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The Relationship of Stress to the Expression and Treatment of Bipolar Disorder – Part II

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The Relationship of Stress to the Expression and Treatment of Bipolar Disorder  (Part II)

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

 

The Comorbidity of Bipolar Disorder and Stress disorders

 Comorbidity is common in BD, further complicating the diagnosis.  In one study, a comorbid disorder was found in all of the samples, and in 59% the condition preceded the onset of BD symptoms (Kessler, Rubinow, Holmes, Abelson, & Ahao, 1997).  Common among the comorbid disorders are anxiety, substance abuse, ADHD, Oppositional-Defiant Disorder, Bulimia, Social Phobia, Panic Disorder, and Obsessive Compulsive Disorder  (Correll, et al., 2007) and (Perugi, Ghaemi, & Akiskal, 2006), many of which are stress related.  Personality disorders also occur at a higher rate than the general public, which may actually be an expression of phenotypic expression of a bipolar diathesis (Correll, et al., 2007).  BD has the highest prevalence of any psychiatric disorder for alcohol and other substance use disorders, with a lifetime comorbidity estimated from 17 – 61% (Vizzarri, et al., 2007).  In one large study of 500 bipolar patients, a lifetime substance use disorders was found in the entire sample (Simon, et al., 2004).     In many cases, it is unclear whether these co-occurring disorders are truly biologically distinct, or simply risk markers, prodromal states, overlapping  characteristics, or subtypes (Correll, et al., 2007).

 Comorbidity of BD with anxiety disorders is particularly high.  In one large study of 500 BD patients, the lifetime comorbidity with anxiety disorder occurred in over half the sample (Simon, et al., 2004); approximately 11-63% had panic disorder, 8-47% social anxiety disorder, 3-35% obsessive compulsive disorder, 7-39% posttraumatic stress disorder and 7-32% generalized anxiety disorder.   Overall anxiety comorbidity was higher in Bipolar I disorder than Bipolar II disorder. The presence of anxiety predicted a lower age of onset (about 16 as opposed 20 years old) and a shorter time in the euthymic state.  Presence of anxiety disorder also was associated with impaired function, poorer quality of life, decreased likelihood of recovery, greater prevalence of substance abuse, and greater likelihood of suicide attempt.    In my experience, those in hypomanic states have a high reactivity to stress, often engaging in activities to relieve stress, such as compulsive shopping, sexual activity, or risk-taking.  Substances are often used to “self-medicate.”

When chronic stress in family, romantic, and peer relationships is present, there is less improvement in mood symptoms in adolescents.  “The association between chronic stress in peer relationships and mania symptoms is likely a recursive one in which the most impaired youths generate the highest levels of peer-related stress, which further exacerbates their mood symptomatology”  (Kim, Miklowitz, Biuckians, & Mullen, 2007, p. 37).  Possibly, this may create a pattern of dysfunctional reactivity to stress.

In one case example, Bob is an 18 year old male, who expressed BD at the age of 5 after a family stress.  Although he did not receive a diagnosis of BD until the age of 12, his symptoms where characteristic of juvenile BD.   He had symptoms of obsessive compulsive disorder, social anxiety disorder, separation anxiety, and generalized anxiety disorder.  His mind was often occupied with ruminative “bad” thoughts.  He developed many compensatory behaviors to relieve his stress including a shut-down depressive state, psychomotor agitation and tics.  Bob manifested psychotic symptoms and suicidal ideation during times of heightened stress.  School, for example, was a continual source of stress from teachers and peers, resulting in poor performance and exacerbation of bipolar switching.  This further resulted in a deterioration of peer relationships, recursively leading to a greater number of bipolar episodes.

Copyright (2011):  Julie Myers, PsyD:   All rights reserved.

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Written by Julie Myers, PsyD, MSCP

June 25, 2011 at 6:48 pm

Heart Rate Variability Biofeedback

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Heart Rate Variability Biofeedback

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

 

Biofeedback is a commonly used method to teach individuals voluntary control of physiological functions.   Specific biofeedback techniques include electromyography (measures muscle tension), galvanized skin response (measures sweat response), electroencephalographic (measures brain waves), skin temperature, and heart rate variability biofeedback (synchronizing heart rate and breathing).  Using biofeedback, an individual receives feedback about his/her own physiological state and learns methods to control these physiological states.

Heart rate variability biofeedback (HRVBF) teaches people how to regulate their own heart rhythm and rate to increase heart rate variability (HRV), which directly exercises the body’s physiological control mechanisms.  HRV is the measure of the rhythmicity of the heart, in its complexity and amplitude of the heart beat.  High HRV is recognized as a sign of healthy heart functioning and as a measure of autonomic activity.  Using HRVBF to sync breathing and heart patterns, an individual can learn how to breathe in a way that strengthens the parasympathetic response, thus creating a calmer mind-body state.

Decreased heart rate variability has been observed in those disorders related to autonomic dysregulation, substance use disorder, and some affective spectrum disorders, including fibromyalgia, depression, and anxiety.  HRVBF has been used for a variety of physiological and psychological disorders, particularly stress and stress related disorders, which are often directly or indirectly related to substance use disorders.  Learning how to regulate emotions that negatively affect heart rate variability, while learning how to regulate physiological signals through HRVBF, can be highly beneficial to those who experience problems with self-regulatory behaviors.

I use heart rate variability biofeedback in my practice to help patients learn a self-empowering way to calm themselves, particularly those recovering from addictive disorders and anxiety conditions, such as panic disorder.  I am Board Certified in Biofeedback.

– Julie Myers, PsyD, MSCP

http://www.DrJulieMyers.com
Copyright (2011):  Julie Myers, PsyD  All Rights Reserved

Stress Relievers for Urge Control

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Stress Relievers for Urge Control

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego, California

 

Have you ever thought about how much stress triggers your using?   Stress (and the resulting anxiety or anger) drives people to seek relief.   For many people, such stress means searching out relief with drugs and/or alcohol.   But there are other ways to relieve stress!  Here are just a few:

  • Exercise.  Try a walk or even something with more exertion!
  • Slow, regular breathing
  • Call a friend and talk it out
  • Make a plan for how you’ll deal with stressful events
  • Develop coping statements to redirect yourself.
  • Soothing music

Try some of your own brainstorming, make a list, and keep it handy.    When a stressful event occurs, you’ll be glad to have a list of alternatives to using!

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.