Very Deep Emotional Pain
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Q:  Very Deep Emotional Pain

When I feel emotional pain, I feel deep deep deep emotional pain---to the point of hurting so bad I can't hardly stand up. It's like somebody jabbed a knife into me. It this a common bipolar trait. Help, no one can understand my deep, deep pain. They think I'm overreacting but it's very, very real!!!!!! What can I do about it. Sometimes it lasts for 10 min. or 20, or 2 hrs. then suddenly dissipates for no reason. I feel so so alone when I go thru this deep deep kind of pain. Like I'm totally alienated from the rest of the world

Dear Trudy --
Common? I don't think we could go that far. But is it related to bipolar disorder? I would think probably so, at least in some fashion.

This could be a "temperamental feature". Here's what that means. Some people who have bipolar relatives, but who do not have bipolar disorder as such themselves, can sometimes be "up" in energy and mood, all the time. They don't cycle, they just stay up there, noticeably more positive, energized, and productive than people around them. They tend, as you might imagine, to do quite well in life. This has been called "hyperthymic temperament", from the Greek word "thymos" which means feelings. These people have strong feelings -- generally positive ones -- all the time.

The near opposite has been called "depressive temperament". Some people just live down there all the time. They don't cycle either. "Eeyore" from the Pooh stories, if you know them, has been cited as the example for this.

Now, I suppose there could be an emotional equivalent in terms of capacity to feel pain as well: more potential to experience pain, from the same emotional experience, than other people. I've not heard this described, nor has a patient of mine described it, at least as the sole problem. I've definitely seen folks who seemed to be having this experience when they were having other symptoms. But generally it would ease when their symptoms did. Thus I hope it makes sense why I would be trying to explain the "temperament" concept. Perhaps you are "just wired" that way.

As for "what can I do about it?" Well, I'm sure you're frustrated with people expecting you to handle this pain as though it were like the kind of pain they know about from their own experience. So I don't want to add to that by sounding like I "don't believe"; I hope that the paragraphs above suggest I'm taking you seriously. At the same time, when you get right down to it, if this is really "temperamental", I'd think your main option is to become a real expert in the techniques people (who don't have to live with this all the time, but are living with it now, so are ready for treatment!) are using to handle these kinds of symptoms. These are primarily two, that have some solid research behind them at least. The first is cognitive behavioral therapy, which is really hard to get expert at on your own, you generally will do best to have a therapist who knows that technique help you (although you can read about the guts of the technique, though reading is different than doing, in a book called Feeling Good, by David Burns, M.D.. This technique has been around a long time but sometimes it's hard to find a therapist who's really proficient at it. Check by asking "do you do cognitive behavioral therapy?" Do you prefer to use other techniques? and look for the gal/guy who emphasizes it).

The second technique is much "newer" in terms of research, but in my opinion is a major addition to the CBT approach. It's called "mindfulness-based cognitive behavioral therapy", as described in a book of that title by Zindel Segal and colleagues -- but this too would be best to get from a therapist who knows it and does it. The book is mostly a description for therapists of how the technique came to be described, which aspects of Zen and other "eastern" ways of handling thoughts and feelings have been incorporated, and how to teach the technique in groups of clients. However, the use of this "mindfulness" aspect of CBT I think is an important addition, especially for someone like you.

Finally, I'd hope that your bipolar disorder is well controlled. If it wasn't, it's more than likely you'd see some reduction in this experience when you were no longer cycling (in fact, if you were still cycling, I'd wonder if you'd had times when to your surprise someone said something hurtful and you didn't have your usual reaction, and thought that strange). Good luck with all that.

Dr. Phelps

Published January, 2004


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