Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). People with bipolar disorder experience periods of unusually intense emotion and changes in sleep patterns and activity levels, and engage in behaviors that are out of character for them—often without recognizing their likely harmful or undesirable effects. Bipolar disorder is often diagnosed during late adolescence or early adulthood and usually requires lifelong treatment.

Mania vs. Depression

Types of Bipolar Disorder

There are several types of bipolar disorder, including bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Individuals who have bipolar I disorder have had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. Individuals who have bipolar II disorder have had at least one major depressive episode and at least one hypomanic episode, but they have never had a manic episode. Individuals with cyclothymic disorder have had at least two years (or one year in children and teenagers) of many periods of hypomania symptoms and periods of depressive symptoms. Sometimes a person might experience symptoms of bipolar disorder that do not match one of these three categories, and this is referred to as “other specified and unspecified bipolar and related disorders.”

Comorbid Disorders

Fig. 1. BMC Psychiatry.

Many people with bipolar disorder also have other mental disorders or conditions, such as anxiety disorders, ADHD, substance use disorder, or eating disorders. Sometimes people who have severe manic or depressive episodes also have symptoms of psychosis, which may include hallucinations or delusions.

A 2022 study found that there is a high prevalence of medical disorders comorbidities in the group of patients that participated in the study. 96.3% of BD patients had at least one medical disorders comorbidity, and of the patients that had at least one comorbidity, 77% had two or more comorbidities (Fig. 1).

Bipolar Disorder Statistics

• Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year.
• More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with major depression.
• The median age of onset for bipolar disorder is 25 years.
• Both men and women develop bipolar disorder, and only slightly more women are diagnosed than men (Fig. 2).
• Bipolar disorder is the sixth leading cause of disability in the world.
• As many as one in five patients with bipolar disorder completes suicide.
• When one parent has bipolar disorder, the risk to each child is l5-30%. When both parents have bipolar disorder, the risk increases to 50-75%.

Fig. 2. Sandstone Care.

As we normalize talking about mental health, many are raising awareness about more common disorders like anxiety and depression. However, there is a lack of awareness surrounding less common mental health disorders, so I have decided to start a series in which we cover less well-known disorders. Today, we will talk about an eating disorder called avoidant-restrictive food intake disorder, or ARFID. ARFID was first introduced in the DSM-5 in 2013, and many people do not fully understand the disorder, even as awareness of ARFID is increasing.

When thinking about eating disorders, most people picture someone changing their eating habits in order to lose weight or alter their body in some way. While many eating disorders, such as anorexia nervosa and bulimia nervosa, fit this description, not all eating disorders do. For example, those with ARFID do not restrict their food intake with the goal of losing weight. Rather, eating can be physically and emotionally difficult for these individuals, causing them to consume less food or limit their diet to certain types of foods.

What is ARFID?

Fig. 1. Nutrients.

Those diagnosed with ARFID have trouble meeting nutritional and/or energy needs for any of the following reasons:

1. Lack of interest in eating or food: those with ARFID may say that they have no appetite, don’t enjoy eating, or are full after eating a small amount.
2. Avoidance based on sensory characteristics of food: those with ARFID may avoid or eat foods only of certain texture, taste, smell, temperature, or appearance.
3. Concern about aversive consequences: those with ARFID may have a fear of choking or vomiting.

To be considered ARFID, the restrictive eating pattern must affect the individual in at least one of the following ways:

1. Significant weight loss
2. Need for enteral feeding (tube feeding)
3. Severe nutritional deficiency
4. Negative impact on psychological/social functioning
   

   Fig. 2. Developmental Medicine and Child Neurology.

Comorbid ASD and ADHD

ARFID is linked to neurodevelopmental disorders, particularly autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). One study found that among patients with ARFID (n=263), comorbid ASD was present in 58.3% of patients relative to 41.7% in the non-ARFID group (Fig. 2). Sensory sensitivities common to those with autism and ADHD contribute to the acceptance or refusal of food because of texture, presentation, temperature, color, or smell.

ARFID Statistics

The prevalence of ARFID in the general population is not known. However, it is known that the rates of ARFID are between 5% and 14% in pediatric inpatient eating disorder programs and up to 22.5% in a pediatric eating disorder day treatment program. ARFID also affects more males than females, and it is more common in children and young adolescents and less common in late adolescence and adulthood.

Treatment

The most appropriate level of care for treatment depends on the patient’s overall health. Eating disorder treatment may include inpatient-level care, residential-level of care, partial/intensive outpatient programs, or outpatient therapy. The treatment process for ARFID typically involves providing education about the diagnosis, treatment, and importance of nutrition as well as monitoring food intake and increasing volume and/or a variety of fear foods.

Attention-deficit/hyperactivity disorder, or ADHD, is a neurological disorder characterized by a persistent pattern of inattention that interferes with daily functioning. Individuals with ADHD might also have symptoms of hyperactivity and impulsivity, but they are not required for a diagnosis.

Common Symptoms in Women

Women more commonly have inattentive symptom presentation, which includes these symptoms (according to the DSM-5):

• Forgetfulness in daily activities 
• Getting easily distracted
• Failing to give close attention to details or making careless mistakes in activities
• Trouble holding attention on tasks

Women with ADHD struggle more with socialization than men do. Women often experience rejection sensitivity, which is an intense emotional response to real or perceived rejection. Women are often overwhelmed by the demands of relationships and tend to have fewer meaningful relationships. They often also have trouble maintaining friendships.

Women also tend to experience more hypersensitivities, including sleep difficulties, tactile defensiveness and sensory overload, as well as headaches, migraines, stomach aches, and nausea. Furthermore, psychological distress, feelings of inadequacy, low self-esteem, and chronic stress are common.

Fig. 1. Teh, Dawn. Health Match.

Symptoms of impulsivity in women increase their chances of engaging in high-risk behaviors as well as addictive behaviors.

By adulthood, most women with ADHD have at least one comorbid disorder. In fact, 25-40% of people with ADHD have an anxiety disorder. Other common comorbid disorders include mood disorders, dysregulated eating, and personality disorders. 

Researching ADHD

There is very little research studying the effects of ADHD on women, as most research focuses on children, adolescents, and men. In children, studies show that boys often get a more accurate diagnosis than girls. Boys tend to show more hyperactive behavior than girls do, and ADHD researchers often focus on studying hyperactive behavior over other symptoms of ADHD that are more common in girls. More research is necessary to help experts accurately identify, diagnose, and treat symptoms earlier in girls and women. 

Fig. 2. Koch, Jenna. Marquette Wire.

ADHD Diagnosis

The prevalence rates of ADHD in men and women are similar, yet the diagnosis rate among American men is 69% higher than it is among American women. Men and boys are diagnosed far more commonly than women and girls, and most women with ADHD do not get an accurate diagnosis until they are in their thirties or forties. 

There could be several reasons for this:

• Research shows that women are highly motivated to hide their ADHD symptoms and compensate for them. The symptoms that are observable are often anxiety or mood-related, which can lead to misdiagnosis.
• Rating scales for ADHD are still skewed toward male behavior symptoms.
• Stereotypes, bias, and gender role expectations all impact the diagnosis of women and girls. 
• Parents, teachers, and pediatricians might miss ADHD symptoms in young girls because they are not obvious. 
• ADHD is often a misunderstood disorder, even by many doctors. 

According to a study conducted by the CDC, the number of privately insured US women ages 15-44 years who filled a prescription for a medicine to treat ADHD increased 344 percent between 2003 and 2015. This reveals that more women have started to finally receive an ADHD diagnosis and receive treatment.

Research is an essential part of practically every field of study. Biology, economics, anthropology – you name it. However, research is not always perfect. Researchers sometimes focus on data that “shows what they were looking for – findings that are only true if they look at information a certain way,” according to Kevin Loria.  

In the field of psychology, research is necessary to better understand human behavior and mental illnesses. But researchers in psychology have begun to face a major problem – a potential replicability crisis. 

Replicability is obtaining consistent results across studies aimed at answering the same scientific question, each of which has obtained its own data. Put more simply, replicability is being able to repeat a study and get consistent results. If a study is able to be replicated, its results are seen as much more reliable than the results of studies that are unable to be replicated. 

A replicability crisis means that studies that are repeated may lead to different results. In order to figure out how prevalent the crisis really is, Brian Nosek (along with 270 other psychologists) repeated 100 studies published in three of the top psychology journals and published their findings in the journal Science.

Fig. 1. Science.

Originally, 97% of the studies were statistically significant. However, only 36% of the studies were still significant when repeated (Fig. 1).

The psychologists also looked at how much of an effect there was in the study. As Ed Young explains, “the effect values measure the strength of a phenomenon; if your experiment shows that red lights make people angry, the effect size tells you how much angrier they get.” The effect size changed after repeating the studies; the median effect size for most studies was less when the studies were repeated, and on average, the effect sizes of the replications were half those of the originals (Fig. 2). In some studies, there was even a negative effect, meaning that the new results were opposite those of the original study. 

Fig. 2. Science.

Many are questioning the reliability of studies in psychology. While the replicability crisis is a problem, this does not mean that you should not believe in psychology at all. Importantly, failed replications do not discredit the original studies. There are numerous reasons why different results may have been produced. It could be due to random chance. The original study might be flawed, or the replicated study could be flawed. There could be differences in the people who volunteered for both experiments or differences in the way in which those experiments were conducted. 

According to Nosek, “This doesn’t mean the originals are wrong or false positives. There may be other reasons why they didn’t replicate, but this does mean that we don’t understand those reasons as well as we think we do. We can’t ignore that. We have data that says: We can do better.” 

The study conducted by Nosek is an important step toward understanding research in the field of psychology. While it is important to maintain a healthy level of skepticism when reading research studies, do not assume every study is a false positive. 

Recently, I have been having recurring dreams, and this is not the first time I have experienced this type of dream. When I was about five or six, I watched The Chronicles of Narnia: The Lion, the Witch, and the Wardrobe and had dreams of wolves chasing me for months afterward. While terrifying at the time, it is hilarious looking back on it (especially since few people consider The Chronicles of Narnia to be a scary movie). 

After waking up from one of my new recurring dreams, I remembered my nightmares as a kindergartener and decided to do a deep dive into the science behind recurring dreams. 

What are Recurring Dreams?

Recurring dreams are dreams that are experienced repeatedly over a long period of time. Between 60 and 75 percent of American adults experience recurring dreams, and more women experience them than men.

Fig. 1. Hyde, McKenzie. America’s Most Common Recurring Dreams.

They are not necessarily nightmarish (though 77 percent of these dreams are negative); they can also be pleasant. Recurring dreams are unique to every person, but there are themes that are commonly seen in these dreams, including flying, falling, not being able to speak, being chased or trapped, being unprepared for an exam, and finding new rooms in a familiar building. 

Fig. 2. Hyde, McKenzie. America’s Most Common Recurring Dreams.

What Causes Recurring Dreams?

It is common for recurring dreams to occur during times of stress, and these dreams may reflect unresolved conflicts in the dreamer’s life. Dreams, in general, help us to regulate our emotions and adapt to stressful events. The repetitive content in recurring dreams might represent an unsuccessful attempt to make sense of these emotions or stressful events. Once a person has resolved their personal conflict, they often stop experiencing recurring dreams.

Interpreting Recurring Dreams

If you are experiencing these types of dreams, there are ways to figure out their meanings and determine the reason that you keep having them. 

When attempting to figure out what your dreams mean, it is helpful to think of them as metaphors, since recurring dreams often metaphorically reflect the emotions of the dreamers. For example, a dream about being unprepared for an exam might represent something in the dreamer’s life that makes them feel unprepared or judged by others. A dream about being naked or inappropriately dressed might represent something in the dreamer’s life that makes them feel embarrassed or humiliated.

In recurring dreams, the scenario almost never appears exactly the same way in each dream, since there are typically changes or shifts to the basic scenario. For example, if you are dreaming about driving a car with no breaks, there might be variations in the type of car or where the car is going. Dr. Kelly Bulkeley explains, “These variations on the recurrent theme can be very helpful in understanding why the dreams come when they do. If the basic scenario of a recurrent dream has a metaphorical meaning, how do the changed details in a particular dream connect the metaphor to something happening in the waking world right now?” 

I hope this post helped you to better understand and interpret recurring dreams.

Fig. 1. IMDb.

In the 2016 movie Split, a man with 23 distinct personalities kidnaps three teenage girls and imprisons them in a secret underground lair. The man, who has dissociative identity disorder, is portrayed as dangerous because of his diagnosis. This psychological thriller sensationalizes mental illness and inaccurately portrays dissociative identity disorder – and it is not the only film to do so. 

The misrepresentation of individuals with DID as dangerous and violent is common in the media, leading to the public’s fear of those with the disorder and isolating those who have received a diagnosis.

What is Dissociative Identity Disorder?

Dissociative identity disorder (DID), previously called multiple personality disorder, is characterized by the presence of two or more distinct personality identities, each with its own traits and personal history. The transitions between personalities result in changes in the individual’s behavior, consciousness, memory, consciousness, and cognition. Individuals with DID experience gaps in their memories, and some may also experience hallucinations.

DID is often the result of severe abuse or trauma, and transitions from one personality to another are often caused by emotional distress. The disorder is thought to be a coping mechanism that enables the individual to detach themselves from trauma. 

Psychotherapy is the primary treatment for those with DID. Therapy focuses on merging the individual’s separate identities into a single identity, working through past trauma, and managing sudden behavioral changes.

There are many harmful misconceptions about the disorder that are perpetrated by the media. 

Misconception #1: People with DID are dangerous or violent. 

A DID diagnosis does not mean that an individual is dangerous. People with DID are actually much more likely to be victimized by others than to victimize them. They are also at high risk to repeatedly attempt suicide and self-harm. According to the DSM-5, 70 percent of individuals with DID have attempted suicide at least once. 

In a recent study on individuals with DID, the participants reported low rates of recent criminal behavior in the last six months. Three percent of participants reported a legal charge, 1.8 percent reported a fine, and 0.6 percent reported being incarcerated.

Misconception #2: DID is a “fad.”

DID is not merely a fad. DID has been formally recognized as a disorder for over four decades. Since the 1980 publication of DSM-3, the disorder has been included in four different editions of the DSM. DID patients can be reliably and validly diagnosed with structured and semi-structured interviews.

Misconception #3: DID is primarily diagnosed in North America by DID experts who over-diagnose the disorder. 

1. DID is not primarily diagnosed in North America, and patients are consistently identified in outpatient, inpatient, and community samples around the world. 
2. DID is diagnosed by clinicians around the world with varying degrees of expertise in DID, not just by DID experts.
3. DID is not over-diagnosed. In fact, most individuals who meet criteria for DID have been treated in the mental health system for 6 to 12 years before they are finally correctly diagnosed. 

Fig. 2. Renzoni, Camille. The Recovery Village. 

Fortunately, many have begun to correct harmful stereotypes about DID, and there is even a petition to boycott Split because of its misleading representation of DID. 

Many already know that poor posture can lead to physical discomfort, such as neck, shoulder, back pain, eye strain, and headaches. But did you know that posture does not only affect your physical health; it also has an impact on your mental health. Good posture has many psychological benefits. 

Good posture helps reduce stress and can increase positive mood and self-esteem.

In a small study of 74 participants, researchers concluded that adopting an upright seated posture in the face of stress can maintain self-esteem, reduce negative mood, and increase positive mood compared to a slumped posture. They also note that sitting upright may be a simple behavioral strategy to help build resilience to stress.

Good posture increases confidence.

Several small studies indicate that good posture does increase confidence. In one study, students who maintained an upright posture had more confidence in their own thoughts as they speculated about future job performance.

Good posture activates your assertiveness.

When you stand tall, your posture promotes respect from others as well as self-respect, regardless of your actual position in an organizational hierarchy. It may also increase your chances of success in a job search.

Good posture helps you perform better under pressure.

In a study of 125 college students asked to do simple math problems, those who sat upright reported they found it easier to do the math. The authors of the study speculate that using an empowered position can help you focus on a variety of performance situations, not just math tests.

Tips for good posture:

• Keep your chin parallel to the floor.
• Keep your shoulders back and down.
• Activate your abdominal muscles to pull up from your waist.
• Keep hips and knees even, with knees pointing straight ahead.
• Distribute body weight evenly on both feet.
• Aim for a neutral spine.

If you consistently experience high levels of stress without taking steps to manage it, exhaustion eventually takes over – leaving you emotionally and physically burned out. Towards the end of the semester, especially as the weather becomes colder, many students experience burnout. If you are experiencing burnout, there are many strategies you can use to help you cope and recover. 

Self-Care

Because lack of self-care is one of the most significant contributors to burnout, it is important for those trying to recover from burnout to intentionally make time for self-care. Prioritize getting adequate amounts of sleep, eating well, and exercising. If you feel that you do not have enough time or are too exhausted for self-care, you can start with just 10 minutes a day. Even just going to sleep 10 minutes earlier than the night before or going on a 10 minute walk can really help you cope with the exhaustion that comes with burnout. 

Ask for Help

Let those close to you know that you are burned out and exhausted, and do not be afraid to ask them for help. Asking for help with studying, errands, or meals can be extremely helpful, and it can allow you to save some of your energy and give you more time to recharge. 

Set Boundaries

Setting boundaries means not overextending yourself. When you are not in class or doing schoolwork, try not to think about school. When you are not working, leave your work behind. Make sure to set aside time during the day to rest, even if you can only squeeze in 15 minutes. 

Practice Self Compassion

Those who experience burnout might also experience feelings of failure and a loss of purpose or life direction. Grant yourself the same love and support that you would give to a loved one in this situation. Remind yourself that it is okay to take a break and that you do not have to be perfect.