Gender Identity Problem or Personality Disorder & BP Symptoms
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Q:  Can having a gender identity problem or personality disorder be causing my bipolar symptons. I have been diagnost as axis I, bipolar II. Please consider answering me.


Dear Charles -- 
The way bipolar disorder is currently understood, the answer to your question is clearly no.  Now for a few qualifications on that answer.  First, having a gender identity disorder, or shall we say, the symptoms that get a label from psychiatrists which clearly gives away the value judgments that used to (but no longer should) accompany such diagnoses...ahem, where was I? Ah yes, having a gender identity struggle, searching for a less laden term, most likely is a pretty stressful thing to go through.  And stress has been associated with bringing on episodes of mood problems, from depression to and including bipolar disorders.  So in that sense, the answer to your question is yes.  Please note the distinction:  if you somehow managed to have the gender issues without experiencing them as stressful, then in the current way of thinking about bipolar disorder, again the answer is no.  That's how I see it, anyway. 

Now, how about "personality disorders?"  Again, we see that old value judgment sticking out there.  This really bothers me.  In my experience this term is used by most psychiatrists I know to distance themselves from the patient and, I believe, excuse themselves from having to try to really help this person the way they would a patient who didn't have a "personality disorder" -- after all, the patient has an axis II condition, blah blah, ... and one can just hear in their voice the underlying assumption that this means the patient is not helpable in the same way other patients are helpable.  Sorry, there goes a soapbox, eh?

Anyway, it's relevant to your situation in that the same logic applies here as with the gender issues.  Whatever it is that's getting labeled (in some people, perhaps not you) "personality disorder", those very symptoms can can severe stress (disrupted relationships or lack thereof; intense, extreme emotional reactions to minor events; and so forth).  That's not to mention the stress that might go along with being treated by a psychiatrist who is like the ones I'm describing above, who say "personality disorder" and then don't show much empathy, for example.  (Just to finish that soapbox, now that I've got myself started:  I'm not saying the symptoms that "personality disorder" aren't there in some people; it's just the value judgment about what "kind of person" that label means has the symptoms, that's what bugs me. And it's also true that these kinds of symptoms are hard to treat, and sometimes we can't really help much, but very often there are symptoms there that can be treated.  And what bothers me is that the label, and the labeling process, can sort of give permission to the mental health person to not try not treat the symptoms could respond, or try less hard.  There, all done.  For now.  Oh well, no, better add one more thought to this rant...).  

All that ranting needs to be accompanied by an acknowledgement that psychiatrists and other mental health types are human, and sometimes have their own damaged places, and I suppose we should cut them some slack too.  It's really hard to sit there while someone acts out their symptoms on you.  I just try to remember that I'm supposed to be there to treat those symptoms, not throw people out (even to a small degree emotionally) for having them. But sometimes, especially when you've seen a whole bunch of patients in a short while, or a bunch of folks with this kind of symptom-set, even a good psychiatrist can end up doing his/her own acting out.  I certainly have.  So if you've encountered it, it's smart to try to look for some empathy for the psychiatrist first -- and use that to keep my rant in perspective.  

Sorry, got off your track a bit; but I hope that helps address your concern to some degree.  

Dr. Phelps

Published April, 2004


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