The diagnosis of the manifestations of bipolar disorder, which can be described according to the two-dimensional and three-dimensional coordinates illustrated in the previous article, however, has different connotations depending on the contexts and points of observation.
The prototypes of bipolar disorder
At the point where we had arrived, the orbit that takes place around the temperamental nucleus defines the “prototype” of bipolar disorder. Several have been defined, more numerous than the classic pictures 1 and 2, called I ½, II ½, III, III ½, IV, V.
The variants of the disorder 1 and 2
The distinction I-II (psychosis, not psychosis) holds again, but if you also consider the temperament you can get these further variants. So for example:
- depression on cyclothymic temperament = prototype II ½
- depression on hyperthymic temperament = prototype IV
- Prototypes III in reality do not coincide with entities different from the others, but only with forms “induced” by pro-manic substances or drugs (almost all antidepressants), which can be superimposed on the others as manifestations.
These irregular ellipsoids obtained inside the sphere are therefore prototypes of affective syndrome that continuously pose the phases , considering sequence, polarity, amplitude and quality. This both in the short term and as a course and residual symptoms over time.
The consequences of the polarization of mood on the bipolar patient
What is the effect of this “polarized” humoral path on the person’s biography, that is, on the history of his life, his relationships, his consolidated behavior patterns
This would be called personality, a word that can mean everything and nothing, but let’s say that it refers to a rigid tendency in perceiving reality, themselves, set up and manage relationships with others and their goals and follow psychological priorities that do not always coincide with effective methods of achieving their goals and therefore their satisfaction.
Bipolar personalities on paper are not indicated as such, historically a series of pictures have been described, usually referred to as “narcissistic”, “histrionic”, “borderline”, “antisocial”, “passive-aggressive”.
Diagnosis of bipolar syndrome and personality disorders
Research on the overlap of these diagnoses with those of bipolar syndromes basically indicates that the terms used for personalities correspond to variants of bipolar syndromes. Above all, it is the more continuous forms, with continuous or rapid cycles, which begin early in childhood and continue without free intervals and with an increasingly “chronically unstable” mood, which configure the so-called “personality disorders”. Not one in particular, but one of the group of so-called “dramatic” personality disorders (that is, with striking external behaviors and manifestations).
To say that a person with rapid or continuous bipolar disease has a personality disorder and in short, a synonym. It is not necessary that we are dealing with disorders with severe and psychotic phases, continuity and abrupt cyclicality are sufficient.
- Cyclothymic temperament superimposed on bipolar 2 disorder results in a borderline personality;
- cyclothymic temperament superimposed on bipolar 1 disorder results in “antisocial” behavior;
- histrionics and narcissism are more or less the “normality” of minor bipolar syndromes, perhaps the first as a female variant and the second male.
Change of personality and surrounding environment
These personalities can change in response to different environments or when the disorder goes through phases of quiescence. Let’s imagine having our irregular ellipsoid and then translating it out of the sphere, into the surrounding space, in a variable direction depending on the environment in which we want to insert it.
The environment is like a filter that will make certain parts of the disorder see better or worse, making a bipolar seem more narcissistic or more histrionic, or neither or antisocial.
While the course of the disorder remains that more or less throughout life, even with long intervals, the pathological personality can normalize in a given environment.
Precisely for this reason, the diagnosis of personality often constitutes a diagnostic “abuse”, because it is the most changeable one, less stable over time and therefore less suitable for indicating an entity with precise references of course, prognosis, specific clinical characteristics.
Diagnosis of three-dimensional bipolar disorder
The diagnoses of bipolar disorders are more precise, but limiting and the “richest” and most precise way to describe these syndromes is to consider the three spherical dimensions, thus leaving the fourth as the more volatile dimension.
Often the diagnostic paths, if bipolar syndromes are not considered, start in this way:
- start as depression
- then a “personality disorder” is added, which in many cases becomes “mixed” or “not otherwise specified / nas”.
These diagnoses correspond to a variety of situations, of varying severity, in which, paradoxically, the “personality” rather than the definition of the phases emerges from the clinical observation of a few days.
The personality, instead of being considered a provisional point of view, is considered as a “point of arrival”, which does not have to motivate further diagnostic definitions as it contains all the complexity. Unfortunately, however, it does not embody the simplicity of bipolar geometry.
