I started this glossary in an effort to educate myself about bipolar disorder and post-traumatic stress disorder (PTSD). It is very much a work-in-progress and I both encourage and appreciate constructive feedback (key word being “constructive” — please don’t call me retarded or compare me to Hitler).
adverse childhood experience (ACE) negative experiences during childhood that put one at a heightened risk for behavioral problems, mental illness, and/or physical illness later in life.
There are three basic categories of ACE’s: abuse, neglect, and household dysfunction. Abuse can be emotional, physical, and/or sexual; neglect can be emotional and/or physical; and household dysfunction includes domestic violence, mental illness, incarceration, and substance abuse.
ACE’s increase the risk of developing a variety of behavioral, mental, and physical problems. Examples of behavioral problems include substance abuse and employment difficulties. Common physical health problems include obesity, diabetes, stroke, and heart disease. There is a clear connection between ACE’s and depression, but given the correlation of childhood trauma and mental illness, there could also be heightened risk for developing other mental illness and disorders. For example, multiple studies have demonstrated a causal link between early childhood neglect and borderline personality disorder.
anhedonia loss of interest in and inability to feel pleasure from activities that are usually enjoyable: hobbies, time with friends and loved ones, sex, etc. Anhedonia is one of the most common and recognizable symptoms of both unipolar and bipolar depression.
anosognosia inability to recognize one’s own illness. Anosognosia is distinct from denial, which is a psychological defense mechanism practiced by people with and without illness, that at some level is willful: a person chooses not to believe or accept a fact when confronted with it because it conflicts in some way with their value system, personal agenda, or understanding of reality. Anosognosia is neurological, resulting from damage to the brain’s right hemisphere, and as such is involuntary. Unlike denial’s (even subconscious) recognition and willful rejection of a fact, anosognosia is an obliviousness to one’s own illness.
Up to 50% of people with schizophrenia and 40% of people with bipolar disorder experience anosognosia, but people who have suffered stroke, brain injury, and paralysis can also exhibit it. Anosognosia can cause nonadherence to medication; conversely, adherence to antipsychotic medication may alleviate anosognosia over time.
anxiety disorder psychiatric disorder characterized by excessive and sustained anxiety, worry, and stress and a fight-or-flight response disproportionate to the potential for danger. Anxiety disorder can occur when the fight-or-flight response is repeatedly triggered or triggered over a prolonged period of time. It may manifest as constant anxiety, panic attacks, aversion to certain activities such as social engagements, a need to exert control over one’s surroundings and/or relationships, and addictive behaviors stemming from attempts to self-medicate. There are many types of anxiety disorders including obsessive-compulsive disorder, social anxiety, and post-traumatic stress disorder.
Cognitive Behavioral Therapy (CBT) a form of psychotherapy that focuses on altering one’s thinking to change and manage emotions. CBT emphasizes identifying the internal (mental illness, trauma, etc.) and external (stress, interpersonal issues, etc.) triggers of emotions and creating constructive strategies for defusing negative emotional responses and states. It includes asking oneself questions (Socratic Method) about what real-life circumstances, prior traumas, or other factors could be causing or feeding into current emotional suffering or clouded judgment.
CBT is effective because it is practical and encourages the practitioner to counteract emotional tidal waves by applying logic to his or her emotional responses. This does not mean disqualifying the emotions or pretending that they don’t exist, but understanding their real-life causes in an effort to gain or maintain perspective. For example, a common symptom of depression is the sufferer feeling that he or she is worthless. If this sentiment is prevalent, the CBT practitioner would look to what traumas and/or recent events could be causing or magnifying this feeling, remember ways in which he or she is not worthless, compare his or her assessments of self to assessments of other people in similar circumstances, and point out logical flaws in his or her assumptions and conclusions.
CBT includes changes in behavior and activities to counteract negative emotions. Practitioners of CBT will often create a “toolkit” for themselves that consists of activity-based coping strategies to manage negative emotional responses. In the aforementioned example, the sufferer of depression would create a list of constructive activities that relieve stress and improve self-esteem, which he or she could turn to when hitting an emotional low. Another facet of the toolkit is identifying people, activities, situations, and patterns in thinking that trigger or exacerbate negative emotional responses and states and figuring out how to avoid them or, if that’s not possible, how to assert oneself, anticipate the emotional responses, and have an action plan on hand to manage them.
cyclothymia a condition on the bipolar spectrum in which one experiences emotional highs and lows that do not meet the criteria for full-blown mania or major depression. Sometimes called “bipolar light.” People with cyclothymia experience swings from hypomania to mild to moderate depression. These mood periods tend to be shorter than in bipolar I and II. Cyclothymia differs from bipolar II in that the depressive episodes aren’t as severe; however, it is possible for a person with a cyclothymic diagnosis to develop bipolar II.
dissociation temporary alteration in identity, memory, or consciousness; a temporary disconnection from one’s body and/or physical surroundings. Dissociation exists on a spectrum. It can be caused by stress, depression, sleep deprivation, or trauma. When induced by trauma, dissociation can be seen as the mind’s way of protecting itself from fully experiencing the causative violence or abuse. People who dissociate describe it as an out-of-body experience, as being lost inside themselves, or as simply blanking out and losing chunks of time.
fight-or-flight response a physiological response to real or perceived danger intended to equip one with the ability to flee from or fight the threat by increasing propensities for awareness, speed, strength, and withstanding pain (pain threshold). It is also known as hyperarousal and acute stress response.
The fight-or-flight response is a product of evolution. It is a function of the sympathetic nervous system. This is part of the autonomic nervous system, which controls the basic visceral functions of the body including heart rate, respiratory rate, pupil dilation, perspiration, and sexual arousal. As such, the fight-or-flight response is automatic and involuntary.
When the response is triggered, the sympathetic nervous system goes into high alert as nerve cells fire signals to other parts of the body. The brain produces neurotransmitters known as endorphins, which diminish sensitivity to pain. The adrenal gland ups production of the hormones adrenaline and cortisol and releases them into the bloodstream. Adrenaline boosts heart rate and blood pressure. Cortisol, also known as the “stress hormone,” increases the amount of glucose in the bloodstream and intensifies the brain’s use of glucose. Cortisol also redirects energy from non-vital bodily functions. All of this results in heightened senses, energy, and strength for fighting or fleeing.
This spike in nervous center activity and hormone production creates numerous physiological changes. Heart rate escalates, veins expand, and arteries constrict, increasing blood pressure and circulation. The lungs and breathing passages expand to maximize oxygen intake. Pupils dilate and hair stands on end to improve perception. The digestive system is suppressed as energy is redirected, resulting in a decrease in saliva production known as “dry mouth.” Blood vessels under the skin contract to prevent blood loss from injuries, while perspiration increases in response to heat produced by the metabolic stimulation and in anticipation of physical exertion; this is what causes the skin to feel cold and clammy.
Obviously, all of this enables the physical efforts necessary for survival and safety. Once the danger is thwarted or averted, the amounts of adrenaline and cortisol level off. However, if the fight-or-flight response is repeatedly triggered or triggered for more than a short length of time, it takes an enormous toll on the body. It taxes the cardiovascular system, which can result in hypertension and heart attacks. Cortisol redirects energy from other bodily functions, which in the long term can have many adverse effects. It redirects energy from the immune system, so repeated triggering of the response will diminish the body’s ability to fight illness and repair itself. Because it redirects energy from the digestive system, heightened amounts of cortisol can cause weight gain and digestion problems such as Irritable Bowel Syndrome.
Over-stimulating the fight-or-flight response also negatively affects the brain. Too much adrenaline creates a state of hyper-awareness and exaggerated perceptions of danger; the mind literally cannot be calm. This can cause anxiety and insomnia. Cortisol redirects energy from the hippocampus, which controls the brain’s ability to make memories. In addition, heightened cortisol levels interfere with neurotransmitter activity, which can further hinder the brain’s efforts to make and retain memories.
flashback an abrupt and intense recollection of a traumatic event that can engage all of the senses: sights, sounds, smells, tastes, and physical sensations. They are a common symptom of post-traumatic stress disorder.
It is not accurate to classify flashbacks as memories. Flashbacks are involuntary and intrusive. They can completely take over the sufferer’s consciousness. They are more like reliving an experience than remembering it; the sufferer may feel literally transported back to the trauma-inducing event. They are flooded with the same emotions they felt at the time: numbness, terror, helplessness, bewilderment, etc. Their fight-or-flight response is usually activated. When having a flashback, sufferers may dissociate, become hysterical, or reenact the trauma-inducing experience.
Flashbacks can be actuated by psychotropic drugs, particularly hallucinogens. They can also be brought on by discussing the source of the trauma or encountering something associated with the traumatic experience (trigger). However, flashbacks can also occur without any external triggers.
Flashbacks usually leave the sufferer feeling shaky and anxious. It is not uncommon to suffer from panic attacks, insomnia, dissociation, and/or nightmares in the wake of a flashback. Flashbacks stir up trauma and bring it to the surface, so it makes sense that sufferers may also experience other symptoms of PTSD.
Flashbacks indicate the need to resolve trauma. Experiences that cause trauma overwhelm the mind, and for that reason they are not properly processed and remain unresolved. This is especially true for children, whose cognitive functions are still developing and who may not have the ability to identify, much less understand, what has happened to them.
Flashbacks can be mitigated in several ways. Resolving one’s trauma is vital, but it is a painful, long-term process and examining the roots of trauma may result in a temporary increase in intensity of PTSD symptoms. A person working through their trauma should be prepared for this.
Flashbacks can be managed similarly to panic attacks. Sufferers should identify and then avoid or minimize triggers. They can utilize dialectical behavioral exercises such as redirection: do something that causes an intense but harmless physical sensation, such as immersing their hands in a bucket of ice. They can also employ cognitive behavioral exercises to refocus their minds; one technique is memory games like rote recitations of the names of state capitals in alphabetical order. Diaphragmatic breathing lowers heart and respiratory rates, counteracting the physiological changes caused by fight-or-flight response. Sufferers should talk to their loved ones about their flashbacks and work together on an action plan to manage them when they occur.
hedonic set point standard level of happiness and contentment when not manic or depressed. Hedonic set points can be positively influenced by regular cognitive behavioral and/or dialectical behavioral exercises.
hypomania an elevated mood that is not as extreme as mania. A hypomanic person demonstrates some or all of the traits associated with mania: euphoria, hyper-productivity, impulsivity, pressured speech, charisma, confidence, gregariousness, decreased need and/or ability to sleep, agitation, anxiety, and racing thoughts–but to to a lesser extent than full-blown mania.
A person in the grip of mania can go days without sleep, often has delusions of grandeur and/or persecution, will work without stopping, and has so many thoughts and ideas that they can’t keep up with their own mind. Sufferers may have complete breaks with reality (psychosis) and be so overwhelmed by their own thoughts and anxiety that they cannot function. Because it is less severe, hypomania is harder to identify, especially since a lot of hypomanic people seem to be functioning well. People with bipolar II often do not see their hypomania as problematic and will not seek treatment until they are severely depressed; this is primarily why they are commonly misdiagnosed with unipolar depression.
Hypomania is like the uphill ascent of a roller coaster, and if left unchecked will develop into full-blown mania in people with bipolar I. For people with a bipolar II diagnosis, hypomania will result in a crash into major depression without a manic episode. It is not unheard of for people with a bipolar II diagnosis to surpass hypomania and become floridly manic, in which case their diagnosis may be changed to bipolar I. Either way, a person with a bipolar diagnosis must learn to identify when they are becoming hypomanic and manage the upward mood swing with some or all of the following: cognitive and dialectical behavioral exercises, calming activities such as yoga and meditation, an adjustment in medication, changes in diet and caffeine intake, monitoring their mood with a mood chart or journal, avoiding or minimizing stressful and over-stimulating activities, and regulating work and sleep schedules.
night terrors sleep disorder in which a person experiences a state of severe panic and fear while sleeping. A person suffering from night terrors may scream, cry, bolt upright in bed, open their eyes, thrash around, even sleepwalk, without waking up. Also known as sleep terrors and pavor nocturnus.
Unlike nightmares, night terrors occur during the non-REM cycles of sleep, usually within the first third of the sleep cycle. Like sleepwalking, they are classified as a parasomatic occurrence. People experiencing night terrors evince physiological changes associated with fight-or-flight syndrome: increased perspiration and accelerated heart and breathing rates. They usually don’t know what caused their fear or remember having the night terrors when they awake the next day.
Night terrors can be caused by stress and are a common symptom of post-traumatic stress disorder. It is not unusual for children between the ages of three and twelve to suffer from night terrors, whether or not they have PTSD. Children who experience night terrors tend to do so more when they are between the ages of three and five and outgrow them by the time they reach adolescence (if the child suffers night terrors more than once a week, or if the night terrors do not dissipate as the child matures, they may need to be screened for post-traumatic stress disorder.)
When witnessing a person experiencing night terrors, one’s first instinct is usually to wake them up, but this is not recommended. Awakening someone in the midst of night terrors can actually be dangerous; since the sufferer is disoriented and terrified, it is not uncommon for them to flail, kick, or punch. It could also increase their fear. Shouting, scolding, and forcing physical contact are counter-productive.
Instead of trying to wake someone experiencing night terrors, doctors recommend the following: turn on soft lighting so that the sufferer isn’t frightened or disoriented further by darkness and shadows; move anything that the person could hurt themselves with out of the way; repeat soothing comments such as “you’re safe,” “you’re all right”; and monitor them until they settle back into normal sleep. Physical contact is not usually advised, but it can be helpful once the sufferer quiets down. The key is to be as calm, soothing, and non-threatening as possible.
panic attack an intense episode of extreme fear and panic lasting from around ten minutes to a few hours. The body’s sympathetic nervous system produces the same physiological changes seen in fight-or-flight response, the difference being that panic attacks are not necessarily triggered by perceived danger and may not abate after a short length of time. Unlike the fight-or-flight response, panic attacks serve no evolutionary function.
Physical symptoms include rapid heart rate, hyperventilation, clammy skin, tunnel vision, tightness in the chest, and light-headedness. The mind is on high alert with racing thoughts and exaggerated perceptions of danger. The sufferer may dissociate or feel disconnected from reality. Many people experiencing their first panic attack assume they are having a heart attack or nervous breakdown.
There is no one known cause of panic attacks. They can be triggered by extreme stress or a perception of danger, but they can also occur seemingly out of nowhere. Heredity, stress, previous experiences of psychological trauma, and exposure to danger over extended lengths of time increase the risk of panic attacks. Being predisposed to passivity in communication and interpersonal relationships may also be a factor, with the attack occurring as a manifestation of internalized anger and anxiety. It is possible to have a single panic attack without recurrence, but most sufferers are likely to experience repeat attacks.
Diaphragmatic breathing and tranquilizers such as Lorazepam can mitigate panic attacks. Cognitive behavioral techniques, dialectical behavioral techniques, meditation, and exercise can reduce intensity and recurrences. The sufferer should identify likely triggers and sources of stress and take the necessary steps to avoid or minimize them. Besides stress management and reduction, a key factor in counteracting panic attacks is awareness of the physical symptoms and racing thoughts that signal the onset of an attack. When implemented early, breathing techniques and therapeutic exercises may stave off panic attacks.
pressured speech the rapid-fire flow of speech commonly exhibited by people who are manic or hypomanic. The speech may be difficult or impossible to follow. A manic or hypomanic person engaging in pressured speech is filled with an urgent need to express themselves; they usually dominate discussions and may not accept or notice interruption. Their speech tends to follow their racing thoughts and is marked by endless extrapolation and/or a stream-of-consciousness-like shift in focus. People on the receiving end of pressured speech often feel that they are being talked at as opposed to talked to.
psychosis a total break with reality, often including delusions (false beliefs) and/or hallucinations. While psychosis is usually associated with schizophrenia, people with bipolar disorder are also at risk of experiencing psychosis when they are at the heights of mania or in the depths of depression. When in the clutches of psychosis, the sufferer may dissociate, forget who or where they are, or create a fictional reality for themselves. They might experience memories and past events as a current reality. They may conflate fantasy with reality and place exaggerated importance on symbolic and artistic associations and implications.
The delusions may be ones of grandeur when manic: believing you are invincible, thinking you can simultaneously accomplish an impossible amount of Herculean tasks, thinking you are capable of anything, etc. A depression-induced psychosis tends to run the other way, with the sufferer believing they are evil, they are displeasing to God, etc.
People experiencing psychosis may also have delusions of persecution. They might think that everyone is talking about and judging them, that the people they love no longer love them or are against them, that forces–up to and including God or gods–are aligning to undermine or destroy them. Anxiety and trauma will exacerbate this sense of persecution.
It is possible for someone with bipolar to hallucinate when psychotic. People with bipolar disorder are more likely to hallucinate while manic, but it is possible to hallucinate when suffering from both moderate and severe depression. The hallucinations are usually visual or auditory.
post-traumatic stress disorder (PTSD) an anxiety disorder caused by experiences or witnessing events that result in psychological trauma. Symptoms of PTSD include increased anxiety, emotional sensitivity, panic attacks, dissociation, night terrors, phobias, and flashbacks.
Sufferers of PTSD include survivors of physical, sexual, and emotional abuse and people whose professions involve constant danger such as soldiers, fire fighters, and law enforcement officers. People who have survived calamities such as natural disasters and car accidents can also suffer from PTSD. Not everyone who experiences these things will suffer from PTSD, nor will everyone who does suffer from it do so in the same way or to the same extent. How PTSD manifests depends on a variety of factors including temperament, previous experiences, the presence or absence of emotional support and safety, and mental health.
trauma psychological damage caused by seeing or experiencing something that intensely threatens one’s sense of safety and overwhelms their ability to integrate an emotional response. From the Greek word trauma, meaning “wound.”
Trauma can be caused by singular occurrences such as violent assaults, natural disasters, or car accidents. Events are more likely to cause trauma if they happen during childhood, befall someone who already has a history of trauma, are unpredictable, or are repeated. Man-made catastrophes and acts of violence, especially those involving caregivers, loved ones, and authority figures, are more likely to cause trauma than natural ones.
Trauma is highly subjective in that it depends on a person’s perception of an event. While two people may undergo the same experience, one may have a traumatic reaction to it while the other may not. This depends not only on the aforementioned variables but also on the degree to which one feels endangered; the stronger the sense of vulnerability, the more likely the trauma.
Effects of trauma include increased anxiety, emotional sensitivity, panic attacks, dissociation, night terrors, phobias, and flashbacks. People suffering from trauma may engage in self-injurious behavior or reenact the experienced abuse against others. Extended, severe reactions to trauma manifest as an anxiety disorder called post-traumatic stress disorder (PTSD).
trigger something that “triggers” the symptoms of trauma by reminding the sufferer of the trauma-inducing experience. When someone with trauma encounters a trigger, they may experience any to all of the symptoms of PTSD: flashbacks, panic attacks, anxiety, and/or dissociation. The sufferer’s reaction may be mild to severe depending on their mental state, stress level, distance from the trauma, how unexpected the trigger is, etc.
Some triggers are obvious. Media is a big one: a person with PTSD caused by combat should probably avoid war movies with realistic battle sequences, while a person with trauma resulting from sexual assault would be well-served not to watch Law & Order: SVU. Poems, paintings, plays, songs–any kind of art or media could be triggering. Sometimes, triggers are small details that have personal traumatic significance: smells, sounds, a specific phrase, or sensations can also be triggering. The place in which the traumatic experience occurred could itself be triggering: a survivor of childhood sexual abuse could be triggered by revisiting their childhood home.
A person with trauma must identify triggers in order to manage their responses. Pay attention to what the triggers are and why, specifically, they’re triggering. Read film reviews to check movies for their content before seeing them. Sometimes the trigger is something that can be avoided or at least minimized; however, depending on what the trigger is and how necessary it is to encounter it, the sufferer may need to learn to manage their responses with dialectical behavioral and cognitive behavioral exercises.
Kintsukuroi 
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