This is a special Q&A episode in which I pull questions directly from the private Hardcore Self Help Facebook group. If you aren’t yet a member, request access at http://facebook.com/groups/hardcoreselfhelp
I took four questions from the group that cover a wide variety of topics. I think you’ll really enjoy this one.
Today’s episode is a question and answer session with questions that I pulled from the private Hardcore Self Help Facebook group. If you aren’t a member yet, you should definitely consider requesting access. It’s a private group, meaning that your family and friends can’t see what you post there unless they are also a member. I do weekly challenges and frequent live streams. It’s also a place to ask questions and get feedback from other people who are also trying to improve their lives and mental health.
Before we get into the questions, I want to congratulate this week’s book winner. Astor Arensin wrote an awesome review of the F**k Anxiety audiobook. If you want to win free stuff, just write a review of any one of my products and send me an email or social media message with the proof and I’ll consider you for the next giveaway. Astor, I’ll be contacting you to send out a free print copy of either one of my books. Thank you!
Let’s get into the questions…
My counselor I’ve been seeing for 7+ years says I have a mood disorder but don’t qualify as bipolar according to the DSM. What the hell does that even mean?!
Mood disorders are a class of disorders in the DSM that mainly involve disturbance to one’s mood. This can be disorders that elevate or decrease one’s mood. In general terms, mood refers to how you are feeling – are you happy, are you sad? So a mood disorder can go in either direction, increasing or decreasing somebody’s mood. In the newest version of the DSM, mood disorders are broken into bipolar and related disorders and depressive disorders.
Bipolar disorders include bipolar I, bipolar II, cyclothymic disorder, and bipolar due to substances or other medical conditions, all of which result in states of mania and states of depression. Depressive disorders include things like major depressive disorder, persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, and disruptive mood dysregulation disorder (new childhood disorder). There are also some catch-all categories called Other Specified or Unspecified, which basically refer to disorders that share a lot of features of a given disorder, but don’t quite meet criteria for a specific disorder. This is sometimes called NOS (not otherwise specified).
Talk about it
If your counselor says that you have a mood disorder, but don’t qualify for bipolar, it may be that you have some symptoms of bipolar that significantly interfere with your life, but you don’t quite tick all the boxes to meet full criteria. If you are interested in diving deeper, you might ask your counselor to look into it together and see if you would meet criteria for something like cyclothymic disorder, which is basically when you almost constantly have bipolar and depressive symptoms that don’t quite meet full criteria for hypomania or major depressive episodes.
In practical terms, this doesn’t really mean to much for you. I think what your therapist is trying to get at is that you can approach the situation from the same frame of mind that you might when treating bipolar. If you agree or disagree with your therapist’s assessment, feel free to talk to them about it. That can sometimes lead to a deeper discussion about your situation and achieve a better understanding both for you and your counselor.
Likely what you guys will need to work on is establishing some consistencies and tools that you can use when you are feeling unregulated. Things like journaling, making consistent routines or rules that you try to stick to whether you’re feeling up or down, and noticing the signs of your changing mood will all be important.
So good question – only put as much stock into the diagnosis as you’d like to. It’s a shorthand way of conceptualizing the situation and giving your counselor and yourself some common ground to start from.
I’d love to know how to deal with those in your life who struggle with mental illness while you yourself do as well. How can you keep yourself safe while trying to help others? How to establish boundaries (especially when you’re codependent and have attachment/abandonment issues) or what to do when you’ve tried everything you can as a friend to help and to ask what I can do but I just get met with “nothing” and my support just kinda gets shrugged off.
I think one thing to remember is that it’s super common for people to respond with “I don’t know” or “nothing” when you ask what you can do for them. Most people really don’t know how to answer that. It takes a significant degree of self-awareness to know what you might need. There are some basic things that may be more clear, like if somebody needs space or support, if they want to talk or don’t want to talk, but when questions are very open-ended like “what can I do for you?” it’s very common for the other person to give little or no response to that. There’s nothing wrong with that and it doesn’t mean they don’t appreciate the offer or help, it’s just rarely we know the exact answer to how somebody can help us. So don’t feel shut down by that.
Offering support that isn’t followed up on is also very common. I have a blog post about the 4 cs of supporting someone with mental illness. The two most important are consistency and clarity. A person who is struggling may very well not be in a spot to internalize what you are saying and take it to heart. They still hear it though. Over time, repeating the same clear and consistent message may breakthrough when they need it to.
You don’t need to do it all
Another tip is to be careful about trying to support someone else in every way that they need. No one person is going to fulfill all of someone else’s needs, even in a romantic relationship. You don’t need to serve every purpose for them. Instead, you can find some specific ways of supporting. I like to think of it as being a team member. If you are on a sports team, you are going to play a specific role such as goalie or center. You might shift into other roles temporarily in the course of a game, but your main purpose is to fill a specific role for the overall team.
In the same way, you can be a team member for this person that you want to support. Maybe your primary role is calling them out when they start acting like an asshole. Maybe your role is to do fun stuff with them without making things serious so that they can take their mind off of the problems they are struggling with for a bit. Maybe you are simply an ear to listen to them vent. But you don’t need to do it all.
I also want to mention that sometimes change can’t come from you if you are too close to the person. I could never serve the same function as my wife’s therapist. That’s just not how it works. You are inside the bubble and sometimes you need someone outside the bubble to help influence change. It’s not your responsibility to change for them. Maybe you lead them toward resources or offer to help facilitate the process of them seeking help, but you can’t force them to change.
Check in with yourself
Regarding your own boundaries and health. I think the fact that you acknowledge your patterns of fearing abandonment and codependency are important. Take some time to think about this. Journal about it. Write down the things that you feel are unhealthy that you have encountered in other relationships. What makes you know that you have this codependent style or this fear of abandonment? What were some of the telltale signs that you were going down a problematic path in a relationship? Then these are the things that you can look out for. Just in the same way that I would encourage someone with anxiety to figure out what their first symptoms are so that they can recognize panic building and intervene before it becomes a major problem, I’d encourage you to determine your early “symptoms” of codependency or problematic attachment.
Again I’ll come back to the clarity piece. There is absolutely nothing wrong with letting the person in your life know that you have a deep desire to help them, but there are times when you go overboard and that if you notice some of those signs in yourself, you may be less available to them for a period of time. But no matter what happens, you care about them deeply and will always be there in the long game.
Check in with yourself each week. Whether this is through journaling, with a trusted advisor in your life, or in therapy. These tools can help you look at your reactions and your feelings to see if you might be losing yourself in this other person. By engaging with these other things that give you an outside perspective, that can help you recognize you’re losing yourself in this relationship and the need to pull back and have more appropriate boundaries.
There are often simple markers that indicate that you are not being kind to your own mental health. Are you feeling sad more often than happy? How much are your thoughts about this person influencing your emotions and your decisions? Are you continuing to eat well, exercise, do the normal things that you enjoy? Is supporting this person fitting into your life or is it consuming it? Look for these simple markers that highlight possible dysfunction and provide a sign that we need to intervene in some sort of way.
Backing off does not imply that you don’t care and it does not mean that you will not be available to be helpful to them again in the future. We are all human and have our ups and downs. The default needs to be you. The common advice that you can’t help others if you aren’t taking care of yourself holds some weight. I would say that you can certainly care for others really well when you are being terrible to yourself, BUT it’s not sustainable and you will pay for it in the end. OR the other person will pay for it since you are not able to be as supportive and helpful as you would be if you were taking better care of yourself.
Whenever possible, stating things clearly and explicitly is helpful. Whether just for yourself or with the person that you care about. Outline the simple rules that you want to make sure you abide by. When I notice that I am xyz, then I need to do the following things to care for myself before trying to step back in as a support. Here is how I can best communicate that to the other person. Here are my resources for getting my head on straight when I feel like things are getting out of hand.
The last thing I will say is that you don’t get to expect praise for your support. It’s nice to be appreciated and any praise or thanks that you get is awesome. But it may be that this person feels like they don’t deserve help and didn’t ask for it in the first place. Some people even feel like when someone asks them how they can support, it puts the pressure on the person suffering to think of something. Be mindful of the other person’s feelings and be careful about falling in the trap of trying to help to ease your internal sense of tension rather than actually give the person what they want or need.
Can you talk about emotional cheating?
Emotional cheating is a term that is basically interchangeable with emotional affair. It refers to infidelity in a relationship that is not physical. Rather, it is when someone in a relationship steps outside and has their emotional and romantic needs met by someone else, such as flirting. Now I need to back up here and say that this is not very easily defined because all relationships are different. There are certainly things that I could do with my friends within the bounds of my marriage that might be considered unfaithful or inappropriate to certain people with a much more strict set of boundaries and rules.
For any type of cheating, infidelity, etc. It comes down the a violation of what you might call the “monogamy agreement” or if you are in a committed non-monogamous relationship, you would adjust the term to fit that. But within any relationship, there are going to be expectations and boundaries. Often these are not discussed or outlined and that often becomes a problem. When one partner goes out to dinner with someone from work, they may think there is nothing wrong with that, but at the same time, the other partner feels betrayed. This is because the couple never discussed what sort of behaviors and interactions are appropriate within the bounds of their relationship.
Things to consider
So emotional affairs can be hard to pin down when these things have not been discussed. One aspect to look out for is secrecy. Does the person know that they are doing something that the other would not approve of, even if it hasn’t been explicitly stated and they hide the interactions from their partner for fear of getting in trouble. That could be a signal for indiscretion for some people.
The other thing to consider is the purpose of the interaction that you might be considering emotional cheating. Is the partner dissatisfied with an aspect of their relationship and going out to have that need met somewhere else or is this simply an extension of the person’s personality and they have always had this sort of interpersonal interaction and this is just how they are. The latter does not necessarily mean that their behavior is okay or appropriate, but it’s something to consider when you are operating in this realm of undefined boundaries within the relationship.
With the internet, there has definitely been an increase in concern about emotional cheating. Does liking someone else’s sexy Instagram pictures count? Does it make a difference if you know them or not? Does private messaging with someone without telling your partner count? The availability of interaction and the lack of direct contact needed really facilitates communication in general, which of course can go down the route of being sexual or romantic.
Again, this is something that required introspection and conversation. You need to think about what sort of behaviors are and are not okay in your opinion within a romantic relationship. And you need to talk to your partner about their expectations. In the end, some agreement needs to be made about this, which then you can hold one another too.
Relationship agreements can also always be renegotiated and discussed. For instance, there might be a married couple that is very exclusive and protective of their relationship in the early stages. After a number of years, they may want to loosen the boundaries a bit. Maybe it would be okay to go out to a semi-romantic dinner with a friend. Maybe flirting is okay in the presence of one another, but inappropriate when it’s hidden. It could be anything. People have their own preferences and relationships are not one single thing. Certainly, it can be hard to think of all possibilities up front, but when there is a situation that is concerning to you, address it. Talk about how it makes you feel and have the conversation about whether it fits into both of your relationship boundaries.
Communicate, communicate, communicate.
And if you can’t get to the place of being able to communicate openly about this within the relationship, schedule a session with a couples counselor to serve as a mediator and help you out.
How to recognize the difference between good mental health and hypomania?
Let’s first talk about what hypomania is. Hypomania is a period of persistently elevated, expansive, or irritable mood that lasts at least four consecutive days and is present most of the day. During the hypomania period, you will see inflated self-esteem or grandiosity, decreased need for sleep, more talkative or pressure to keep talking, racing thoughts, increase in goal-directed activity, distractibility, and poor judgement with regard to pleasurable activities. The thing that separates it from a full manic episode is that it’s not severe enough to cause serious impairment in social or occupational functioning or require hospitalization. It doesn’t rise to that level where it’s really interfering with your life, but is still something that is present.
Super productive or hypomanic?
I will say that sometimes it can be hard to tell the difference between when someone is just kicking ass and in the zone vs when they are hypomanic. At a certain level, it doesn’t always matter. Even though the criteria say that the hypomania is not severe enough to really impair you, it can still cause some problems. My wife has bipolar II and there were periods of time in the past where she was definitely hypomanic. Focused and driven absolutely, but that also meant that simple things like dishes, making necessary appointments, checking the bank account before purchases, and things like that were not getting done. So while it wasn’t a devastating state to be in, it could certainly cause some issues in the long run.
BUT at the same time, in my wife’s situation there were some benefits to her being in this state. She was able to build a website from scratch for herself that she subsequently sold. She helped me to get my brand up and running. What it comes down to is whether you are able to manage your essentials in life despite the disruptive force of hypomania. If you are able to establish good systems and routines that help you get the necessary everyday tasks done and you ensure that your physical health needs are met, you can ride the wave of hypomania and sometimes make good use of it.
Recognize the signs
You need to get to know your patterns. Even people with the same diagnosis will have different styles. You need to work toward gaining insight into what your personal signs of hypomania are. Often sleep is a telltale sign. If you are feeling like you are just running on a motor and you only need 2-3 hours of sleep, that may be a significant warning sign that you are in a hypomanic state and you need to be more careful. For others, it might be the fact that they are going out or spending money on Amazon purchases at a much more rapid rate, without much thought. Whatever it is, you will want to spend some time looking back on your previous episodes and see what those particular signs are for you.
When you are able to pull out those signs, you can use that information to set yourself up for success. I encourage people to develop protocols and checklists. Okay, I slept 3 hours last night and I’m waking up feeling like I want to run for the first time in months and also brainstorm and maybe call my ex for a booty call. That would be a sign to go whoa nelly! Alright, that is probably a sign that I’m sliding into hypomania. Let’s pull out the checklist and review it because my head is reeling right now.
Maybe on that checklist, you notice that you haven’t eaten a healthy meal yet, that you haven’t checked your calendar before making impulsive plans for the day, and there’s also a reminder that it’s never a good idea to call your ex for a booty call. So it’s like a checklist, almost like a flow chart, that gives you a protocol to work through.
Again, I think that a lot of successful people probably have bipolar II and just make good use of that elevated period when it comes around. The trick is making sure that it doesn’t get out of hand and making sure that you can make a smoothish transition back into your more neutral state without a lot of wreckage to clean up.
The other thing that separates hypomania from simply being productive, having good self-esteem etc., is that it is by definition an abnormal elevation for you. If any of you are familiar with the entrepreneur Gary Vaynerchuk, that guy is basically always in a state of hypomania. But that’s just how his personality is structured. He’s always on the go and always making these quick huge decisions about the projects that he’s working on. That wouldn’t be hypomania. Now if there was a week where his sleep was suddenly cut in half and he was making inappropriate decisions, that might be an indicator that there is something more going on.
Hopefully that helps to clear up the difference between hypomania, good mental health and whether it always matters so much. Thanks for the awesome question!
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