Is It LOVE, Or Is It MANIA?

By Stephanie Stephens







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Giddy romance and mania have a lot in common, so learn the signs that tell you which is which.



In Irving Berlin’s catchy Broadway tune “You’re Just in Love,” a puzzled young man wonders why he can’t sleep or eat, yet feels like he’s walking on air. It’s OK, he’s told:

You don’t need analyzing,

It is not so surprising…

You’re not sick, you’re just in love.

When you have bipolar disorder, though, the question becomes more complicated. Is it love when you’re swept by euphoria, erotic stirrings, a special feeling of connection and constant thoughts of the one you desire?

Or are those traits actually signs of looming mania?

Turns out a group of psychiatrists has been looking at the love vs. mania conundrum. Members of the Human Sexuality Committee of the Group for the Advancement of Psychiatry—an organization dedicated to addressing the social needs of people with a mental disorder—are trying to come up with helpful answers to guide individuals with bipolar.

Elizabeth Haase, MD, an assistant clinical professor of psychiatry at Columbia University and a member of the sexuality committee, says learning to tell the difference can help avert harmful choices.

“When you’re in a hypomanic or manic state, you’re also more likely to feel you’re in love,” says Haase. “You may then act on that feeling when making major long-term life decisions, not understanding your state had something to do with what you were feeling.”

Robin, a 38-year-old artist from the southern United States, remembers diving into toxic relationships during periods of elevated mood.

“I’d feel ‘zip-a-dee-doo-dah!’ in love with myself in hypomania, but then when someone comes along, I’d feel even more so about him,” says Robin, who was diagnosed with bipolar in her 20s.

She recalls a draining love affair with a man she thought was her “absolute perfect soul mate”—despite his controlling behavior and their constant arguing. In retrospect, she assesses him as “a fake, … and narcissist.”

Still, she adds, “I wasn’t really a victim of him—I was a victim of myself.… I didn’t have a healthy gauge then and I was repeating certain patterns.”

Now that she’s stable and better educated about her disorder, Robin says lessons she learned from that tumultuous relationship helped her set better boundaries going forward.

“Even though the roller coaster left me confused and less trusting of myself, I use it as a reminder to slow down and better vet the object of my feelings, along with my feelings themselves,” she says.

Bipolar Mania vs. True Love

Slowing down is good advice for anyone caught up in the intense emotions of new love, says David Goldenberg, MD, an assistant clinical professor of psychiatry at Weill Cornell Medical College.

During that early phase, he explains, it’s common to shy away from the “uncomfortable parts” of getting to know another person. The impulsivity associated with bipolar can make it even more likely you’ll steamroll ahead.

On behalf of the sexuality committee, Goldenberg and Haase prepared a working paper titled “In the Mood for Love.” In it, they describe the emotional state of limerence—early stages of romantic love characterized by blissful euphoria and intense longing for another person—and compare it to the egocentricity, grandiosity, and elation of mania.

The paper goes on to identify some of the key differences between true love and hypomanic exuberance, including a seasonal pattern of love affairs, reckless lack of judgment, and over-the-top impulsive actions. For people with bipolar, “lovesick” can be more than a metaphor.

“There is a very strong similarity between that ‘swept away’ experience of being in love and that of mania,” agrees Joseph F. Goldberg, a clinical professor of psychiatry at Mount Sinai Hospital in New York City. However, an individual’s orientation is very different in the two states.

“In love, a person thinks about the other person—their welfare and well-being are paramount,” he explains. “In mania, I’m thinking about you, but I might also think about how you’re a means to an end for my own self-aggrandizement.”

In a clinical setting, the feeling of being in love isn’t usually what brings someone in for treatment, says psychiatrist Lakshmi Yatham, MBBS, FRCPC, but it can certainly be one of the symptoms of mania.

Yatham is a professor of psychiatry at the University of British Columbia in Vancouver and regional head of the psychiatry department at Vancouver Coastal Health. When a patient with bipolar disorder declares undying devotion to someone, he asks questions like, “How long have you known this person?” “How did you meet?” and “Does she love you?” to determine whether the patient’s emotional enthusiasm is part of mania or based in reality.

He also assesses changes in mood, energy, sleep, cognition, and judgment for indicators of a manic episode.



A. Morin, a licensed social worker , has her clients consider what she calls the “three Cs” of relationships: chemistry (“You can’t control who you have that with”), compatibility (“Determine if you want the same things”) and commitment (“You should both seek the same level”).

Morin sees a tendency in her clients with bipolar disorder to use romantic relationships as a kind of antidote, at least in the first flush of happiness.

“They say, ‘Life’s great. My depression is cured.’ I find women especially may go from relationship to relationship, while some develop a ‘love addiction’—always chasing their next high.”

Bipolar Love on the Brain

The British band Roxy Music sang “Love Is the Drug” back in the 1970s, and decades of research have shown there’s literal truth to those words. In a study published in the Journal of Comparative Neurology on December 5, 2005, researchers using neural imaging confirmed that early-stage romantic love fires up the same “dopamine-rich” reward pathways in the brain that are activated in addiction.

Since then, scientists have learned more about the brain in love. For example, people in the intoxicating throes of early love have higher levels of a brain protein called nerve growth factor, which tapers back to normal after about a year.

In people experiencing mania, though, nerve growth factor seems to be lower than average. And functional magnetic resonance imaging shows that completely different areas of the brain’s emotional and reward systems rev up during mania than during the rush of romantic love.

For now, unfortunately, there’s no quick test to find out which sections of your cortex and limbic system are in play when you feel the giddy stirrings of l’amour. The only tool at hand is vigilance—weighing every behavior and feeling as a possible clinical symptom, however distasteful that may be.

“People with bipolar disorder are entitled to the human experiences that anybody else could have—like falling in love,” says David H. Brendel, MD, PhD, medical director of the Mood Disorders Program at Walden Behavioral Care in Massachusetts.

“However, both vulnerability to bipolar disorder and falling in love—when they conspire and happen at the same time—can produce a complex picture.”

Jim, a baby boomer who lives on the East Coast, decided to marry his wife of 25 years two months after they met. He was 29 at the time and hadn’t yet been diagnosed with bipolar.

It happened one night when he came down with the flu and the couple decided to stay in rather than go out to dinner as planned.

“Things just clicked in my mind, and I suddenly proposed,” Jim says. They were engaged three months later and married a year after.

Jim is uncertain now as he ponders the impulsivity of that proposal. “About seven years into the marriage, after I was diagnosed, part of me wondered, ‘Was I really manic then? Did we get married too soon?’ It’s still a bit of a sensitive issue to us, even with the strengths in our relationship.”

He adds, “With mania, you come to distrust your own emotions—there’s the risk that you’re getting carried away. I’m much more cautious about myself.”

Bipolar & This Thing Called Love

Maybe the Marshall Tucker Band said it best for anyone whose soul is stirred by an overwhelming infatuation:

My heart’s feeling something all new inside

I say love is a mystery

Love is a mystery

Am I falling in love with you?

Or as Goldenberg says, “Distinguishing love and defining it has always been challenging for researchers, yet always great for poets, storytellers, and lyricists.”

Science is coming to see that both love and hypomania “occur in the context of other influences on behavior: impulse problems, compulsions and addictions, and mind-body influences such as hormones,” he adds. “This contextualization helps bring the study of love and hypomania out of the poetic and into the clinical without sterilizing one of the most valued and necessary of human experiences: love.”

Goldenberg emphasizes that it’s possible to have bipolar and navigate relationships wisely, enjoy intimacy and maintain a sense of love in your world—as long as the illness is taken into account.

B. LeVine, a Los Angeles social worker and author of the new book Beating Bipolar, goes a step further.

“In Alcoholics Anonymous you’re counseled not to pursue a romantic relationship until you’re stable and healthy,” says LeVine, who was diagnosed with bipolar as a teenager. “The same is true with bipolar disorder.”

When someone begins obsessing and giving up everything for another person, LeVine says, that smacks more of mania than love. So does optimism run rampant, as with one client who told him she was getting married after a single date.

“Sadly, the person never called her back,” LeVine recalls.

LeVine says bipolar pushed him in the opposite direction: He was scared to put himself out there because “you feel unlovable—worried whether the other person will accept you that way.”

He’d been in recovery for more than a year when he met a “wonderful girl” and took the plunge. LeVine says the “many positive experiences” he had during that two-year relationship have contributed to the success of his marriage. He and his wife have been together for 10 years, married for six, and “have a beautiful 4-year-old daughter,” he reports.

That makes him a living example, he says, that “with the right steps it is possible to find love while living with bipolar.”

* * * * *

I’ve Got You Under My Skin

When a new relationship is taking off, try to step back and consider course and context:

Cyclical Patterns and/or Related Symptoms

When Cupid’s bow strikes every May along with scribbling new movie ideas and cleaning until the wee hours of the morning, this pattern ought to trigger concern.

Judgment & Bipolar Impulsivity

People in love are often impulsive but their judgment remains relatively intact. Have you neglected to discuss safer sex because your mind is racing and concentration destroyed, or are you deciding not to use a condom because you are making a thoughtful commitment to be together forever?

Flying off to Rome to throw a coin in Trevi Fountain would be fun, but it won’t get your union blessed by the Pope, and is it really a good way to spend a first date? Perhaps you should question whether such a grand impulsive plan might not reflect the disinhibition or spirituality of manic symptoms.

Exclusivity

The lover is focused on the beloved, often irritating friends and family with their infatuated raptures over every imperfect inch. A person in mania tends to engage with people and plans more indiscriminately.



—From “In the Mood for Love,” Haase and Goldenberg

I Want to Know What Love Is

During a period of stability, analyze core aspects of healthy love relationships for you, as well as core qualities of your illness. When in doubt as to whether you’re truly in love or experiencing mania, refer back to your answers.

What Characterizes Your Bipolar Manic States?

This question is a basic for anyone with bipolar disorder. Although it may vary somewhat, there’s generally a pattern you can identify when it comes to relationships. Do you embrace romance? Start a friendship group in your apartment? Pursue sexual encounters in person or online? Note other tell-tale symptoms, such as changes in sleep patterns or excessive spending.

What Is Love for You?

Can you identify differences between your experience of love when healthy and when manic? This knowledge may be elusive and change with different stages of life, but reflection should provide you with some guideposts.

What Qualities Would a Loving Partner Have?

Who would make a compatible mate? Ask yourself this question for three points of time in your life: when you are depressed and needy, manic and invincible, and at a point when your mood is even. You will need a partner in all three states.

What about Sex?

What is your normal comfort level and how does that change during mania? Sexual discussions are often uncomfortable within families but should be part of a clinical assessment. Talk frankly with your doctor and therapist about the whole range of your sexual experiences and desires, past, present, and future.

—From “In the Mood for Love,” Haase and Goldenberg

Almost Like Being in Love

When you’re in the throes of new love, do a mental check for the possibility of mania.

Are your feelings for everyone more intense, both good and bad?

Are you thinking a mile a minute about just this one person, obsessed and preoccupied, or are you just thinking a mile a minute?

Is a new love affair the only new thing in your life, or have you started new projects in other areas of your life as well?

Are the interests of this person connected to interests you only have when manic?

Is this about you? Do you think you are super talented and special, or is it your new lover that is the most perfect thing? People who are manic become full of themselves, or “grandiose.” Lovers are infatuated with the beloved.

Bought anything recently? Lovers’ gifts, even if expensive, tend to be intimate—a diamond watch because she loved it in the window, a personalized playlist you made just for him. In contrast, manic purchases are more likely to be status-driven, such as a Porsche you can no way afford, or multiples, such as six similar purses in a day.

What’s up with your zeitgebers, or personal clocks? If your appetite, energy, sleep cycle, and response to the season are in your manic pattern, try to be suspicious of yourself, something obviously hard to do as mania takes hold.

—From “In the Mood for Love,” Haase and Goldenberg



Printed as “Is This Love That I’m Feeling?” Winter 2013