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Diagnosed nearly two decades ago, Victoria Maxwell shares what she’s learned about living with bipolar disorder.

Living with bipolar disorder is an ongoing life struggle, but Victoria Maxwell has turned her personal story into art.

Maxwell, now 43, of Vancouver, British Columbia, Canada, was diagnosed with bipolar disorder in 1992. “It probably took five or six years for me to come to terms [with] the diagnosis and the fact that I had a mental illness,” she says.

Originally trained as an actor, Maxwell later trained as a mental health worker and ended up writing three one-person plays about coping with bipolar disorder —Crazy For Life; Funny, You Don’t Look Crazy; and a third as-yet unnamed play scheduled to premiere in October 2010.

“I have been presenting my plays at health conferences, to give people insight into what it’s like to live with bipolar disorder,” Maxwell says. “I never thought I would get back into acting. It just happened to work out that the skills I’ve been trained in are an advantage to what I’ve been trained to do.”

Living With Bipolar Disorder: Before the Diagnosis

Prior to her diagnosis, Maxwell had been going through severe depressive episodes. She was oversleeping, wrestling with fatigue and hopelessness, andbinge eating. Following a meditation retreat, Maxwell experienced a mood swinginto mania. She began thinking and speaking very quickly, having odd thoughts and delusions, getting very little sleep, and becoming very promiscuous.

Her manic swing ended in a full-fledged psychosis. “It was so vivid. I really thought I was supposed to meet God,” she says. In the grip of the psychotic episode, Maxwell stripped off her clothes and ran down the street naked.

“I was lucky, I guess, that I did it in a very safe neighborhood, but I was caught by police and taken to the hospital,” she remembers. “Obviously, that was a very big wake-up call.” Maxwell’s first reaction to her diagnosis was denial. “I didn’t really agree with the doctors. I just felt it had to be something else other than mental illness.”

Her family recognized and accepted her bipolar disorder years before she was willing to. “My mom was diagnosed with bipolar when I was 8 or 9 and she got treatment,” Maxwell explains. “Their acceptance of it did not necessarily help me out. [But] they did everything they could to help me see what I was going through.”

Part of that support involved inviting her to come back home to live while she dealt with her bipolar disorder. “It meant I had a stable place to stay,” she says. “It was a safe place that wasn’t around drugs or alcohol. They gave me some parameters — they set some good boundaries for me, and I didn’t walk all over them.”

Maxwell’s bipolar disorder also helped her discover who her true friends were. “I had some friends stay and support me, a couple of friends in particular. I burned a lot of bridges and lost friends,” she recalls. “I was doing very odd and unusual behaviors that I think could make people uncomfortable, and they didn’t know what to do.”

Getting the Right Bipolar Treatment

Before she got serious about her treatment, Maxwell flirted with alternative therapies. “I tried a lot of different things,” she says, including Reiki and taking St. John’s wort and valerian. “None of the alternative stuff was able to take root, so the things I tried didn’t work. They didn’t seem strong enough to affect long-term change. But to be honest, I didn’t give it a fair shot.”

Coping with bipolar disorder is an ongoing challenge for Maxwell. “My energy level still fluctuates a lot,” she says. “There are times when I may only be able to work for only two hours or four hours. The benefit of being self-employed is that I can set my own hours.”

Maxwell’s husband also provides invaluable support. “He’s quite good at checking in with me,” she says. “What happens often is when I’m working I end up getting carried away with work. He’ll sort of tap me on the shoulder and say, ‘You didn’t go to bed until 11:30 or midnight and then you got up at 6.’ I’ll say, ‘Yeah, I need a nap, I need to go to bed early.'”

Maxwell currently takes a mood-stabilizing, anti-epileptic drug as well as an antidepressant. She also sees a psychiatrist for cognitive-behavioral therapy and talk therapy and finds that regular physical activity helps, explaining that exercise has become a big part of coping with bipolar disorder. “I run — I’m not an excessive exerciser, but I run two to three times a week. That’s something that has helped me manage my mood,” Maxwell says.

Maxwell hasn’t needed to try any of the newer treatments for bipolar disorder, but she expects that might change in the near future. “I anticipate that as I get closer to menopause, I will need to be more vigilant,” she says.

She is concerned that those who need to take medication might be misunderstood or looked at as different by the general population, rather than supported for their commitment to getting treatment. “I think sometimes people are worried about what medication can do,” Maxwell says. “Just because we have a mental illness doesn’t mean we’re violent and doesn’t mean we’re unpredictable. Lots of people are good workers, dedicated to managing their illness. You don’t know about it because they’re managing it well, and they are as reliable as anybody else. It’s possible to have a really enjoyable life, a good quality of life, even when you have to manage a mental illness.”

When people think of treating depression, it’s often thought that the best treatment comes in a bottle. But that’s not necessarily true, and some of the key triggers that can help eliminate depression are simple life changes.

To begin with, one of the biggest changes a person can make in their lifestyle to help combat depression is to get enough sleep. There’s nothing like being awake all night to put one in a bad mood. Going to bed at the same time each day, turning off the phone, TV and computer screen a bit earlier than a person is used to is a great first step towards eliminating depression.

Another important change a person can make to eliminate depression is getting more exercise. It’s well known that exercise is valuable for an overall healthy body, but it also has many mood-boosting effects. A person doesn’t need to run a marathon to gain the benefits of exercise, but exercising a few times a week will reduce a person’s cortisol levels (a body’s stress hormone).

Changing one’s diet is also necessary to help eliminate depression. One of the biggest factors to someone’s health is their blood sugar level. Eating a sugary snack that results in a spike and a crash an hour later is enough to put anyone in a miserable mood. It’s now thought that sugar may play a bigger role in depression than previously thought. So eating healthy snacks, especially ones that are a good source of protein, is certainly a good way to help eliminate depression.

Another important part of a person’s diet is healthy fat. Omega-3 polyunsaturated fatty acids, similar to those found in fish, help reduce depression symptoms. Flaxseeds are also an excellent source of omega-3s, as are walnuts.

Lastly, one of the biggest triggers to eliminating depression is finding a passion and purpose for life. Eating healthy, getting enough sleep and exercising will help with boosting a person’s mood, but having a sense of purpose, a reason to get up every day, is key to combating and eliminating depression. This type of change is probably the most difficult to accomplish, so people need to really find something that they enjoy doing. Whether that be changing careers, or finding a hobby that they truly enjoy, making these changes will give them a sense of purpose and meaning.

Depression is a difficult condition to overcome, and those who battle it on a daily basis often times feel that there is no hope. Seeking out medical help will certainly be beneficial to battling and eventually eliminating depression from their lives, but making these small, but meaningful life changes will certainly play a big role in overcoming this condition. People looking to make these changes should start small by choosing one of these triggers and initiating that change. Each time they feel a sense of accomplishment in that change, move on to the next one. Eventually combining all of these triggers and working them into one’s daily lifestyle will help them move past depression once and for all.

Obsessive-compulsive disorders are a group of psychiatric disorders characterized by some combination of repetitive thoughts, distressing emotions, and compulsive behaviors. The specific types of thoughts, emotions, and behaviors vary according to each disorder within this group.

The idea of a spectrum of disorders with obsessive-compulsive features is nothing new. Indeed, evidence spanning over a 20-year period has continued to accumulate. This research supports the theoretical and clinical utility of grouping these disorders together. As research continues, the types of disorders included in this group may change. Moreover, our understanding of this obsessive-compulsive spectrum will continue to be refined.

The Diagnostic and Statistical Manual of Mental Disorders- Edition 5 (DSM-5; APA, 2013) places these disorders into a category called obsessive-compulsive and related disorders (OCRDs). The DSM-5 is a manual used by mental health professionals to diagnosis mental disorders. The primary purpose of theDSM-5 is to help clinicians reliably identify and diagnose various mental disorders.

Each disorder in the DSM-5 includes a list of symptoms associated with that disorder. The manual also includes additional features of the disorder (e.g., age of onset, family history, etc.). It further provides criteria for distinguishing the disorders from each other. This is particularly important as many mental disorders share similar symptoms. Accurate diagnosis aids clinicians to identify which people may benefit from treatment. Perhaps more importantly, it helps clinicians select the most effective treatment approach. Just as there are many cancers with different methods of effective treatments, so too are there many mental disorders with different forms of effective treatments.

The following disorders are included in the DSM-5 category called obsessive-compulsive and related disorders category (OCRDs):

• obsessive compulsive disorder (OCD);
• body dysmorphic disorder (BDD);
• hoarding disorder;
• trichotillomania (hair pulling); and,
• excoriation (skin picking) disorder.

In addition, several other “lower order” disorders are included in this category:

• substance/medication-induced obsessive-compulsive related disorder;
• obsessive-compulsive and related disorder due to another medical condition;
• other specified obsessive and compulsive and related disorders; and,
• unspecified obsessive-compulsive and related disorders (such as body-focused repetitive behavior disorder and obsessional jealousy).

Decisions about which disorders are grouped together in the DSM-5 are based on whether there is some underlying relationship between two or more disorders. In other words, do these disorders have something in common with each other? With respect to mental disorders, there are several things that suggest a similarity between disorders. Some examples are: symptom similarity; frequency of co-occurrence (called comorbidity); the onset and usual pattern of the disorder; genetic risk factors; environmental risk factors; neural substrates, biological markers; and treatment response. To date, the strongest evidence for similarities among the OCRDs comes from symptom similarity, as well as the high degree of co-occurrence (comorbidity) among the disorders.

It is interesting to note the rationale used to organize the entire DSM-5 manual is similar to the rationale used for grouping the obsessive-compulsive and related disorders (OCRDs) together. For example, the chapter on anxiety disorders precedes the chapter on OCRDS. The purpose behind this placement is to inform clinicians there is a similarity between anxiety disorders and OCRDs. While anxiety is a key feature in OCRDs, there are enough unique differences between anxiety disorders (e.g., panic disorder, social phobia) and OCRDs to justify a separate category.

To recap, the hallmark features of OCRDs are repetitive thoughts, distressing emotions, and compulsive behaviors. Although there is symptom similarity and overlap, each disorder has its own unique features. These differences affect treatment decisions in several ways: 1) the choice of treatment type; 2) the ordering, and pacing of therapeutic interventions; and, 3) setting realistic goals and expectations for clinicians, patients, and family members about treatment progress. These differences are discussed in the treatment section.

In the next section, we describe the diagnostic criteria for OCRDs. We also compare and contrast the disorders to highlight their similarities and differences.