Bipolar disorder: Am I at risk?

Dear Bi Polar literate,

Coping with mental illnesses, whether it be your loved one’s or your own, can be a challenging experience. A new diagnosis can bring up feelings of fear, uncertainty, shame, or anger. Alternatively, it can also provide some relief as it’s the first step on the path towards treatment. It’s common for individuals who have relatives living with a mental illness to question whether or not they would benefit from seeking out psychiatric testing. While genes are a risk factor for bipolar disorder, obsessive-compulsive disorder (OCD), anxiety, and depression, they are not the only risk factor. Other risk factors can be environmental or developmental, although they aren't fully understood. With that said, it can’t be determined whether or not you’ll develop these conditions simply because your mother has them. The decision to seek a diagnosis can be a highly personal one, so only you can decide to pursue psychiatric testing.

Before delving into factors influencing your decision to seek a diagnosis, you might want to read up on bipolar disorder, OCD, and depression. If you’d like to learn more about each kind of anxiety disorder, the National Institute of Mental Health (NIMH) is a great resource. Though these conditions may be worrisome to you, they can be managed with therapy (behavioral and cognitive), medication, or a combination of the two. As you may experience with your mother, determining the most effective and suitable treatment option(s) is often a process, not instantaneous.

While it’s understood that family history increases a person's risk for each disorder stated above, it’s unclear how the genes for these disorders are passed down from one generation to the next. Studies have shown that adult relatives of people with bipolar disorder are ten times more at risk for bipolar disorder than those without a family history of the illness. For people who develop bipolar disorder, the average age of onset of symptoms is 18 years old for Bipolar-I disorder and mid-20s for Bipolar-II disorder. Similarly, OCD is linked to multiple genes and symptoms usually present when individuals are, on average, 19 years old. The average age of onset for depression is 32.5, while the average age of onset for anxiety varies based on the type of anxiety the person is experiencing.

It’s great that you’re seeing a mental health professional, as they can be instrumental in providing guidance, reassurance, and support. Given your mother's diagnoses, you might find it useful to talk with them about your concerns and fears, including about being tested, if you haven't already. You may choose to ponder the following questions: Have you let your mental health professional know about your mother’s most recent diagnosis? Have you talked about whether diagnostic testing is appropriate for you? What are you expecting or hoping to get out of testing? Additionally, if you decide to discuss this with your mental health professional, you can bring up your concerns, perhaps about your fears that you will also experience mental illness like your mother. Voicing all of these thoughts and feelings will help them understand where you’re coming from and how to best address your concerns.

In the event that you do seek a diagnosis, what can you expect? The first step for diagnosing all of the disorders mentioned is a physical exam and lab tests to eliminate other potential medical problems which may contribute to your symptoms. These can be ordered by your general health care provider or a psychiatrist. Then, a psychiatrist will complete an assessment of your thoughts, feelings, behaviors, and symptoms. At this point, you may be asked to do a variety of tests for each disorder. For bipolar disorder, you may be asked to complete a mood chart, which is essentially a daily diary of your moods, sleep patterns, and any other relevant factors. For OCD, some of your blood tests may assess your thyroid function, determine your total blood count, and screen for alcohol and other drugs. Screening for anxiety and depression may require you to complete psychological questionnaires and undergo psychological screenings. After all of the appropriate tests are done, all symptoms will be compared with those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) before your provider makes a final diagnosis. If your mental health care provider determines that you do, indeed, have a mental illness, remember that a diagnosis better equips your health care provider and mental health professional to design and provide you with the most suitable treatment options. As mentioned previously, receiving a formal diagnosis isn’t always so simple and can be distressing. You might consider some of these strategies to help you cope:

• Allow yourself to experience your emotions as they come —whether it be stress, anger, frustration, sadness, shame, or fear, acknowledging that each one is valid can facilitate coping.
• Evaluate your relationship with your health care provider — do they promote an understanding, validating, and caring environment? Have they designed a treatment regimen that aligns with your goals and alleviates your concerns?
• Get involved with your treatment — do your research and prepare some questions for your provider. If you’re uncomfortable with your diagnosis, treatment, or anything else, voice your concerns.
• Openly communicate with your loved ones about the kind of support you desire — most times, people are unsure of how to care for others, so some advice may be appreciated. If you’re also interested in seeking support elsewhere, you can ask your provider for referrals to local support groups.
• Look into your health coverage options — inquire about available mental health services that accept your specific health insurance or have reduced-cost or sliding-scale fees.

At the end of the day, it’s a highly personal decision to seek a diagnosis and follow through with a treatment plan. What’s more, it may be difficult to determine exactly what your risk is for developing any of the same conditions with which your mother has been diagnosed, so speaking with your mental health professional about your concerns will give you the most clarity on your specific situation. That said, if diagnostic testing will help put your worries at ease, then it’s something you can pursue further with the help of a mental health professional. If you want to forego testing, you can choose to continue your current therapeutic relationship. Ultimately, you have control over your mental health decisions.

Best of luck!