Bipolar Disorder Symptoms – Beyond the DSM

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

Matthew, age 26, was recently 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 getting his hands on 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.

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 has no schema for the seriousness of the consequences of his behavior. Matthew’s father, supported by his wife, is determined to let the criminal justice system run its course with Matthew unless he complies 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 aggravated by the character issues displayed by the likes of Matthew, these types of patients 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 you excel at being a supportive-type clinician, nurture that strength and keep performing it to the best of your ability. That is, keep building on what you’re good at instead of laboring to shore up where you consider yourself deficient. This way you’ll carve out a path of success (not perfection) for yourself – a strategy that is much more satisfying than continually trying to fit a round peg into a square hole.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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