me to hold my head up high no matter what. I guess I wasn't able to do that. My paternal grandmother always called me lazy. To this day I dislike her for that.

I loved school up until 7th grade when I transferred. I was teased daily. For the first time I would start pretending to be sick so that I didn't have to go. I was an outcast because I "acted white." I felt so ugly because no boys liked me. I felt lower than low. I didn't know how to do cool things with my hair so I was made fun of tremendously for that. I was a loser and everybody reminded me of it. I never told my parents. I was too ashamed. It wasn't much different with my cousins. They made fun of me as well. I felt like I just couldn't ever win. I still feel like that. An eternal loser.

Were you physically or sexually abused or were you neglected as a child?
My mother would punch, kick, and slap us. My dad would spank us.

I was molested by an older cousin but I do not like to talk about that. I have never told anyone, and I am only writing it now because I want to be completely honest.

Have any of your close relatives or caregivers been diagnosed with a mental health problem, such as a personality disorder?
My grandmother had dementia. Not sure if that counts.

Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
Yes. I was on Welbutrin for anxiety and depression, but it made me act odd. I had a lot of energy and couldn't sit still. Xanax did the same. When I went to the mental hospital I was given Celexa for depression, Loxitane for my moods, and Ativan for anxiety. I did fantastic while in the hospital, but once I left and ran out of medicine I resumed my old ways.

Are you currently being treated for any other medical conditions?
No. I am relatively healthy. Slight high blood pressure, but I'm not being medicated for it. Just trying to control it with diet and exercise.

Thank you for taking the time to read all of that.

Thank you for your response. So my next step should be getting medication. I was previously on Lithium, but I did not stay on it very long. The medication combination I had the most success with in the past has been 40mg Citalopram, 10mg Loxitane, and 1mg Ativan as needed. Should I swap out the Loxitane for Lithium?

Once I resume medication, should I reach out to you to begin therapy?