Coping with Bipolar 2 Disorder
Bipolar 2 is a milder condition than the full bipolar disorder. It involves less severe moods of depression, and the more elated states are hypomanic rather than full mania. Medication is not usually required, although it can play a role in some cases.
Bipolar 2 is often comorbid with ADHD.
The key to managing and coping with bipolar 2 condition is to understand its nature and be aware of its pattern. Keeping a mood diary over a period of time can be helpful, because this can allow a clearer and more objective perception of the fluctuations of mood and their triggers. This is important because each mood state may be comprised of a constellation of emotional thoughts, views of self and the world and the future, such that when in one state of mood, it can be near impossible to access or retain a memory of the other state. Each mood state will feel like the truth. The sense of self and identity will be fragile and shifting.
Fluctuations in mood in bipolar 2 are often triggered by interpersonal events that may be experienced as rewarding or wounding. An early psychoanalytic description of people prone to what is now termed bipolar 2 was that they are ‘love addicts’, continually in need to ‘narcissistic supplies’ of attention, approval, admiration, and affection (Rado, 1928; Fenichel, 1938). When these are missing, or when the person feels overlooked or slighted, a mood of depression may ensue, often involving shame. These ‘narcissistic injuries’ may appear to others to be small or subtle, but in the mind of the sufferer they may loom large and represent immense humiliation – this reaction in itself being a further source of shame, precipitating an intensifying downward spiral of depression. There may be noisy, and sometimes aggressive, attempts to engage attention and approval from others so as to restore the fragile self-esteem. When these fail, the person may retreat into a prolonged mood of gloom. After a while, the ego may rebel against the gloom and embark on a hypomanic phase.
People with bipolar 2 tend to have emotional reactions that can be paradoxically both intense and shallow at the same time. Their moods can be labile.
Mood states distort the perception of events and circumstances and their meaning. In a state of depression, the person may feel gloomy about their current situation and perceive the future as bleak. When in a more elated state, the person may be unduly optimistic.
A key point for the person with bipolar 2 to bear in mind is that moods are not accurate or reliable indicators of truth. If you suffer with bipolar 2, your emotions and moods will distort your perception. You need to learn ways of stepping back from your emotions so that you can view your situation and future prospects more realistically.
People with bipolar 2 may work too hard – or in some instances socialise too hard. They are driven by a need for approval and love. The search for external ‘narcissistic supplies’ is really to compensate for deficits in the internal brain chemistry of reward. This lack of inner reward, mediated by brain biochemistry, gives rise to feeling unloved, even when the person is loved - the lack of well-being, caused by a deficit at the neurobiological level, is misattributed to an absence of external love (Mollon, 2015). Good diet, rest and sleep, and engagement in pleasurable activities are important in restoring the biochemistry of reward.
Energy psychology modalities, such as acupoint tapping, can be helpful is soothing narcissistic wounds and regulating affect. Acupoint tapping helps to loosen rigid cognitive structures, such as fixed negative core beliefs about the self. The origins of such beliefs can also be targeted with acupoint tapping.
When a person is in a depressed mood state, a crucial yet simple question to consider is what has triggered this. Having plunged deeply into the negative mood state, the person may actually have lost sight of its cause or trigger. By reconnecting with the wounding event, and the associated experience of shame, and ‘suffering’ these, instead of taking flight into depression (Mollon & Parry, 1984), a more authentic and organic healing process becomes possible. Blocked feelings of anger, and anger turned against the self, are often significant factors in states of depression. Acupoint tapping can help to release and process these.
Reference
Fenichel, Otto (1938). The Drive to Amass Wealth. Psychoanalytic Quarterly. 7: 69–95. doi:10.1080/21674086.1938.11925342.
Mollon, P. & Parry, G. (1984). The fragile self. Narcissistic disturbance and the protective function of depression. British Journal of Medical Psychology. 57. 137-145.
Mollon, P. (1986). Narcissistic vulnerability and the fragile self. A failure of mirroring. British Journal of Medical Psychology. 59. 317-324.
Mollon, P. (1993). The Fragile Self: The Structure of Narcissistic Disturbance.
Mollon, P. (2015). The Disintegrating Self: Psychotherapy with Adult ADHD and Autistic Spectrum. London. Karnac.
Rado, S. (1928). The problem of melancholia. International Journal of Psychoanalysis, 9. 420-438