Think You're Bipolar? You May Have PTSD Instead

PTSD and CPTSD patients are often misdiagnosed because we look so much like something else

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People with PTSD are often misdiagnosed because the symptoms are similar to other mental illnesses, but the root cause is different. 

Getting to the right diagnosis is central to healing. By way of analogy, I recently discovered that my downstairs ceiling is showing water damage. I could call in restoration folks to repaint the ceiling, but that would be a temporary cover-up. Unless I figure out where the water leak is coming from - in my case, a leaking toilet on the floor above, and solve the issue from the source, the problem will just keep coming back. 

Starting from about when I was a teenager, I suffered from severe anxiety and insomnia, so much so that I do not know how peace feels. I started therapy as soon as I could afford it, and I've been in treatment now for twenty years.

Over time, the doctors have diagnosed me with a range of DSM ailments - Generalized Anxiety Disorder (GAD), Obsession Compulsive Disorder, Clinical Depression, and Bipolar type II. 

Doctors that thought I had anxiety issues prescribed Selective Serotonin Reuptake Inhibitor (SSRI). The drug made me hyper and more extraverted than I already was, but the doctors kept having me try one type of SSRI and then another because this drug worked for a lot of people. I lost weight at a rapid rate because my brain was flooded with serotonin, and I slept even less because I was high all the time.

So I decided to try another psychiatrist, and he put me on Depakote. Depakote is a drug mainly to treat epilepsy, with an off-label use as a mood stabilizer, so it is often prescribed to bipolar patients to mitigate mood swings. This drug helped - my mood is more stable, and I could handle stress better. 

Since Depakote helped, by way of inference, the doctor thought I must be bipolar. Being an engineer by trade, I know his logic is faulty. He made the classic logic error of confusing necessary vs. sufficient condition - if I have bipolar, the drug will work, but just because the drug works on me, it does not mean that I have bipolar.

Unlike people with bipolar, I do not go through cycles of highs (mania) and lows (depression). My anxiety and depression are always triggered by stressful events and my lack of ability to handle them.

It was not until this year, with a new therapist that specializes in treating trauma that I believe I got the right diagnosis. She diagnosed me with chronic Complex Post Traumatic Stress Disorder (CPTSD) stemming from years of parental abuse.

The difference between CPTSD and post-traumatic stress disorder (PTSD) is that PTSD is an anxiety disorder that results from a single traumatic event, such as a natural disaster or a car accident. CPTSD, on the other hand, results from repeated trauma over months or years, typical of what prisoners of war and childhood abuse survivors went through.

Repeated trauma causes neurological, i.e., structural changes in the brain. For example, in people with PTSD, the amygdala, the alarm center of the brain, is overly developed and hypersensitive to real or perceived stress and makes it difficult for people with PTSD to relax. 

On the other hand, our ventromedial prefrontal cortex, the region of the brain responsible for regulating emotional responses such as fear, show a marked decrease in the volume and functional. 

The brain change explains why people with CPTSD have a lot of difficulties handling stress and regulating challenging emotions. It also explains why Cognitive Behavior Therapy (CBT), which relies heavily on the medial prefrontal cortex being able to use logic to calm the rest of the brain, doesn't work as well.

What makes sufferers of CPTSD look similar to bipolar patients is we are also not good at regulating emotions. Friends of mine comment that I seem to feel emotions more vividly than others, whether it’s when I am happy or when I am sad; the amplitude is just larger.

Similar to people with ADHD, people with PTSD and CPTSD often feel agitated, anxious, and unable to focus. With so many shared symptoms between us and other mental ailments, it is not surprising that doctors often misdiagnose us.

If you have experienced prolonged, repeated traumatic events, I urge you to read about CPTSD and see if the diagnosis fits. Specifically, I found Tim Fletcher's series on Complex Trauma tremendously helpful in diagnosing myself.

For me, getting the correct diagnosis is a huge relief. Finally, everything adds up. Now I can focus on practices that strengthen my ability to regulate emotions, such as journaling and meditation, and stop wasting energy on therapy that only works at the surface level. 

“Beauty is truth, truth beauty. That is all ye know on earth, and all ye need to know.” ― John Keats

Brain injuries are frustrating because it's not visible to the eyes. Until scientists invent a way for people to experience living in another person's brain, it is hard for people with a normative mind to related to us. 

As difficult as it is to live with CPTSD, what gives me hope is that unlike most handicaps, the brain can grow, change and heal itself. This is why I started this newsletter to share my healing process and what worked for me.

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