Bipolar Disorder Symptoms – Beyond The DSM

We know all the classic symptoms of manic-depressive illness and its unpredictable cycle of intense mood swings. Significant to bipolar though, and more often linked to the manic characteristics of the disorder, are ego issues, arrogance, an entitlement mentality, an inability to calculate consequences and a general lack of awareness. Here’s a case example to illustrate:

under_arrestMatthew, age 26, was referred to me via the criminal justice system. Matthew was able to successfully hack into his father’s IRA account and remove $500,000. Matthew’s father had set up simple, easy-to- remember passwords which Matthew easily deciphered. He was able to circumvent other fail-safes, thereby gaining access to the money with which he purchased yet-to-be-developed condo property in South America. Upon discovering this, Matthew’s father pressed charges. As a result, Matthew is doing a stint in the New Orleans parish prison system.

The referring judge asked me to evaluate Matthew and make recommendations to the court. As Matthew posed a flight risk, he was accompanied to my office by a court attendant. They arrived early; I hadn’t yet finished up with another client. While waiting, Matthew attempted to pass out his business card to other clients in the waiting room, and this was uncomfortable for these people — to say the least. As I ushered him into my office, he attempted to do the same with me.

Appearing distracted – with pressured speech, flight of ideas and full of grandiosity — our initial session began with him stating that this whole issue over his father’s money had been overblown. When I asked why, he said that as an only child, he was going to inherit the money anyway, and since his father is rich, it’s no big deal. Because he is in an acutely manic state, he is unable to fathom the gravity of the circumstances he’s facing and the seriousness of the potential consequences of his behavior. Matthew’s father, supported by his wife, is determined to let the criminal justice system run its course, particularly if Matthew doesn’t comply with treatment recommendations.

In Act 1, scene 3 of Shakespeare’s Hamlet, Polonius speaks these words to his son Laertes:

To thine own self be true. If you’re intolerant of unruly behavior and are easily ruffled by symptom displays like Matthew’s, this type of patient will wear you out. And there’s absolutely nothing wrong with admitting to yourself that you’re not personally equipped to best manage such treatment challenges. If, on the other hand, for example, you excel at being a supportive-type clinician, nurture that strength and keep building on it to the best of your ability. That is, keep honing what you’re good at instead of laboring to shore up the areas where you’re not as strong. This way you’ll carve out a path of success (not perfection) for yourself — a strategy that is much more satisfying over the course of a long career.


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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.