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Brittle Bipolar


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There really isn't much out there for detailed information. My best understanding of the term 'brittle' when used within the bipolar spectrum describes when people with traits of the affliction are easily affected by changes in their environment. 

Random surprises, or things not going as planned, or expected send them into a mental frenzy.

A few examples.. Going to the grocery store for milk.. and finding the shelf empty? Asking somebody for a ride somewhere.. and noticing an unmentioned stranger in the car when your friend shows up? Looking forward to a day at the beach.. then it rains the whole time? Applying, doing well at interviews, then not getting the job that you thought would be perfect for you?

Rather than a naturally occurring chemical imbalance that is the major contributing factor to the symptoms, environmental considerations play a much larger role. The stress reaction becomes the triggering mechanism for the hypomanic state that follows. The depression is the negative over-reaction following the energy of instability.

In the past, I have looked for detailed information to substantiate the diagnosis. ICD 10 and DSM-V make no mention of 'brittle' as a formal bipolar classification. It likely falls into a sub-classification within the dreaded, difficult to quantify, NOS designation. So, why would medical professionals invent their own private terminology outside the official diagnostic guidelines? That is sketchy.

Given the implied contradiction, (is it a stress reaction vs. is it a chemical imbalance), I would definitely ask the doctor for their reasoning or their interpretation of what 'brittle' means to them. 

From a treatment standpoint, in this case, everything changes based on the cause of the symptoms. Even though bipolar is listed as a potential diagnosis, treating the individual to be less reactive to the stress would likely avoid the manic mimicking symptoms that follow. Perhaps a PRN benzo would be effective without the need to expose the affected person to the antipsychotics Medicoaster?

In some research, with the 'brittle' descriptor, the manic symptoms are seen more as a self-effort to cheer up or distract the affected individual. In this case, the impulsive nature almost becomes a conscious choice. (Contradicts the diagnostic criteria for establishing a bipolar spectrum disorder?) From what I have read, the depressive side can also be tied to the same environmental influence that caused the initial reaction. 

I am not a professional. Just sharing my opinion here. The lack of reference material available online would definitely have me asking the psychiatrist to pull whatever they are using for a diagnostic manual off their bookshelf and show me their reasoning.

The mind works in wierd ways. It is totally possible that too much stress can eventually cause a chemical imbalance, or create an environment that exploits an existing imbalance to manifest into some really strange symptoms within the bipolar spectrum.

I am a total pain because I question everything. Always.

 

 

Edited by Lms-Kaz
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