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Selah R, M.S. LPC
Selah R, M.S. LPC, Therapist
Category: Mental Health
Satisfied Customers: 582
Experience:  Licensed Professional Counselor; over 13+ yrs exp working with adults, teens, & families/couples.
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Hi there. I just took a Goldberg Bipolar Spectrum Screening

Resolved Question:

Hi there.

I just took a "Goldberg Bipolar Spectrum Screening Questionnaire" and I scored 39. This is significantly higher than the "25 or higher" which was stated, so I assume this is statistically significant. I'd like to know, however, how significant. Am I one sigma above the mean? or three sigma? How many people in the population would get a 39 or higher? I guess that's a tough question since "having had a major depressive episode" is a criterion to be conditioned upon before taking the test. Maybe this isn't known, also, since not everyone is open to participating in mental health.

Part of the reason I'm asking is that I'm worried about going to a professional. A psychiatrist in private practice has a monetary incentive to say that his/her patients have various things at least in borderline cases. I fear that incentive might impair their judgment. Please forgive me for making such a grave accusation against your entire profession. But since I'm not paying you very much ($25 barely counts), I trust you much more.

Also, I should note that I was medicated for being a sex addict from age 26 until the present, with some interruptions. I took Naltrexone for a while, and after a long gap did Propecia instead. While most people find that Propecia cures baldness with the unfortunate side effect of causing a reduced sex drive... for me, it has the reduction in sex drive as the major affect, and reducing my hair loss as a happy coincidence.

How much does having one condition already make it easier/harder to treat the bipolar disorder? I also am relatively sure that I have hypergraphia.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Selah R, M.S. LPC replied 3 years ago.

Selah R, M.S. LPC :

Thank you for trusting JustAnswer with your important question.

Selah R, M.S. LPC :

First of all, Bipolar Disorder is a difficult diagnosis to create a screening tool for, because the symptoms can overlap other disorders (such as Major Depression, Anxiety Disorder, Personality Disorder, Cyclothymic Disorder, etc.).

Selah R, M.S. LPC :

It really is best to get a diagnosis from a professional who is able to talk to you in-depth about your symptoms, your history, and your family's mental health history.

Selah R, M.S. LPC :

I can understand your hesitancy to see a psychiatrist. May I suggest seeing a therapist, counselor, or even a psychologist instead? They don't prescribe medications, so there is maybe less risk that they will falsely diagnose in order to maintain treatment?

Selah R, M.S. LPC :

The Goldberg Bipolar Screening instrument, and others like it, basically take the DSM criteria for Bipolar and turn it into questions. There is nothing magical about them, and they can be wrong. You can also have mood swings caused or made worse by other medical and hormonal conditions, which is another reason why it's recommended that a professional evaluate you.

Selah R, M.S. LPC :

That being said, Bipolar I is more accurately diagnosed than Bipolar II, which doesn't have the hallmark mania signs. Many with Bipolar II may be misdiagnosed as having Major Depressive Disorder, but fail to respond (or get worse) to typical antidepressants. This failure to respond in expected ways to treatment for depression may be what gets them to the correct diagnosis, and different medication options, seen with Bipolar II.

Selah R, M.S. LPC :

Having worked with people with Bipolar I and II for several years, and in the clinical literature, we see a very strong correlation between having a Bipolar disorder and having an addiction.

Selah R, M.S. LPC :

For some people the addiction is a way of trying to break out of the depression, and for others it is activity made worse by their mania symptoms. Some have multiple addictions, and vary their addiction of choice based on which mood state they are feeling the most symptoms for.

Selah R, M.S. LPC :

For example, using uppers like Meth when depressed and downers like Marijuana or alcohol when manic. We also see non-substance addictions like gambling, shopping, sexual, pornography, and self-injury addictions.

Selah R, M.S. LPC :

Having an untreated or unmanaged addiction can make it harder to treat Bipolar, and vice versa.

Selah R, M.S. LPC :

This is especially true when the client is mixing psychiatric medications with other drugs or alcohol, because it can change how effective the medications are.

Selah R, M.S. LPC :

If you feel like your addiction is well managed with the medication, but that you are still having mood swings that are decreasing your functioning (work, social relationships, school, family life, etc) or making it harder to keep your recovery going, then it's time to see someone for a diagnosis.

Selah R, M.S. LPC :

Cognitive behavioral therapy (called CBT) has been shown to be an effective form of talk therapy for Bipolar, or people who may be showing some of the symptoms of Bipolarism without meeting the full diagnosis. It may be useful to pursue if you do not want to seek medication for your mood issues.

Selah R, M.S. LPC :

Many in the field believe that long term use of mood stabilizers is the best way to try to have control over Bipolar, and to try to prevent episodes from increasing in severity and frequency. This is especially true when the depressive episodes are long lasting and cause significant impairment in life.

Selah R, M.S. LPC :

Many clients do not like the side effects of these medications, so some refuse medications or only take them when "things are bad."

Selah R, M.S. LPC :

Going off medication too fast after getting benefit can lead to a relapse, so most mental health professionals recommend that you stay on a mood altering medication for 3-6 months before discontinuing it, to try to prevent that rebound of symptoms.

Selah R, M.S. LPC :

The key aspect in diagnosing Bipolar I or II, from other disorders, is the presence of a manic or hypomanic episode.

Selah R, M.S. LPC :

This website offers and overview of both the depressive and manic symptoms needed for the diagnosis:

Selah R, M.S. LPC :

http://psychcentral.com/lib/2009/bipolar-disorder-fact-sheet/

Selah R, M.S. LPC :

Also follow the links in the side bar for more information, especially take note of the fact that symptoms have to last a certain amount of continuous time for them to count as a depressive, manic, or hypomanic episode. This is a key component of proper diagnosis. We all have mood swings, we all have days that go from good to bad. The key difference is in Bipolar people are stuck in these moods for days or weeks, and that the good or bad mood causes impairment in their lives (lost jobs, ruined relationships, school problems, legal issues, self harm/suicidal thoughts, etc.).

Selah R, M.S. LPC :

If your symptoms are mild, and not causing impairment in major areas of your life, you may not meet the diagnosis. But it's still something to keep an eye on because Bipolar can begin to cause impairment at any time. Most frequently people are diagnosed in their late teens and 20's, but some are diagnosed later as life stressors (kids, marriage, career loss, etc.) can cause their disorder to really surface.

Customer :

After reading your very detailed and informative reply, I find most interesting the line "later as life stressors (kids, marriage, career loss, etc.) can cause their disorder to really surface". My mood has never impaired my work performance, so far as I can tell, except in two seasons of my life. First was a two year period, one year before and after my PhD was completed, and the other is right now, where a job is coming to an end and I am not sure where I'll be in the Fall. Both events have been very stressful.

Customer :

I think the conclusion I am tempted to draw is that (1) if I find a nice stable job for the Fall, I might not need to take medicines or seek therapy, but (2) if I do not find a nice stable job for the Fall, I think that my moods did not only impair my productivity this past year but they also made the job search far, far far harder. I felt as though I was operating at one-fourth normal speed while doing tasks related to the job search, e.g. reading ads, than when doing a similar activity not related to the job search. Does this sound reasonable? If I seek therapy, how do I find the right person?

Customer :

Thanks!

Selah R, M.S. LPC :

Yes, if the impairment level grows to the point that you feel it is becoming a barrier to reaching your goals instead of just an annoyance or beyond normal levels of stress, then it's time to seek help before things deteriorate further. I would start with a talk-therapy counselor type person, who has experience working with mood disorders, and let them help you decide if and when medications may be needed based on how severe your symptoms are. They can work with you on non-medication-based coping skills for the mood symptoms, and stress management tools as well.

Selah R, M.S. LPC :

PsychologyToday.com has a "Therapist Directory" that you can search for therapists/counselors in your area. You can specify certain insurance companies, fee ranges, and even specialties. I would recommend looking for people who have identified Mood Disorders as one of their specialties. Then read their bios and make phone calls to the ones that interest you. Feel free to ask them if they have experience working with mood disorders, possibly Bipolar, with little or no medication involvement.

Selah R, M.S. LPC :

http://therapists.psychologytoday.com/rms/prof_search.php

Selah R, M.S. LPC :

Then make an appointment to meet someone. You will probably know in the first session or two if the counselor is a "right fit" for you, or if you need to move on and meet with a different counselor. You need to work with someone who you believe understands you, and whom you feel you can trust to be honest about anything going on in your life. You also need to feel like the counselor is a right style fit for you based on how they do therapy (some clients want therapists to mostly listen, others want to work on workbooks and have homework each session, and some want therapists who use a lot of therapy tools like EMDR, Hypnosis, Biofeedback, etc.).

Customer :

A truly superb, helpful, and useful dialog. Thank you very much.

Selah R, M.S. LPC, Therapist
Category: Mental Health
Satisfied Customers: 582
Experience: Licensed Professional Counselor; over 13+ yrs exp working with adults, teens, & families/couples.
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Selah R, M.S. LPC
Selah R, M.S. LPC
Licensed Professional Counselor
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Licensed Professional Counselor; over 13+ yrs exp working with adults, teens, & families/couples.