Personality and Mood Disorders: Clinical Description

CAVEAT: Mental illnesses do not fit into neat and tidy categories. Instead, there is a spectrum of behaviors. The borders between various types of mental illness are "fuzzy." For example, 20% of people with bipolar disorder also suffer from borderline personality disorder (BPD) and vice versa. And bipolar disorder can be either "classic" or "atypical," which is actually more prevalent than the former. That's why mental illnesses are often difficult to diagnose and treat. Genetics (bad genes) account for many occurences of these illness; they tend to run in families. Mood and personality disorders are serious conditions that can lead to risky behavior and even suicidal tendencies. One of our children who inherited the bad genes in our family bloodline eventually became a suicide. Pregnancy and postpartum are high-risk times for relapse for those with a mental illness.

Consequences of Mental Illness : Common complications of personality and mood disorders are strained relationships, impaired social functioning, and difficulty communicating with other people. Not surprisingly, the divorce rate for people with these disorders is high (90%). Mental illnesses also open doors for demonic influence. Christians shouldn't be surprised by this (Ephesians 6). Unclean spirits will exploit any weakness they can find in a person, including fatigue, alcohol, drugs, stress, and mental illness.

• Mood disorders affect moods. They have been likened to storms that periodically move into a persons life and then dissipate (mood swings).
  Bipolar disorder affects an estimated 2.8% of the US population. The median age for the onset of bipolar disorder is approximately 20 years of age. Consequently, neuroscientists speculate that bipolar disorder may be associated with failure to properly complete the major brain reorganization that normally occurs during the late-teenage years. Someone with bipolar disorder (a.k.a. manic depressive disorder) has extreme mood swings ranging from depression to mania. These mood swings may come on suddenly or randomly without an apparent trigger. Theses mood swings are associated with swings in brain neurotransmitters (serotonin, norepinephrine, dopamine, etc.). Consequently, medication that stabilizes the chemical balance in the brain is often helpful. Bipolar disorder is associated with a number of other issues: irregular sleep patterns, migraines, diabetes, brain atrophy, and shortened life span.


• Personality disorders affect personality. They have been likened to fundamental flaws in a person's internal wiring.
  Borderline personality disorder (BPD) affects an estimated 1.5% of the US population. BPD is characterized by long-term dysfunctional patterns of thoughts, feelings, and behaviors that cause persistent distress and problems - particularly in self-image and relationships. Early childhood traua or abuse is a common cause of this faulty "wiring." Personality disorders respond to therapy (intentional "rewiring" of the brain) but less so to medication.

Since mood and personality disorders (usually) do not significantly impair cognitive thinking, people with mood and personality disorders often "present" well in the workplace and other public situations. Their personnae (the part of their character that they present in public) often gives little indication that they suffer from a mental illness. Therefore, their illness tends to be a "family secret," known only to those who actually live with the mentally ill person.

SYMPTOMS OF PERSONALITY AND MOOD DISORDERS:

ANOSOGNOSIA: A frustrating part of having a mentally ill family member or loved one is their unawareness of their condition and their stubborn refusal to get professional help. But this often goes a lot deeper than denial. Denial is a psychological coping mechanism to avoid dealing with something that we find stressful or unpleasant. But anosognosia is a neurological condition in which a person is completely unaware of their illness. Anosognosia can be caused by mental illness, dementia, or physical injuries to the brain. Experts estimate that anosognosia affects between 50% and 98% of people with schizophrenia, about 40% of people with bipolar disorder, and more than 80% of people with Alzheimer's disease.

Anosognosia has been localized to a specific area of the brain - the ventrolateral frontal cortex (VLFC). This area is responsible for self-reflection, our conscience, and wise decision making. Brain imaging studies show that the VLFC is impaired in patients with bipolar disorder and dementia. In plain language, this is a huge handicap when it comes to being a decent human being! Anosognosia has the following adverse consequences:

1. Incorrect Self-Image
   Self-reflection tells us who we really are, which is essential for a well-balanced life. But people with anosognosia have difficulty understanding the truth about themselves. In addition, who we are is a "moving target" as we change with age and experience. A healthy person continually modifies and updates their concept of self. But people with anosognosia have difficulty updating their concept of self. So when they develop a mental illness who they think they are vs. who they really are are two different things. And everyone can see it but them!


2. Impaired Conscience
   To various degrees, people with bipolar disorder are sociopaths. A sociopath is a person who has little or no conscience, lacks empathy, and is self-centered. A properly functioning conscience is what enables a person to distinguish between right and wrong. It also restrains a person from impulsively acting upon their "raw" urges and desires. It makes us feel guilty when we do something bad and good when we do something kind. But mental illness impairs the VLCF. The bottom line is that people with bipolar disorder are bothered less than the rest of us when they think, say, or do wrong things. If your conscience bothers you at times, praise God and be thankful that it still works!


3. Refusal to Accept Therapy and/or Medical Help
   Because they cannot see the truth that they are mentally ill, people with anosognosia stubbornly refuse therapy and medical treatment - no matter how clear their need is to others. Of those who begin treatment or therapy, most do not stick with it. People with a mental illness continually remind me of Prov. 26:26, "He who trusts in himself is a fool." They are also a continual reminder that I need to remain open to correction from other people.


4. Victim Mentality
   We all have difficulty seeing our own faults. But people with a anosognosia have extreme difficulty in this regard. It's not that they are in denial of their faults; it's that they are totally unaware of them. Consequently, whenever a problem occurs they automatically view themselves as the victim and blame others for the problem - even when it's a stretch to do so.

SUICIDE:
Mental illness is a life-threatening condition! Approximately half of the people with bipolar disorder attempt suicide one or more times during the course of their life. Approximately 20% die from suicide. Our bipolar daughter Luanna died from suicide after she went off her meds.

LACK OF TRUE EMPATHY:
People with bipolar disorder have difficulty relating to the emotions of other people - except in a “cold” intellectual manner called "cognitive empathy" that is devoid of true emotional feeling. For example, after our daughter Luanna died I cried for months every time something triggered a memory of her. If it happened while I was driving I would have to pull over to the side of the road until the hot tears subsided. But I never saw my spouse cry. Not even once! Brain imaging reveals that when a normal person is having a lively conversation the emotional centers of their brain light up. But they remain dark in the brains of people with bipolar disorder. How dreary it must be to live like that! If you lose the ability to empathize with others, it's like replacing a world of vibrant colors by drab shades of gray.

RAGE! Normal people have a healthy balance between those parts of the brain that generate anger (amygdala) vs. those parts that regulate it (ventral prefrontal cortex). With regular anger there is usually a trigger. But with mental illness anger can flare up over inconsequential things or sometimes with no apparent reason or trigger at all. At its worst, this anger can explode into full-blown rage with uncontrolled verbal and/or physical abuse. It is a waking nightmare for the person in it's grips and for everyone in its path. It is uncontrollable, unstable, and dangerous. Like a drunk, a person with a mental illness usually does not remember much about what they said or did during a rage.

SELF-ABSORPTION: Personality and mood disorders are often accompanied by excessive and unhealthy self-absorption. I see it every month at NAMI meetings.

SPLITTING (DICHOTOMOUS BLACK & WHITE THINKING): Splitting is a dysfunctional defense mechanism in which a mentally ill person goes between extremes of:

• Idealization (in which a person attributes exaggeratedly positive qualities to someone or something)
• Devaluation (in which a person attributes exaggeratedly negative qualities to someone or something)

It is particularly noticeable in BPD (Borderline Personality Disorder). Splitting creates instability in relationships because the same person is alternately viewed as either personified virtue (Idealization) or personified vice (Devaluation) at different times. It all depends on whether they gratify the mentally ill person's needs or frustrate them. This oscillation between extremes without any middle ground, along with similar oscillations between extremes in their self-image, causes a mentally ill person to suffer from chaotic and unstable relationships, identity diffusion*, and mood swings.

          *Identity Diffusion is a psychological state of mind where a person doesn't really know who they are.

PROGNOSIS: Currently there is no cure for mood and personality disorders. But they can be managed with a combination of medication, therapy, and living a healthy life style. People who take control over their disorder can still live productive lives with fulfilling relationships. But if left untreated their condition usually becomes progressively worse.