Bipolar disorder: What clues you in to the difference between legitimate fear/paranoia and symptomatic or imagined attacks?

In my personal experience with bipolar disorder, I can’t readily tell the difference until afterwards. That’s the problem.

I can’t recognize the unreasonable, delusional fears from the legitimate ones. (Running from a bear is excepted, of course.)

I have a couple of very close friends whom I tell everything, and they help keep me on track. I rely heavily on my therapist, too. She will quickly decry anything too outlandish.

I take medicine for my bipolar disorder: one anti-psychotic, one anti-depressant, and one mood stabilizer. It all works to keep me on an even keel, more or less.

Anxiety can occur with the depressive phase of bipolar disorder but it is not the most frequent symptom. Paranoia is very rare. You may need a better assessment and diagnosis.

@Hawaii_Jake can you share which meds are working for you? I’m afraid of taking meds, which I know is ironic given my career field.

My therapist was helping a lot until she became too much of a “friend” and then I didn’t want to disappoint her by doing poorly so the helpful part of our relationship timed out.

She always asked if I was having paranoia episodes which I took to be a symptom of bipolar disorder, but @Dr_Lawrence, you could very well be correct in saying I need better assessment from an impartial professional.

What clues me in…?

I look at my present circumstances and ask myself two basic questions:

1. Are the people around me calm or at least capable of showing they can take care of themselves and have healthy boundaries? If yes, then I’m misinterpreting the people around me and I need to exercise self-calming techniques.

Sometimes, though, I over analyze things and rely on my intellect to justify my emotions which may or may not be completely accurate. I am learning to simply “check in” with the person nearest to me whom I think may be against me or whatever.

2. Am I taking proper care of myself? This includes a consistent sleep schedule, practicing moderation, meditating, seeing my therapist, taking my medication and reporting any side-effects or changes in my mood (I take numerous meds for psych and health reasons), eating properly, avoiding alcohol and triggering behaviors, etc.

If the answer is no, then I am not in the position to perceive my emotions as completely accurate. (Note: self-care is the hardest part for me, and I paid the consequences recently for not taking a particular medication several days in a row. Self-care needs to by my number one job in order to be gentle with myself and with others. If I neglect this, then I know I will undoubtedly have consequences. Sometimes, I think I’m smarter than the consequences (i.e. I can outsmart them if I do X, Y, or Z).

One would think that after 20+ years of knowing my diagnosis and its symptoms I would not risk consequences due to stubbornness or whatever. But, I’ve learned the hard way that age and experience means nothing if I do not continually practice self-care.

@Blueroses you stated that you don’t have any specific triggers. Have you tried keeping a log of incidents and preceding events? It might help to show a pattern of behaviors leading to unwanted incidents.

@Blueroses I would rather not say what medicine I’m taking presently, because I don’t want to prejudice you either for or against them. Everybody reacts differently to psychiatric medication, and I often suggest that patients work closely and honestly with their doctor.

That is sounding like paranoid schizophrenia to me, but I am not a medical professional. It makes sense to me that being bipolar can come with anxiety, and anxiety can get out of control leading to fear, including paranoia. But, since you wrote imagined attacks I wonder if there is actual hallucinations involved?

I definitely think changing meds or an additional med might be in order. Or, are you saying you are not taking any medications at this time? Have you been seen by a psychiatrist? Or, just a therapist/social worker/psychologist? I hate taking any medication also, but most people I know who are bipolar do benefit from medication, and I think you need another person to evaluate you anyway if you have only seen one person for what you are going through.

I have bipolar and I have anxiety issues but the anxiety issues only arise when I am under way too much stress. This is a backwards story I suppose.

The last time I had an anxiety attack was when my husband was in the hospital and I found out simultaneously that my dad was diagnosed with cancer. All of a sudden I had this strange feeling overwhelm me and I couldn’t breathe. I just remember things sort of coming to as a loved one was shouting at me “breathe dammit, breathe!” I guess we were all stressed out :/

Anyway, somewhere along the way, before the losses, I dove straight for psychotic depression ville. That was fun. Talk about added stressors. And yes anxiety does come with it. I didn’t help the situation much. And now I’m just working myself out of the depression part then after that I am clueless. I used to be smart as a whip. Now I don’t know who I am. I only know what I was. I’ve lost my passion and my pills take away my emotion.

I am zombie.

The other day in friendly conversation I told a stranger that my dog is a human garbage can.

There is no thinking, there is only doing. It’s the monster mash of thoughts now. :)

My mom has bi-polar and generally if she’s in a manic state, she calls me and we talk through it. I am not a fan of paranoia and am gentle with her, but I also am her ‘watch dog’ when it comes to mania, or paranoia or delusions of grandeur, etc… So I’d say talk to a close friend or family member who may be able to talk you down.

There are many support groups that can be of help, too. Peer counseling through National Alliance for the Mentally Ill. I highly recommend it for anyone with or without a support system.

I wanted to add, please be sure they check your thyroid. Your GP can do it if you are not going to see a psychiatrist. This is a common test and problem for people who are bipolar. Thyroid problems can cause/mimic mania and depression. People with both problems, if the thyroid is outside of normal limits it can exggerate bipolar symptoms. Thyroid blood test is mandatory in most psych hospitals for patients being put into inpatient.

Thank you so much for all of your helpful and kind responses.

I do have one close friend (the only person near me who I don’t feel like I have to put on a show for) who is great for giving me perspective but it seems unfair to put all reliance on one person.

@JLeslie I suspected thyroid also and had it checked. It’s borderline low and my GP won’t prescribe synthroid for me. He wanted to give me Ambien instead to manage my sleep patterns. I will NEVER take that drug! also time for a new GP, perhaps?

Also, my paranoia symptoms are not hallucinatory. They do fall more in line with panic disorder… a sudden feeling that everyone in the room is thinking poorly of me, a need to avoid looking at them, an urge to fly out the door before I break down in tears. Or getting to a landing on a stairwell and being suddenly afraid to keep going down. There be dragons down there!

I’m on a very low maintenance dose of fluoxetine which has worked quite well for 2 years but isn’t now. Also prn valium for anxiety but that’s practically worthless. I think it has such a short half-life that all it does is pause symptoms for 15 minutes which may or may not be enough time to evaluate a situation.

@Blueroses No hallucinations, got it.

Now, about your thyroid, does low mean your thyroid stimulating hormone (TSH) is low, or your thyroid borders on being hypo? It works inversely. The most basic thyroid test is TSH, and if the TSH is low it means you border on being hyper, and hyper is more likely to cause problems falling asleep and staying asleep, and anxiety and panic. Not that hypo does not have possible anxiety and panic also, anxiety and depression often go hand and hand, it’s all so complex. Howveer, usually they tend to be more lethargic and need more sleep. But, since you are bipolar there is a whole other set of stuff going on.

Anyway, if you have your labwork, the TSH range is usually around .5–5 more or less, and most GP’s will leave anything in that range alone, while endocrinologists will keep their thyroid patients below 4. There have been arguments in the medical community to change the upper part of the normal range down to 3.5. If you are anywhere near the edges of normal, they should check other thyroid indicatore like T3 and T4 free. Your doctor may have done it, I am not assuming he didn’t. But, I will say that GP’s and endocrinologists look at the numbers very differently.

Thank you @JLeslie
We actually have an opportunity this month to have free blood panels and evaluations for employees at my hospital, followed by counselling and referral to appropriate professionals. I’ll take advantage of that and consider what you said. You’ve given me some questions to ask.

@Bluerose Lean on friends it’s what they’re there for. You sound very rational to me!

@Blueroses I hope it helps. Just FYI, I don’t think it will be a magic bullet, but if there is a thyroid problem, it might help make things a little better if it is addressed and monitored.

Give us an update if you find out anything new. I hope you can get some of your out of control feelings back under control. Paranoia and anxiety suck.

Thanks @JLeslie
I have suspected a thyroid issue in addition to bipolar for a long time. Thing is, I have all symptoms of hypothyroidism except weight gain. I’m losing weight that I don’t really need to lose.

Are we all crazy in our own ways? WTF is normal?

@Blueroses hyperthyroidism has a lot of the same symptoms as hypo, not everyone has all symptoms. Both dry skin, both brittle hair, falling out hair, both goiter, both muscle pain, joint pain, dry sticky eyes. Hypo tends to have high blood pressure and low heart rate. Hyper low blood and racing or pounding hearts. The symptoms aren’t perfect though, because other conditions can affect some of the same body systems. I am extremely symptomatic when my numbers move outside of normal. Some people barely know they need a medication change.