What Is Midlife Crisis?

Summaries of Midlife Crisis

•       Midlife Crisis Test
•       Components of Midlife Crisis
•       Parker-Pope, Tara.  “The Midlife Crisis Goes Global.”
•       Summary of Conway’s Stages of Midlife Crisis
•       Stumpf, K-R. “Stages of Midlife Crisis.”

Testimonials from MLCers and their spouses

•       Forum post from a woman whose father battled depression
•       MLC Script:  The reasons spouses give for leaving
•       Forum posts from the spouses of MLCers
•       Responses to Huffington Post article on midlife crisis
•       Forum posts on how MLCers use Facebook
•       A female MLCer’s story
•       A male MLCer’s story
•       Another male MLCer’s story
•       Return stories and length of time to reconnection

The Biochemistry of Midlife Crisis

•       “Holy Hormones Honey!”:  the relationship between anger and dropping testosterone
•       Costa and McCrae Normative Aging Study
•      selection from Carver, Joseph, PhD.  “The Chemical Imbalance in Mental Health Problems”
•       Gardner, Amanda. “Depression in Middle Age Linked to Dementia.”
•       Coles, Jeremy.  “Great Apes May Have ‘Mid-Life Crisis,’ A Study Suggests,” on the biological basis of midlife crisis
•      “Genes ‘Play Key Happiness Role,’” on the genetic predisposition toward happiness or unhappiness
•       Nauert, Rick.  “Immune Disorders Tied to Mental Illness?”

The Psychology of Midlife Crisis

•       Engs, R. C. “What Are Addictive Behaviors?”
•       Pittman, Frank.  “Beyond Betrayal:  Life After Infidelity,” on the link between depression and infidelity
•       Folk-Williams, John.  “Why Depressed Men Leave.”
•       Carver, Joseph, PhD.  “Depression:  Causes, Symptoms and Treatment.”
•       Bipolar Disorder

Typical MLC:  What You Might See and Hear

•       Signs of Depression in MLC

Signs of Depression in MLC

#1: MEN IN MIDLIFE CRISIS WILL OFTEN VIEW THEIR LEFT-BEHIND SPOUSE AND THEMSELVES AS ONE PERSON

The man in midlife crisis’ lack of boundaries comes from not viewing his spouse as separate from himself. He is so engulfed in negativity that he does not think clearly. As the man in midlife crisis looks to his loved ones to define and deliver his happiness, he eventually feels betrayed, because happiness must come from inside oneself, not from others. This feeling of betrayal may cause some of the anger we see in our men in midlife crisis.

#2: MEN IN MIDLIFE CRISIS ARE UNABLE TO SUSTAIN AND MAINTAIN RELATIONSHIPS AS WELL AS RESOLVE RELATIONSHIP PROBLEMS.

Because of his irrational ways of thinking, mainly due to a chemical imbalance in the brain, the man in midlife crisis will hear/interpret WHAT HE THINKS others are saying rather than hearing what really is being said. He destroys relationships by hearing blame rather than suggestions or means to problem-solve.

#3: MEN IN MIDLIFE CRISIS HAVE DEPENDENT PERSONALITIES.

We are overly dependent on others when we do not feel complete or whole. This is the very essence of a man in midlife crisis. As he continues through the tunnel, the man in midlife crisis gets much worse before he gets better. The left-behind spouse is often forced into a caregiver role, trying desperately to fix the crisis. The man in midlife crisis becomes aware of his neediness and becomes jealous/envious of his loved ones’ strengths and efforts to help, and responds with more anger.

#4: MEN IN MIDLIFE CRISIS ARE UNABLE TO SHOW EMOTIONAL SUPPORT

The man in midlife crisis is unable to stand the emotional pain he is creating. He becomes distant and indifferent to his loved ones. He views the left-behind spouse as the cause of his suffering and therefore treats her as the enemy.

#5: MEN IN MIDLIFE CRISIS ARE EXTREME ATTENTION SEEKERS

Attention, both positive and negative, can confirm love and self-worth to the mid-lifer. To some men in midlife crisis, negative attention becomes better than no attention. Many have experienced "no attention" periods in their childhoods. Many men in midlife crisis use drama, sinfulness and confusion in an effort to get love. This then ensures the mid-lifer of keeping the left-behind spouse close.

#6: MEN IN MIDLIFE CRISIS ARE SELF-CENTERED

It is all about him. As he becomes more absorbed in finding himself, everyone else in his past life gradually becomes more and more obsolete. Most find their way back to what is really important - family and commitment. Unfortunately, they leave a heavy path of destruction that has to be faced.

#7: MEN IN MIDLIFE CRISIS ARE UNABLE TO TRUST

How can the man in midlife crisis trust his left-behind spouse if he cannot trust himself? His emotions and thought processes are unpredictable and irrational. When he cannot trust, he often acts out in angry outbursts and infidelity. He is searching for someone to see him as a perfect hero.

#8: MEN IN MIDLIFE CRISIS ARE UNABLE TO HANDLE STRESS

As the man in midlife crisis progresses through the tunnel, he becomes more and more unable to handle stress. His life is now full of lies, deceptions, betrayals and manipulations. It becomes harder and harder to maintain his superficial world. When he is reminded of his inabilities and flaws, he reacts by getting angry, blaming, spewing, etc...

He will do anything to avoid taking responsibility for his actions. If you doubt this, try having a  "relationship talk." You will no doubt be disappointed in the outcome. Until he is ready to repent and show remorse for his behavior, relationship talks are useless.

#9: MEN IN MIDLIFE CRISIS REWRITE HISTORY

The man in midlife crisis typically has very low self-esteem. He will rewrite past events in his favor to try to build up his fragile ego. He would rather lie than face the possibility that something is wrong with him, let alone a mental illness. His brain chemistry is skewed, not allowing him to distinguish between reality and distorted perceptions. However, the distortions cannot go on forever. ... As time goes on, he often gets caught in his lies because he cannot keep his stories straight.

#10: MOST MEN IN MIDLIFE CRISIS HAVE AFFAIRS

The most painful and devastating part of the midlife crisis for the left-behind spouse, children and family is the affair or series of affairs. Emotional affairs as well as physical affairs occur, and most emotional affairs turn into physical affairs for the mid-lifer. Some of the affairs produce a "love child.” Some result in the mid-lifer marrying the other woman. Even though the mid-lifer is not thinking clearly, there is no justification or excuse for committing adultery. This is by no means meant to excuse his behavior. It is unacceptable. Forgiveness depends upon the abandoned spouse and the mid-lifer’s ability to repent and show sincere remorse.

An affair allows the mid-lifer a distraction from the pain resulting from one or more of the following issues: childhood abandonment/abuse, grief, aging, health, job loss or dissatisfaction, parenting, sexual dysfunction or financial difficulties. The man in midlife crisis feels if he starts over with someone else, all his issues will go away. Little does he realize how much he has just complicated his life, not to mention all the pain he will inflict on "loved ones" and friends. He is self-absorbed and only cares about trying to obtain his own happiness.

The other woman knows little or nothing of his history or flaws. The mid-lifer feeds the other woman rewritten history about his spouse. She starts the relationship by idealizing the mid-lifer. The mid-lifer can portray himself as heroic, perfect and accomplished. Both individuals are living a fantasy. Each believes they have found their soul mate. A new relationship and sex partner is empowering. Morality is no longer important. Lust equals love in the MLC mind.

The other woman is an extremely flawed individual. She has many issues as well, some identical to the mid-lifer’s, which helps create the connection so many men in midlife crisis claim they are missing with their left-behind spouse. The man in midlife crisis chooses someone who is safe. He chooses someone who will not outshine him or pose a threat. The other woman is usually a very insecure, fragile individual who needs to be taken care of in some way, shape or form. In many cases, the mid-lifer tries to create in the other woman a version of spouse he abandoned. Some encourage her to dress and act like the left-behind spouse. They will often take them to the same places as they did the left-behind spouse. Being of weak character and integrity, the other woman allows this and goes along for the ride. Many are in it for the financial and social status benefits that the mid-lifer brings to the table. The mid-lifer is usually not looking to find someone better than his spouse. He wants to find someone that he can feel superior to, which will help nurture his bruised ego.

Eventually, chemical imbalances, stress, and doses of reality hit the mid-lifer, causing him to display his true self. Fears resurface in the mid-lifer, materializing as anger and hostility. The other woman no longer reflects back to the mid-lifer intense feelings of admiration and perfection. Sex becomes routine. Many experience sexual dysfunction during the MLC, but very much want to portray themselves as sexually potent individuals. Responsibilities increase for the mid-lifer, especially if he is maintaining two households. His world collapses very slowly, almost to the point of being hard to detect for the left-behind spouse. The mid-lifer has come full circle. He is now at the same place he started. What the mid-lifer does at this point varies. Some go home after they realize the grass is not greener on the other side, others stay in this miserable state of self-pity and despair, and others just repeat the cycle and find another other woman.

#11: MEN IN MIDLIFE CRISIS ARE CONTROL FREAKS

The man in midlife crisis has no control over his behavior and actions. He feels if he can control others as well as his environment, he will eventually become whole again. This of course is not true. In fact, it usually has the opposite effect. The more controlling one is with others, the more we push him away.

How does the mid-lifer control others? By being verbally/physically abusive, manipulating, complaining, criticizing, blaming, saying things like "I want a divorce,” "I don’t love you,” having an affair, threatening to take your children away, threatening your living arrangements, threatening your financial status, losing his job, threatening suicide, etc.

How does the mid-lifer control his environment? Moving constantly, traveling more than usual, changing jobs, changing what he eats/how he dresses/his overall appearance/what he drives, changing his friends, replacing his spouse, replacing his children, etc.

It is only when the mid-lifer realizes that he is not in ultimate control of others or things that a breakthrough can occur. That is why setting boundaries is important. It makes the mid-lifer realize his limitations and lack of control. Boundaries should be set in a firm but loving way. The man in midlife crisis is more willing to respond to the left-behind spouse’s requests when this is done in a non-authoritative way.

#12: MEN IN MIDLIFE CRISIS HAVE EXTREME ANGER/RAGING/SPEWING

Mid-life crisis is a form of depression. Depression is anger turned inward. Unfortunately, anger is a large part of the MLC journey. Anger is the path of least resistance. It is easier for the mid-lifer to be angry than to deal with his issues. Until that pain is acknowledged and experienced, it continues to trigger anger and depression.

Beneath anger lies pain, and beneath that pain lies fear. If we remember this, we are more likely to become more sympathetic to the man in his midlife crisis journey. Unfortunately at times, it is very difficult to do. The bulk of his anger is directed at the left-behind spouse. The man in midlife crisis very much wants to alter his spouse’s perceptions to match his own.

#13: MEN IN MIDLIFE CRISIS ARE INDIFFERENT

Indifferent is defined as "without interest or concern, not caring, disinterested, impartial and apathetic.” Nothing is harder to live with than an indifferent person. The man in midlife crisis is indifferent primarily toward his past life. He is no longer interested in what his spouse, children, relatives, dog, cat, best friend or church group are doing. He could care less about the lawn being cut, the dishes being done or the bills being paid. His past life no longer exists. He becomes an "alien" to the people who love him. There are many reasons why this happens. The man in midlife crisis is self-absorbed and doesn’t want to focus on anyone but himself. The man in midlife crisis no longer wants any responsibility in his life and just wants to have fun and freedom. People and things of the past remind the mid-lifer of his failures. What better way to not have to deal with his pain then to pretend people and things don't exist anymore?

This indifference creates a whole new set of problems for the left-behind spouse. She now has the responsibilities of two people. The left-behind spouse becomes overworked and overwhelmed, not to mention emotionally devastated. Many times she becomes financially devastated as well. The mid-lifer does not seem to notice the turmoil he has caused his spouse and is again indifferent.

#14: MEN IN MIDLIFE CRISIS CAN BE NARCISSISTIC

The mid-lifer is full of low self-worth. By focusing on his appearance, his possessions, and his needs, he tries to project an air of importance and perfection. He seeks attention by focusing on superficial things and soon discovers that these things bring only fleeting moments of happiness. No matter how many times you remind the mid-lifer that happiness comes from within, he tries to prove you wrong by buying the next item or enhancing another body part. Everything is about the mid-lifer. Everybody else's needs don't exist.

#15: MEN IN MIDLIFE CRISIS MAKE POOR DECISIONS

The man in midlife crisis bases his decisions on emotions as well as faulty perceptions due to chemical imbalances in the brain. This prevents him from functioning properly in important areas of his life like the workplace and home. As he makes his way through the midlife tunnel, he makes more and more poor decisions, eventually causing him to doubt his abilities. This is just another hit on his already low self-esteem.

This is where the role of the other woman comes into play. The man in midlife crisis often will give up some of his decision-making power at this point and depend on his "soul mate" to intervene. The other woman may or may not have clearer thinking at this time, but you can bet her thinking will be in HER favor. The mid-lifer is much easier to convince, manipulate and persuade than ever. Since this is not a relationship based on trust and love, each player in this dysfunctional relationship is out for himself/herself.  The man in midlife crisis also will often choose not to make any decisions due to his confusion.

#16: MEN IN MIDLIFE CRISIS ARE POOR MONEY MANAGERS

The man in midlife crisis has no control over what he does with his money. He tends to be very impulsive and often spends like crazy and makes bad investments. He also uses his money to satisfy and impress the other woman in his life as well as newfound friends. Traveling seems to increase. Credit cards are often used to their limit and he has no awareness of the consequences of his debt. His past financial responsibilities, such as bills and supporting his left-behind spouse and children, are put on hold. This is no longer important to him and he seems oblivious to how he affects others. It is important that the left-behind spouse protects herself financially at this time, and sometimes that means resorting to legal assistance to prevent involvement with collection agencies and bankruptcy. Spending serves as a distraction as well as a feeling of power and control to the mid-lifer. Money makes him feel immortal and special. This feeling slowly dissipates as he faces his pain and debt.

#17: MOST MEN IN MIDLIFE CRISIS ARE ABUSIVE

Emotional abuse is is more prevalent than physical abuse during the MLC journey and can be divided into various categories:

A. Withholding: By withholding love, affection, accolades, sex, children, communication, etc., the mid-lifer is saying, “I have something you want and I can withhold it from you.” The mid-lifer can take this even a step further by withholding love and affection from you and then giving it to someone else.

B. Discounting: By discounting the left-behind spouse's perceptions, the mid-lifer is saying, “I can point out your uselessness.”

C. Accusing and blaming: By blaming the left-behind spouse, the mid-lifer is saying his spouse is to blame for his pain regardless of what he does to you, so he doesn’t have to stop or be accountable.

D. Judging and criticizing: By judging the left-behind spouse, the mid-lifer is saying to his wife, “When I tell you that something is wrong with your thoughts and actions, I put myself in charge of you.”

E. Threatening: This a way for the mid-lifer to have control over his spouse, to imply that he will take away something valuable to them, such as family life, financial stability, home, etc.

F. Name Calling: By calling names, the mid-lifer is saying to his wife that she is worthless and doesn’t exist.

G. Denial: By denying what he is doing to you, the mid-lifer can keep everything like it is and not take any responsibility for his behavior.

H. Abusive anger: By being extremely angry and raging, the mid-lifer is saying, “As long as I am scary, I can have my way.”

The most common element of the categories of abuse is control. The mid-lifer avoids his feelings of insecurity and powerlessness by controlling his wife. If the mid-lifer does not have anyone to have power over, he doesn’t have any power. He often connects with someone who is easier to control and who won't resist his need to dominate. It is in debate if a mid-lifer behaves this way intentionally. I think it can vary with the mid-lifer. Some do not seem to have awareness that they are hurting others. Most men in midlife crisis seem to be totally out of character and are labeled "aliens" by their Standers (waiting spouses). The thing that is very confusing to the Stander is that often men in midlife crisis can control these behaviors in front of others, but seem to let loose when alone with the Stander.

#18: MEN IN MIDLIFE CRISIS MAY ABUSE ALCOHOL AND DRUGS

Another escape from reality is the use/abuse of alcohol and drugs. Those who never used on a regular basis may start experimenting with various substances. Those who routinely used may increase their usage of alcohol or drugs or both. Substance abuse may deepen MLC depression, causing more pain and problems. Misery loves company, and many times the mid-lifer will choose to associate with people who also resort to alcohol and drug abuse.

#19: MEN IN MIDLIFE CRISIS CAN EXPERIENCE SEXUAL DYSFUNCTION

Hormonal changes cause the physical symptoms of menopause in women (irregular periods, decreased fertility, etc.). Hormonal changes cause the physical symptoms of andropause in men (decreased bone density, hair loss, etc.). Hormonal changes in both men and women can cause emotional problems such as depression.

Men can go through what is called andropause, or male menopause. Andropause is characterized by a loss of testosterone. This affects some men more than others. Both males and females experience similar symptoms during this time: irritability, loss of libido in women and erection problems in men, sleep disturbances, mood swings and depression. MLC involves hormonal, psychological, interpersonal, social, sexual and spiritual components.

#20: SOME MID-LIFERS EXHIBIT JEALOUSY

Men in midlife crisis exhibit jealousy as a method of control. Many have fears of abandonment and loss. The man in midlife crisis shows jealousy because of his feelings of emptiness. Deep down he is terrified of losing his loved ones but feels it may be inevitable. The man in midlife crisis senses that he will no longer feel needy if he can only control his spouse.

#21: MEN IN MIDLIFE CRISIS ARE FULL OF SELF-PITY

The man in midlife crisis hates himself. He may or may not show this to his wife, but that is what is brewing underneath all his horrible behavior. Often, childhood issues come to the surface and feelings of rejection and abandonment prevail. Because of his self-hate and low self esteem, he has difficulty accepting that his wife cares for him. Some men in midlife crisis will express this by statements such as, "You cannot love me like I need to be loved,” "Why don't you date other people,” "The kids would be better off with a different father,” “Why don’t you hate me,” etc..... He is so involved with his pity party that nothing else matters to him.

#22: MEN IN MIDLIFE CRISIS DON'T WANT ANY RESPONSIBILITY

Before his crisis, the man in midlife crisis was a very responsible, productive member of his home and work environment. Not anymore. Life is a party and he wants to have fun. Many men in midlife crisis lose their jobs, stop working around the house, ignore their children, don't pay their bills, spend foolishly, the list goes on and on. He actually feels that this is the time for him to get everything HE wants out of life and other people need to take care of their own responsibilities. Chemical imbalances cause him to lose focus and control of himself. The left-behind spouse is forced to take on all his responsibilities as well as her own. This is usually not acknowledged by the mid-lifer or appreciated. In fact, he will use this as an opportunity to criticize or cut down his spouse's way of handling things. This gives him the opportunity to disconnect even more from his wife and family. It is only when his world starts falling apart that he realizes how irresponsible he has been in his work and home environments. Guilty feelings will then set in and eventually be processed by the mid-lifer in later stages.

#23: MEN IN MIDLIFE CRISIS ARE VERY SENSITIVE TO CRITICISM

The man in midlife crisis has an intense need to be respected and admired. He is overly sensitive to any suggestions, comments, helpful remarks and criticisms. Any comments even remotely critical are perceived as attacks on his already low self-esteem. The man in midlife crisis will take these "perceived attacks" and deflect them by finding fault in his spouse. Usually these acts of finding fault are either non-existent or exaggerated remarks or incidents.

#24: MEN IN MIDLIFE CRISIS USE PROJECTION AS A DEFENSE MECHANISM

Psychological projection is a defense mechanism in which one attributes one's own unacceptable or unwanted thoughts or/and actions to others. Projection reduces anxiety by allowing the expression of the unwanted subconscious impulses/desires without letting the conscious mind recognize them.

#25: MEN IN MIDLIFE CRISIS CREATE CONFLICT/ARGUMENTS WITH LOVED ONES

The man in midlife crisis creates conflict/arguments with his wife in order to have her respond in a negative way. When the wife responds in a negative way, i.e. anger, crying, panic, criticism, rejection, etc., this enables the mid-lifer to attach blame to wife's normal defensive reactions. This also enables the mid-lifer to justify his horrible behavior to himself and others. For example, my ex started an argument with me one day on the way back from the grocery store. He said I should have been spending time with him alone instead of shopping for food for the kids. I told him how silly he was behaving and became angry. By the time we got home, he was so upset at my "insensitivity to his needs" that he left the house for that day and spent his time with the other woman. Not only was this a way for him to make me look bad, but it was also a way for him to justify being with his "soulmate".

#26: MEN IN MIDLIFE CRISIS ARE IN DENIAL

Along with projection, denial is another major defense mechanism that mid-lifers use. Denial is the psychological process by which human beings protect themselves from things which threaten them by blocking knowledge of those things from their awareness. It is a defense that distorts reality; it keeps us from feeling the pain and uncomfortable truth about things we do not want to face. If we cannot feel or see the consequences of our actions, then everything is fine and we can continue to live without making any changes.

When the man in midlife crisis is feeling bad, he will often associate these painful feelings with his wife instead of taking responsibility for his own actions. Getting rid of his wife seems to be the only way to escape. Denial can become increasingly worse as the mid-lifer continues on his journey. His list of bad behavior and deeds becomes so long that there is no better place to be than the world of denial. The mid-lifer becomes unrecognizable to his loved ones until various circumstances force him to examine the hell he has created. These circumstances may involve excessive debt, unwanted pregnancy, loss of job, fractured family, divorce, drug and alcohol abuse, loss of friends, homelessness, etc.

#27: MEN IN MIDLIFE CRISIS BECOME VERY COMPETITIVE WITH LOVED ONES

When a man is in midlife crisis, his wife becomes the enemy. The man in midlife crisis is constantly comparing his loved ones to himself. Many times he falls short, and this leads to further insecurity and self-doubt. During his journey, he is out to prove that he is important and admired and becomes very competitive. He will withhold compliments toward family members at this time. He begins to bring people into his life that will make him feel good about himself. Usually this means choosing people who are less accomplished and lower in character in order to make him feel better about himself.

#28: MEN IN MIDLIFE CRISIS HAVE MAJOR MOOD SWINGS

Family members who witness this depression sign often feel like they are going insane. The frequency of the mood swings with mid-lifers varies. Some experience rapid cycling, others much slower. Loved ones describe their mid-lifers as having Dr. Jekyll/Mr. Hyde personalities. They begin to feel like they are walking on eggshells. The littlest thing can set the mid-lifer into a rage or period of depression. Some family members may feel their mid-lifer is on drugs. These mood swings may or may not affect the work environment. Some mid-lifers are better at controlling what they let others see. This can leave the left-behind spouse feeling responsible for the mood swings and her world may begin to fill with self-doubt.

#29: MEN IN MIDLIFE CRISIS ARE MANIPULATIVE

People become manipulative when they are afraid of losing something of value to them. This can range from fear of losing an actual person or losing a perception that someone has of them. The mid-lifer manipulates loved ones into believing his reality, which at times can be very distorted due to chemical imbalances in the brain, guilt, shame, denial, self-centeredness, etc. He may twist words around, create confusion, drama, rewrite history, lie. Unfortunately the mid-lifer’s use of manipulation usually ends up pushing people away from him.

#30: MEN IN MIDLIFE CRISIS HAVE WITHDRAWING/ABANDONING BEHAVIORS

Another very painful characteristic of the midlife journey is when he abandons/withdraws from loved ones. This varies with each mid-lifer and changes with each stage. It can range from emotionally withdrawing to physically abandoning his entire family. Many are simply just imitating a part of their childhood when they experienced some form of abandonment or abuse. Many use it as a form of control and power. To some, it is easier to run than face their demons, so they hide to get away from things and people that remind them of their pain or failures. Regardless of the reason, these behaviors leave loved ones shocked and confused. The mid-lifer is oblivious to the pain and suffering he is causing. Many left-behind spouses lose homes, self-esteem and/or children due to the abandonment.

Information on bipolar disorder from Wikipedia and Health Central.

DSM IV Criteria for Bipolar Disorder

Manic episodes are characterized by:

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

• Inflated self-esteem or grandiosity.

• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

• More talkative than usual or pressure to keep talking.

• Insomnia or hypersomnia nearly every day.

• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

• Flight of ideas or subjective experience that thoughts are racing.

• Distractibility (i.e., attention too easily drawn to unimportant/irrelevant external stimuli).

• Increase in goal-directed activity (socially, at work or sexually) or psychomotor agitation.

• Excessive involvement in pleasurable activities that have a high potential for painful consequences (overspending, sexual indiscretions or foolish business investments)

• The symptoms do not meet criteria for a Mixed Episode

• The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

• The symptoms are not due to the direct physiological effects of a substance (e.g., drug abuse, medication or other treatment) or a general medical condition (e.g., hyperthyroidism).

Hypomanic episodes are characterized by:

• A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood.

• During the period of mood disturbance, three (or more) of the symptoms listed above have persisted (four if the mood is only irritable) and have been present to a significant degree.

• The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

• The disturbance in mood and the change in functioning are observable by others.

• The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Impaired awareness of illness

Approximately 40% of individuals with bipolar disorder do not believe they are sick, and that what they think and feel is real. Impaired awareness of illness, or anosognosia is the single largest reason why individuals with bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere. When taking medications, awareness of illness improves.

Denial is a psychological mechanism. Impaired awareness of illness, on the other hand, has a biological basis and is caused by damage to the brain, especially the right brain hemisphere. The specific brain areas which appear to be most involved are the frontal lobe and part of the parietal lobe. Some individuals’ awareness of their illness fluctuates over time, being more aware when they are in remission but losing the awareness when they relapse. Awareness improves amongst those who take medication.

People resist accepting a diagnosis of mental illness because of denial, a common first reaction; because they are grieving the loss of their dreams; because it means accepting the need for long-term treatment; as a means of preserving self-esteem, and because of delusional thinking, poor judgment or poor reality testing.  They resist taking medication because it means admitting that they have a mental illness, because they do not want to relinquish control, and because many manics prefer their unmedicated high-energy state to a lower-energy medicated one.

Manic episodes

Mania is the defining feature of bipolar disorder. Mania is a distinct period of elevated or irritable mood, which can take the form of euphoria, and lasts for at least a week (less if hospitalization is required). People with mania commonly experience an increase in energy and a decreased need for sleep, with many often getting as little as three or four hours of sleep per night. Some can go days without sleeping. A manic person may exhibit pressured speech, with thoughts experienced as racing. They laugh and smile without cause. Attention span is low, and a person in a manic state may be easily distracted. Judgment may be impaired, and sufferers may go on spending sprees, engage in risky behavior that is not normal for them, and make decisions lacking insight. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant, or intrusive. They may feel out of control or unstoppable, or as if they have been "chosen" and are "on a special mission," or have other grandiose or delusional ideas. Sexual drive may increase.

Dysphoric mania, or mixed mania, is the combination of mania and agitated depression.  A person with this mood swing is agitated, uncomfortable, irritated, depressed, pessimistic and filled with negative energy. They don't sleep well, if at all, and ultimately their behaviors are destructive and sometimes life threatening.

False euphoria is the beginning stage of true bipolar disorder.  Behavior is similar to that seen with drug use, a cocaine-like high.  People with euphoric mania say they feel great/wonderful/beautiful/fantastic, but make many mistakes such as recklessly spending too much money, having sex with anyone who looks appealing, sleeping a lot less and not getting tired and ultimately making very poor life decisions.  It's common for people with full-blown euphoric mania to stay up for weeks, start very risky businesses or simply pick up and leave their current life. Euphoric mania can be very cruel and selfish as the emphasis is strictly on the person with bipolar. The person can be extremely reckless and unable to judge the safety or effect of their behaviors. There will be rapid and sometimes violent mood swings, rage alternating with maniacal laughter.  This type of mania can lead to a lot of drug and alcohol use as the person feels so good they lose perspective on the amount they consume. Euphoric mania always starts out feeling great, but ultimately the person comes down and often sees a path of destruction that is hard to clean up. Bipolar patients have difficulty seeing that their behavior is out of line in an acute manic episode. The massive high, which seems abnormal to us, seems normal to them, and there is an unfortunate tendency to self medicate.

At more extreme levels, up to 70% of people in a manic state and 50% of all individuals with bipolar disorder experience psychosis, or a break with reality, along with loss of ability to reason. Of this 70%, over half are euphoric psychotic manias, which are particularly difficult to diagnose as they can be so appealing and fun to the people around the manic person. Manic behavior attracts people who want to join in on the ride. Left unmedicated, people experiencing bipolar psychosis will resist treatment, as they are convinced nothing is wrong with them, they are sure of their reasoning and enjoy the high.  Three-quarters of manic episodes involve delusions wherein the person truly believes in ideas beyond reason or logic. This can occasionally lead to violent behaviors. Some people in a manic state experience severe anxiety and are irritable to the point of rage, while others are euphoric and grandiose. The severity of manic symptoms can be measured by rating scales such as the Altman Self-Rating Mania Scale and clinician-based Young Mania Rating Scale.

During a manic episode, the person's behavior feels "right," obvious and makes very clear sense, even if it makes no sense to those around the patient or is extremely risky. After the manic episode has run its course, it may be possible for the patient to see how unrealistic, unreal and out-of-touch with reality they were, but this isn't possible during a manic episode.

The onset of a manic episode is often foreshadowed by sleep disturbances. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.

Genetic causes

A review seeking to identify the more consistent findings suggested several genes related to serotonin (SLC6A4 and TPH2), dopamine (DRD4 and SLC6A3), glutamate (DAOA and DTNBP1), and cell growth and/or maintenance pathways (NRG1, DISC1 and BDNF), although noting a high risk of false positives in the published literature. It was also suggested that individual genes are likely to have only a small effect and to be involved in some aspect related to the disorder (and a broad range of "normal" human behavior) rather than the disorder per se.

Functional MRI findings suggest that abnormal modulation between ventral prefrontal and limbic regions (amygdala) likely contribute to poor emotional regulation and mood symptoms.

The neurotransmitter associated with psychosis is dopamine.  Antipsychotics that work on the dopamine system effectively decrease psychotic symptoms.  Most researchers believe other neurotransmitters are involved as well:  serotonin and norepinephrine are also closely linked to bipolar disorder.

There are structural differences in the brains of people who experience psychosis. There can be a chronic shut down of the frontal lobes and there is a particular part of the limbic system called the septal area where the dopamine system is especially hyperactive. Antipsychotic medications work by blocking dopamine in this area. The limbic system, the emotional part of the brain, is also central to the causes and ultimately treatment of bipolar psychosis.

Average age of onset of bipolar disorder is 21; first manifestations are common between the ages of 20-24.  Many start feeling depressed between the ages of 15-25.  Symptoms in teenagers focus on lack of judgment and risky behavior:  drunk driving, substance abuse. The younger the age of onset of bipolar disorder, the more likely it is to find a significant family history of bipolar, depression and/or dementia.  In 10% of bipolar cases, a manic episode occurred around age 50. As an individual ages, s/he may develop new-onset mania associated with vascular changes, or become manic only after recurrent depressive episodes. In the elderly, recognition and treatment of bipolar disorder may be complicated by the presence of dementia or the side effects of medications being taken for other conditions.

The vast majority of patients with bipolar disorder have multiple recurrences (Keller et al, 1993), and it is very rare for patients to have a single episode of hypomania or depression in bipolar disorder over a lifetime. The length of symptom-free intervals often decreases with age.

Untreated bipolar disorder is commonly associated with substance use, abuse and dependence (Tohen et al, 1995); school and work failure; interpersonal dysfunction and relationship breakdown. Personality dysfunction could be the result of a turbulent clinical course at crucial stages of development. The lifetime risk of suicide is 10-20% (Tsuang et al, 1978) compared with a suicide risk of 0.01% for the general population; and there is an increased risk of violence and homicide, especially with poorly controlled psychotic bipolar disorder.

Studies have shown a link between bipolar disorder and Tourette’s syndrome, between bipolar disorder and autoimmune thyroid disease, between bipolar and heart disease, and between autoimmune diseases and schizophrenia.

Prevention

There is some debate about a causal relationship between the use of cannabis and bipolar disorder. Substance abuse may predate the appearance of bipolar symptoms.

Caffeine can significantly increase anxiety; it should be limited to 250 mg/day (two cups of coffee or one cup of coffee and one caffeinated soda).

Prevention of bipolar has focused on stress which, although not a diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. Common triggers include alcohol abuse, drug abuse, a stressful work environment, travel across time zones.

Treatment

Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or involuntary.

Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing early symptoms before full-blown recurrence, and helping the patient maintain remission. Cognitive-behavioral therapy and family-focused therapy are the most effective in preventing relapses, while interpersonal and cognitive-behavioral therapy effectively reduce residual depressive symptoms. Treatment during the acute phase can be a particular challenge.

Mood stabilizers reverse manic or depressive episodes and prevent relapses. The “gold standard” mood stabilizer is lithium, which is effective in treating acute manic depressive episodes and preventing relapses. Treatment with lithium carbonate has been strongly linked to a reduced risk of suicide, self-harm, and death in people with bipolar disorder. Lamotrigine has been shown to have some efficacy in treating bipolar depression, and this benefit is greatest in more severe depression. In both acute and long-term treatment, the combination of lithium carbonate (Eskalith), lamotrigine (Lamictal) and aripiprazole (Abilify) is used. New treatments include Repetitive Transcranial Magnetic Stimulation (rTMS), which places electromagnets next to the frontal part of the skull to change underlying brain activity and alter mood.

Bipolar in the family and the workplace

Mood disorders affect not only the bipolar individual, but also his spouse, family, friends and co-workers. The root cause of all these impacts is the degraded ability the victim has to "perform" in these different areas of his/her life. Thus a seriously depressed person will become morose, incommunicative, withdrawn, and unable to participate actively in what is going on. In the depressed phase, family members and friends have to compensate for the loss of social contributions that would be expected of him in the normal family setting.  In the manic phase, the individual argues, spends irresponsibly, ignores commitments and breaks agreements unilaterally.

It is impossible even to estimate the amount of emotional pain, stress and loss family members experience in trying to deal with, and ultimately to help, a mentally ill person in the household. In many cases, their lives are seriously disrupted, becoming a kind of living hell. Family members are confused and alienated by a person not acting like himself, becoming a person they don’t know and can’t communicate with.  Unpredictable moods leave family members feeling like they’re on an out-of-control roller coaster. Perhaps nothing is more awful than to see someone you love severely degraded by an illness you don't fully understand, to do everything you can think of to help, and have none of it work.

There is no cure for bipolar disorder and so the bipolar medication must be taken for life. Finding the right combination of medication may take as long as several years, and over time they may stop working. For family caregivers, coping with someone who is bipolar, manic or depressed, takes a heavy emotional toll and strains the relationship, often to the breaking point.

How can family members help?  Get educated, so you have realistic expectations and coping options. Learn about the illness, its symptoms and early warning signs; learn about treatment and side effects. Make it a family matter:  acknowledge that the illness affects everyone in the family. Help find clinicians, schedule appointments, keep track of medication, report changes in behavior to the doctor.  Let your family member know you are concerned and want to work with him to get well. Take care of yourself.  Find support. Prepare for ups and downs.  Have hope. On the other hand, refuse to take abuse from your loved one.  This is not your fault. Don’t accept anger and blame.

At work, degraded performance shades into incapacity. In a depressive phase, the individual may begin to be routinely late for work, be unable to make decisions or handle the workload on the job, and eventually will be perceived as an unsatisfactory employee. In mania, the individual will make quick but bad decisions based on little or no knowledge or data, will take serious risks with business assets, become insubordinate or otherwise disrupt the normal chain of command, and will be perceived as unreliable, though energetic, and therefore an unacceptable risk. In a manic phase, bipolar sufferers are particularly resistant to seeking treatment.

The loss of a permanent, well-paying job is one of the worst things that can happen to someone with mental illness. First, it means direct loss of income, perhaps the main source of income in the family. Second, it may mean loss of medical insurance, which may be badly needed in the weeks and months ahead. Third, it means an unsatisfactory performance rating in one's personnel file, which may come back to haunt the victim again and again as he/she tries to find further employment. Fourth, it is a serious blow to the self-esteem of a depressive, whereas a manic may not even consider the loss worth notice. These difficulties are all magnified and accelerated if the victim is the principal wage-earner for a family. In such cases, the role and value of the bipolar individual as an effective spouse or parent erodes quickly, and a separation or divorce often ensues.

People with bipolar disorder are at much higher risk for suicide.  Don’t be afraid to ask, "Are you having thoughts of hurting yourself?" and listen for messages of desperation. Depressed people sometimes develop a higher risk for hurting themselves as they begin to get better and their energy level and ability to act improve. Patients having mixed symptoms - depressed mood and agitated, restless, hyperactive behavior - may also be at higher risk for self-harm. Substance abuse, particularly alcohol abuse, increases the risk of self-harm.

The hardest lesson is that there is no way that anyone can force a person to take responsibility for his illness and treatment. Unless the patient makes the commitment to do so, no amount of love, support, understanding, even threatening, can make someone take this step.  It is normal to feel guilty and angry about not being able to get your loved one to seek treatment.

Selection from Carver, Joseph, PhD. “Depression: Causes, Symptoms and Treatment.”

Causes of Depression

Sudden Severe Loss
In this situation, the individual has experienced a sudden, perhaps surprising severe loss. This loss may be the death of a loved one, loss of a job, loss of friendship, or other grief process. In this type of depression, the patient can clearly identify what is creating the depressed mood.

Long-term High Stress Level
In this situation, the patient is depressed but can't quite put their finger on the cause, the "I'm depressed but I don't know why" condition. Imagine running a video tape of your life, reviewing the past 18 months. Look at the stress you've been under, the amount of responsibility, the number of pressures, and the number of hassles. In actual clinical practice, this cause of depression is seen more often than sudden loss. This type of depression creeps up on you. When this type of depression is experienced, the patient offers comments such as: "I don't know what's wrong!" "I don't know how I feel." "My feelings are numb."

Brain Chemistry and Depression

During long-term high stress, the brain burns its oil, serotonin, at a higher rate. The bottom line in depression and stress: The brain burns up more serotonin than it can replace! In the end, after many months of severe stress, the brain is using serotonin faster than it can create/replace it. Your neurochemical level of serotonin drops and you become depressed.

You'll know your serotonin level is low (and depression is here) by the following symptoms:

1. Most depressed folks experience early morning awakening, usually around 4:00 am.  Serotonin, you see, controls our sleep cycle.

2. Concentration and attention will drop. Depressed children/students will experience a drop in grades. You'll start putting odd things in the refrigerator (a bowling ball is the office record!), forget why you went to the grocery, and become very forgetful and scatterbrained at work/home.

3. You'll lose physical energy. You can sleep for ten hours and you'll still be bone tired. You will cry at the drop of a hat - driving down the highway, doing dishes, sitting at work, etc.

4. Sexual interest, appetite, and general interest will rapidly drop. You will stop answering the phone, stop visiting friends/relatives, and pull the blinds.

5. Most dangerous - your mind speed will increase. Your mind will race at what seems like 200 miles per hour. Depressed people often tell their doctor "I can't get my mind to stop!" The minute you wake up in the morning - it will start up. Your brain will then turn against you. It will reach in your memory and pull out every bad memory it can find - abuse as a child, failed relationships, etc. - anything to make you feel bad and especially guilty. You will be tortured by your own thoughts.

6. As your mind speed picks up, the "garbage truck" will arrive. While the brain is already torturing you with the past, it will create/invent new ideas/thoughts to torture you. In every case of depression, if the depression stays long enough, you will receive the same "garbage" thoughts from your mind.

You will be told:
- you are a burden to your family/friends
- you have failed/disappointed your family
- no one really cares about you
- your children would be better raised by someone else
- your family would be better off without you
- your spouse would be better off without you
- you are going crazy and there's no hope
- it would be better if you weren't around
- you would be better off dead
- you should probably kill yourself

 If you're depressed then you already know about the garbage truck. It's almost impossible to explain this part and the excessive mind speed to someone who has never been seriously depressed. If your depression goes untreated, this constant "garbage" will totally destroy your self-confidence. Try as you may, you will be unable to control this part of depression.

7. As part of the "garbage truck," your mind will try to make you as uncomfortable as possible. You may be flooded with thoughts of violence against yourself and others, you'll think you are condemned by God, or you'll think you deserve this condition for some reason. Your garbage will also tell you that if you seek professional help (physician, psychologist, psychiatrist, etc.) that you'll be committed to an institution forever.

8. When depressed, your brain begins running a mental "video tape" of your worst experiences. If married, a mental tape of the marriage is played daily, only focusing on the worst experiences. Frequent if not constant thoughts and preoccupations about past problems and issues is a common sign of depression.

In short, depression is a neurochemical reaction to severe and prolonged stress, either suddenly surfacing or gradually creeping up on you over a period of many months. The treatment for this dark cloud is much easier than you think.

Some General Thoughts:
If you are depressed, expect your brain to be filled with mental garbage - get ready for it! During this time, do not take action on those garbage thoughts and make no major changes in your life. It's best to wait until the garbage truck leaves before making decisions that will or may change your life.

You may have other symptoms with your depression, such as severe anxiety or agitation (pacing, no sleep at all, "hyper", etc.). That only means another neurochemical has kicked in. In these cases, a psychiatrist can best select the medication for the combination of anxiety and depression.

When you are depressed, those who love you will become a pain-in-the-butt. They will "bug" you constantly, trying to cheer you up, giving you advice and trying to be by your side. Be prepared for this.

During depression, remember that your brain goes on a bad-memory hunt, looking for old memories to torture you. Be prepared to relive or re-feel old hurts, old doubts, old guilt, and old sorrows. Be curious about what memory files the brain selects rather than focus on those memories. You can expect your brain to constantly replay the video tape (your "worst hits" tape) of your life. You'll feel guilty for things you did as a child, mistakes you made ten years ago, etc. You'll live in the past as long as the depression remains. It may interest you to know that as the serotonin level increases, the "past" returns to the past as a memory - not a torture.

In other depressed situations, people become obsessed with other issues, almost always "the road not taken". Often viewed as mid-life crisis, a straight-laced businessman now wants a Harley and a tattoo while another individual begins suddenly thinking about a past sweetheart. In almost all of these situations, the individual acts totally out of character.

All depressed folks look for escapes. Common methods of trying to escape depression are excessive alcohol use, drugs, sexual relationships, changing jobs, etc. A lot of good marriages are lost during these times as the spouse of the depressed partner hears "I've got to have space" or "I've got to get away and find myself!" You'll find these escapes don't work. These methods only complicate your depression and your recovery. Best bet - don't make changes, just get to a professional.

Depression affects more than the individual with the depression - it's a family-and-friends problem as well. If your spouse is depressed, he or she may be constantly talking about the history of the marriage and relationship. Remember, the "garbage truck" is running in their brain, thinking of every bad thing that has been done, said, or not done. The spouse that isn't depressed is frequently "dumped on" with hundreds of accusations and thoughts that are long after-the-fact and totally beyond correction at this point. The non-depressed spouse may suddenly learn that their partner never did like their hairstyle, their mother, their choice of automobile, or the price of the house. The non-depressed spouse will hear many "thoughts" that were present at the time of marital decisions, often years ago, but were never mentioned. The non-depressed spouse may be awakened at night with accusations and complaints that may last for hours. The non-depressed spouse will be made to feel responsible for these unspoken wishes and will be helpless as the depressed spouse lists mistakes and misunderstandings that have taken place during the entire marriage/relationship. Even though they might have been discussed at the time, the non-depressed spouse will receive much blame for past events.

If a friend is depressed, they will suddenly have no interest in maintaining your friendship. They'll stop calling, visiting, or writing. If your depressed best friend suddenly gives you their most prized possession or asks you to be included in their will to take care of their children - be on the alert! Such behaviors are often part of a suicide plan in which the depressed friend wants to "take care of business" before they leave this earth. At that point, a heart-to-heart talk is needed, perhaps offering to accompany them to a professional's office for help. Many depressed individuals are brought to the office by their parents, friends, or work supervisors.

Folk-Williams, John. “Why Depressed Men Leave, Part 3.”

I’ve written a lot about the form of depression in which men look outside themselves to find the cause for an inner pain that simply can’t be faced. They may feel anger, rage, a longing to act out fantasies, or a compulsion to blame and abuse those closest to them. That side of depression is the most aggressive and obviously damaging to relationships of all kinds.  In my experience, it is not only the phase of severe depression that can cause a man to leave his partner -- an emotional withdrawal can be just as destructive as a literal departure.

In looking back at what I’ve been through, I realize that I’ve lived at various times in four different mind/feeling states over decades of chronic depression. In the past, I have behaved differently as I felt in turn each one. Each in its own way has threatened relationships of all kinds, most vitally with my family but also with colleagues at work and with many friends. Thinking of these separately is more helpful to me than listing them as differing signs of one condition. They may well be that, but describing them this way has spurred me to recognize more quickly what I am starting to feel and do, and so take action to reverse what is happening.

Briefly, what I have felt in these different phases looks like this:

• angry, obsessive, blaming, looking outward for causes

• empty, lacking all feeling and attachment

• despairing to the point of suicidal thinking

• apparently restored but convinced it’s only a temporary reprieve

Angry

One is the aggressive side of depression that has probably not yet come to full awareness (“covert” in Terrence Real’s description). This is the mindset of looking to external circumstances, often focusing on family, as causes of inner hurt or emptiness. It leads to the destructive blame, rage, sense of being trapped, longing to escape, etc. that I’ve written about in several posts. Thinking can become fiercely obsessive and paranoid, finding threats, malevolence, betrayal everywhere. The anger, even rage, can explode at my family for little or no apparent reason. That is immediately hurtful and damaging. It turns intimacy on its head and puts in its place the drive for complete control.

Empty

Another phase involves the loss of feeling about everything and a kind of removal from human attachment. Nothing is painful or pleasurable, and nothing matters much. I’ve imagined feeling “fine” in this state while really distancing myself from my family and co-workers. I’m standing in place but no longer there. The effect is an understated absence that is no less hurtful than raging outbursts. I have a brief story about this in the next post.

Despairing

Depression comes to a different sort of crisis when I’ve felt extreme despair and shame about being me. It’s then I’m constantly tearing myself apart, obsessing on every mistake, every failure – and everything looks like failure. Freud’s early description of depression as anger turned inward fits this exactly. Thoughts of suicide are common because I feel this me isn’t worth enough to keep alive. Of course, that means I’ve blotted out the love of my wife and family and feel I’ve failed as well in those relationships. I can’t even hear the words when my wife and close friends offer love and support. My family can only be baffled and hurt at my inability to be present and constant hiding away in solitude. Often, I’m actively pushing them away because I can’t face dealing with anyone.

Restored

I want to include a fourth state because it appears to be the “normal” one. One day I wake up and feel fine – I’m restored to my “real” self. My mind is working again, I can handle anything that comes my way. Once more, I’m the responsive, loving husband, father, son. The problem is that, even when it’s happening, I believe this “recovered” state is unstable. After a good day or week or month, I’m certain I’ll wake up and find myself in the midst of one of the destructive states – or it might just arrive without my being aware of the change. What that means, as I see it now, is that my real self isn’t whole, isn’t recovered. I don’t trust myself, and my wife can’t trust me either. I could turn on her or shut her out in a flash when I disappear again.

Engs, R. C. “What Are Addictive Behaviors?”

Any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially is considered an addictive behavior. A person can become addicted, dependent, or compulsively obsessed with anything.  Some researchers imply that there are similarities between physical addiction to various chemicals, such as alcohol, and psychological dependence to activities such as sex, work or exercise. It is thought that these behavior activities may produce beta-endorphins in the brain, which makes the person feel "high."  Some experts suggest that if a person continues to engage in the activity to achieve this feeling of well-being and euphoria, he may get into an addictive cycle. In so doing, he becomes physically addicted to his own brain chemicals, thus leading to continuation of the behavior even though it may have negative health or social consequences. Most physical addictions to substances such as alcohol also have a psychological component. For example, an alcoholic who has not used alcohol for years may still crave a drink. Thus some researchers feel that we need to look at both physical and psychological dependencies upon a variety of substances, activities, and behaviors as an addictive process and as addictive behaviors. They suggest that all of these behaviors have a host of commonalities that make them more similar to than different from each other and that they should not be divided into separate diseases, categories, or problems.

Common Characteristics Among Addictive Behaviors

There are many common characteristics among the various addictive behaviors:

    1. The person becomes obsessed with the object, activity, or substance.

    2. He will seek it out, or engage in the behavior even though it is causing harm (problems with friends, family, fellow workers, poor work performance).

    3.  The person will compulsively engage in the activity, that is, do the activity over and over even if he does not want to and finds it difficult to stop.

    4.  Upon cessation of the activity, withdrawal symptoms often occur.  These can include irritability, craving, restlessness or depression.

    5.  The person does not appear to have control as to when, how long, or how much he will continue the behavior (loss of control).

    6. He often denies problems resulting from his engagement in the behavior, even though others can see the negative effects.

    7. The person hides the behavior after family or close friends have mentioned their concern.

    8. Many individuals with addictive behaviors report a blackout for the time they were engaging in the behavior.

    9. Depression is common in individuals with addictive behaviors. That is why it is important to make an appointment with a physician to find out what is going on.

  10.  Individuals with addictive behaviors often have low self esteem and feel anxious if they do not have control over their environment.

Nauert, Rick, PhD. “Immune Disorders Tied to Mental Illness?” Psych Central, June 3, 2010.

A provocative study using genetically altered mice finds a cause-and-effect link between the immune system and a psychiatric disorder.

Mario Capecchi, a Nobel Prize-winning geneticist, discovered that bone marrow transplants cure mutant mice who pull out their hair compulsively.

The study provides the first cause-and-effect link between immune system cells and mental illness, and points toward eventual new psychiatric treatments.

“We’re showing there is a direct relationship between a psychiatric disorder and the immune system, specifically cells named microglia that are derived from bone marrow” and are found in the brain, says Capecchi.

“There’s been an inference. But nobody has previously made a direct connection between the two.”
The findings – published in the journal Cell – should inspire researchers “to think about potential new immune-based therapies for psychiatric disorders,” says Capecchi, a 2007 Nobel laureate in physiology or medicine.

“A lot of people are going to find it amazing,” says Capecchi. “That’s the surprise: bone marrow can correct a behavioral defect.”

Nevertheless, “I’m not proposing we should do bone marrow transplants for any psychiatric disorder” in humans, he says.

Bone marrow transplants are expensive, and the risks and complications are so severe they generally are used only to treat life-threatening illnesses, including certain cancers and disabling autoimmune diseases such as lupus.

Capecchi says that mice with the mutant gene that causes pathological grooming now can be used to study the surprising connections between the immune system’s microglia cells and mental illness – and ultimately to produce new treatments.

“Genes ‘Play Key Happiness Role.’” BBC News, March 8, 2008.

Our level of happiness throughout life is strongly influenced by the genes with which we were born, say experts.

An Edinburgh University study of identical and non-identical twins suggests genes may control half the personality traits keeping us happy. The other half is linked to lifestyle, career and relationships. However, another expert said despite the research in the journal Psychological Science, we can still train ourselves to be more content.

Psychologists have developed several methods to assess a person's personality type - and even their level of happiness. The Edinburgh study, in conjunction with researchers at the Institute for Medical Research in Queensland, Australia, looked at results from 900 pairs of twins. The idea behind twin studies is that, because identical twins are genetically exactly the same, while fraternal twins are not, it is possible, by comparing the results from the two groups to calculate how strongly influenced a particular trait is by genetics. In this case, the researchers looked for people who tended not to worry, and who were sociable and conscientious. All three of these separate characteristics have been linked by other research to an overall sense of happiness or well-being. The differences between the results from the identical and fraternal twins suggested that these traits were influenced up to 50% by genetic factors.

Dr Alexander Weiss, from Edinburgh's School of Philosophy, Psychology and Language Sciences, who led the research, said: "Together with life and liberty, the pursuit of happiness is a core human desire. "Although happiness is subject to a wide range of external influences we have found there is a heritable component of happiness which can be entirely explained by genetic architecture of personality."

The Centre for Applied Positive Psychology promotes research into techniques for boosting personal contentment. Dr Alex Linley, from the centre, said that even though other studies supported the genetic argument, it was wrong for anyone to think that nature had dealt them a fixed hand in happiness terms. He said: "What it means is that, rather than a single point, people have a range of possible levels of happiness - and it is perfectly possible to influence this with techniques that are empirically proven to work. "Simple things, like listing your strengths and using them in new ways every day, or keeping a journal where you write down, every night, three things that you are grateful for, have been shown to deliver improvements."

Coles, Jeremy. “Great Apes May Have ‘Mid-Life Crisis,’ A Study Suggests.” BBC Nature, Nov. 19, 2012.

Chimpanzees and orangutans may experience a "mid-life crisis" like humans, a study suggests.

An international team of researchers assessed the well-being and happiness of the great apes. They found well-being was high in youth, fell to a low in midlife and rose again in old age, similar to the "U-shape curve" of happiness in humans. The study brought together experts such as psychologists, primatologists and economists. Results are published in the Proceedings of the National Academy of Sciences.

"What we are testing is whether the U-shaped curve can describe the association between age and well-being in non-human primates as it does in humans," psychologist and lead author Dr Alexander Weiss of the University of Edinburgh told BBC Nature. Dr Weiss hoped the results would show a similar curve because of the close relationship between humans, chimpanzees and orangutans. The study showed that male and female humans, chimpanzees and orangutans have the same U-shaped curve despite differences in social roles, and the phenomenon is therefore not uniquely human.

The sample subjects included 508 chimpanzees (Pan troglodytes) and orangutans (Pongo sp.) of varying ages, from zoos, sanctuaries and research centers. They were assessed by zoo keepers, volunteers, researchers and caretakers who had worked with the primate subject for at least two years and knew its behavior. The animals were numerically scored for well-being and happiness on a short questionnaire, which was based on a human well-being model but modified for use in non-human primates.

Dr Weiss said that the similarities between humans, chimps and orangutans go beyond genetics and physiology. For example, chimpanzees face similar social pressures and stress factors to humans. "You don't have the chimpanzee hitting mid-life and suddenly they want a bright red sports car," explained Dr Weiss. "But there may be other things that they want like mating with more females or gaining access to more resources."

Co-author Andrew Oswald, professor of economics at the University of Warwick, has researched human happiness for 20 years. "One of the reasons we decided to look at ape data was that when you study humans, that U-shape is exactly the same when you adjust statistically for things like education, income and marriage. For Prof Oswald it was "quite mind-blowing... to find it in apes."

The study showed that orangutans may experience a midlife dip in well-being and happiness
He concluded that "the mid-life crisis is real and it exists in... our closest biological relatives, suggesting that it is probably explained by biology and physiology."

Psychologist Dr Weiss said that this research opens a lot of doors. He explained that for a long time this kind of mid-life crisis was considered something specific to human society and human lives. "And what [this study] says is that it may be a part of the picture, but it's clearly not all of the picture. We have to look deeper into our evolutionary past and that of the common ancestors that we share with chimpanzees, orangutans and other apes."

Gardner, Amanda. “Depression in Middle Age Linked to Dementia.” Health.com, May 8, 2012

People who have symptoms of depression in middle age may be at increased risk of dementia decades later, a new study suggests.

Using medical records, researchers tracked more than 13,000 people in a large northern California health plan from roughly their 40s and 50s into their 80s. Compared to people who had never been depressed, those who experienced symptoms of depression in middle age -- but not later in life -- were about 20% more likely to go on to develop dementia.

Those who received a depression diagnosis later in life only were at even greater risk. That group had about a 70% increased risk of dementia compared to their depression-free peers, according to the study, which was published this week in the Archives of General Psychiatry.

The national plan to fight Alzheimer's

In a first, the researchers also found that the timing of the depression seemed to predict which type of dementia an individual would develop. Late-life depression was linked with Alzheimer's disease, while mid-life depression was mostly connected with a related condition known as vascular dementia.

Although Alzheimer's disease and vascular dementia share many of the same outward symptoms, they're associated with different processes in the brain. In Alzheimer's, memory loss and other symptoms are believed to be caused by protein deposits that interfere with brain function. Vascular dementia, on the other hand, appears to occur when blood flow to certain areas of the brain is interrupted, such as during strokes and so-called mini-strokes.

The study participants were 3.5 times more likely to develop vascular dementia if they'd experienced depression symptoms in both middle age and later in life, which suggests that "recurring depression over the life course seems to be triggering vascular changes that puts [people] at risk for vascular dementia," says lead author Deborah E. Barnes, Ph.D., an associate professor of psychiatry at the University of California, San Francisco.

Dr. Charles Nemeroff, chair of psychiatry at the University of Miami Miller School of Medicine, says there is already "quite a bit of evidence" that depression is a risk factor for dementia. However, this study is among the largest to show a link between the two conditions, says Nemeroff, who was not involved with the research.

Previous studies have not distinguished between depression in middle age and depression later in life, making it difficult to determine if depression is a risk factor for dementia or an early symptom, Barnes says. "The question has been, 'Is depression a true risk factor for dementia?'" she says.

The findings do suggest that depression tends to precede vascular dementia, but the study does have a number of limitations that prevent the authors from concluding that depression directly causes dementia.

The dementia diagnoses were based only on a questionnaire, symptoms and medical history, not brain imaging or spinal fluid measurements. The latter techniques are more reliable, especially since the distinction between Alzheimer's and vascular dementia isn't always clear-cut.

The study didn't include any data on whether the depressed participants received treatment, or what type of treatment. That question is "really important," Nemeroff says. "We'd really like to know: If depression [were] aggressively treated with psychotherapy or antidepressants, could you stave off dementia?"

Selection from Carver, Joseph, PhD. “The Chemical Imbalance in Mental Health Problems.”

Full text at http://www.drjoecarver.com/clients/49355/File/Chemical%20Imbalance.html

Dopamine

One type of dopamine works in the brain movement and motor system. As this level of dopamine decreases below the “normal range” we begin to experience more motor and gross-movement problems.

Symptoms:

• Falling when walking
• Loss of balance and coordination
• Gait (walking pattern) disturbance, smaller steps
• Slow movements and difficulty with voluntary movements
• Stiffness and aches in muscles
• Tremors and shaking
• Fixed, mask-like facial expression
• Impairment of fine-motor skills
• Impairment in cognitive/intellectual ability - inability to concentrate

Dopamine in the thinking areas of the brain might be considered the neurotransmitter of focus. Low levels impair our ability to focus on our environment or to “lock on” to tasks, activities, or conversations. As dopamine levels in the brain begin to rise, we become excited/energized, then suspicious and paranoid, then finally hyper-stimulated by our environment. With low levels of dopamine, we can’t focus while with high levels of dopamine our focus becomes narrowed and intense to the point of focusing on everything in our environment as though it were directly related to our situation.

Mild elevations in dopamine are associated with addictions. Alcohol or any addictive substance produces a feeling of excited euphoria by increasing dopamine levels in the brain. Too much of these chemicals/substances and we feel “wired” as moderate levels of dopamine make us hyper-stimulated – paying too much attention to our environment due to being overstimulated and unable to separate what’s important and what is not.


Serotonin

When serotonin is low, we experience problems with concentration and attention. We become scatterbrained and poorly organized. Routine responsibilities now seem overwhelming. It takes longer to do things because of poor planning. We lose our car keys and put odd things in the refrigerator. We call people and forget why we called or go to the grocery and forget what we needed. We tell people the same thing two or three times.

Symptoms of low serotonin include chronic fatigue, sleep disturbances/early-morning awakening, loss of appetite or sweet cravings, loss of sexual interest, social withdrawal, sadness, low self-esteem, loss of personality, headaches and upset stomach.

Extremely low serotonin leads to focusing on negative memories, not knowing how you feel about your life, marriage, job, family, future, significant other, etc., temper tantrums/outbreaks of anger and irritability, escape fantasies, a need for change in lifestyle (divorce, affair, new job, new car), OCD-like behavior, magnification of existing personality traits.

At the bottom, everyone with severely low serotonin hears:  1) You’re a bad spouse, parent, child, employee, etc., 2) You are a burden to those who love or depend on you, 3) You are worsening the lives of those around you, 4) Those who care about you would be better if you weren’t there, 5) You would be better if you weren’t around, and 6) You and those around you would be better off if you were totally out of the picture. At that point, you develop suicidal thoughts.

One in four adults will experience clinical depression within their lifetime. Depression is the “common cold” of mental health practice – very common and much easier to treat today than in the past.

Treatment includes SSRIs.

Norepinephrine

Norepinephrine sets threshold levels of stimulation and arousal. Anxiety and depression are related to norepinephrine levels in the brain, as this neurotransmitter seems to maintain the balance between agitation and depression.

Low levels of norepinephrine are associated with a loss of alertness, poor memory, and depression. Norepinephrine appears to be the neurotransmitter of “arousal” and for that reason, lower-than-normal levels of this neurotransmitter produce below-average levels of arousal and interest, a symptom found in several psychiatric conditions including depression and ADHD.

Excessive amounts of norepinephrine and adrenaline give us extra strength, increased energy/arousal, muscle tightness (for fighting or running), and a desperate sense that we must do something immediately.

Low levels of norepinephrine are often treated using newer antidepressants. Many new antidepressants, known as Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s) with brand names like Effexor and Serzone, treat depression by increasing levels of both serotonin and norepinephrine neurotransmitters.

GABA

Gamma-Aminobutyric Acid (GABA) is a neurotransmitter that decreases the ability of other neurotransmitters to work. GABA is involved in our level of excitability. Rather than encouraging communication between cells such as dopamine, serotonin or norepinephrine, GABA reduces, discourages, and blocks communication. This neurotransmitter is important in brain areas involving emotion and anxiety.

When GABA is in the normal range in the brain, we are not overly aroused or anxious. At the same time, we have appropriate reactions to situations in our environment. GABA is the communication speed controller, making sure all brain communications are operating at the right speed and with the correct intensity. Too little GABA in the brain, the communication becomes out of control, overstimulated, and chemically unstable. Too much GABA and we are overly relaxed and sedated, often to the point that normal reactions are impaired.

Low levels of GABA are associated with bipolar disorder and mania. With GABA levels below average, the brain is too stimulated. We begin talking rapidly, staying up for days at a time, and develop wild and grandiose ideas. In a manic state, we are so “high” and out of control that social problems are quick to develop, often due to hypersexuality, excessive spending, reckless decisions, risk-taking behavior, and grandiose ideas.

Low levels of GABA are also associated with poor impulse control.  When GABA is low in the brain, impulsive behaviors are not inhibited (stopped) by logical or reasonable thinking. Alcohol works by increasing GABA levels, producing mild euphoria, loss of social anxiety, and other symptoms of intoxication.

Costa and McCrae Normative Aging Study

The Normative Aging Study (Costa and McCrae, 1980) conducted at the Boston VA Outpatient Clinic followed men from their early 20s throughout adulthood.  The only ones who had a midlife crisis (i.e., depression, despair, anger, blame, escapism, risky behavior) were ones who were also depressed and anxious in their late teens to early 20s. Once a crisis-prone individual, always a crisis-prone individual, according to this study.

Notes on the “Holy Hormones Honey” podcast (August 8, 2012)

Dr. Ken Stoller said oxytocin helps the brain to heal so it can start processing emotions. Testosterone blocks the effects of oxytocin. Men have less oxytocin to begin with, then from adolescence onward, testosterone blocks its efficacy. As men age and testosterone levels start to drop, the oxytocin begins to be expressed.

Testosterone spikes and dips 4x/hr. It also fluctuates daily, higher in the morning and lower at night, contributing to irritability and anger.  According to Dr. Jed Diamond, it is actually more common for there to be anger and irritability when testosterone is dropping rather than when it is too high.

Men do have hormonal cycles, individual to each man rather than a set monthly schedule like women have.  Dr. Diamond recommends increased exercise, massage, warm baths.

It feels like the man’s partner is going out of her way to get on his last nerve, when in fact, it is the man’s hormone levels that are the cause.  The cause is internal, not external.

Europe has been using hormone replacement therapy for men with good results since World War II.

30-40% of men in male menopause have hot flashes. The hot flashes indicate a more rapid change. The change can happen any time between 35 and 65 for men, though for many it is 40-55, and tends to be a more subtle and slower change for men compared to the rapid drops in estrogen, progesterone and testosterone in women.

Midlife crisis, or “male menopause,” is based on biochemical changes and hormone drops.  For men, sexual changes include erectile dysfunction and loss of libido.  Emotional changes:  increased anger and irritability, depression.  Physical changes:  dry skin, weight gain in the belly despite healthy diet and exercise, increased risk of heart attack (related to hormone levels).

Examples of reconciliations from two anti-divorce forums

s........4             5 month separation
T...2                 total MLC 5-6 years; H gone 6 months
m............s        8 month separation
f......m              8 month separation, 7 months of “I want a divorce”
F........H           8.5 month separation (F MLCer)
a..e                  1 year separation
e......t               1 year separation, married 21 years.
s.....e               1 year separation.
c..e                 1 year affair; H never moved out
b..........m        14 months separation
o......Z            15 months replay (F MLCer)
j.............s       16 months replay (F MLCer)
m....a              15 month separation
s........l            15 months BD to reconnection
r...............r      18 month separation; H moved in and out every three months six times
n.........e            18 month separation
2........c           18 month separation
i.........e           18 month separation
s.............s       18 month separation
s....e               18 month affair; married 20 years.
r..............e     18 months from divorce filing to reconciliation
A.....1             18 months BD to reconciliation facilitated by Retrouvaille
c............e      20 months BD to return; 1 mo. after settlement mtg; divorce dismissed 6 wks later
p......e             6 month separation; another 15 months of processing
d......e             4 month separation, another 20 months before reconnection
s......e             23 months BD to reconciliation
m.....r             23 month affair (MLCer is poster's BIL)
a.......o            2 year separation.  H moved in with OW after 3 months, divorce filed after 18 months, H returned home 7 months later
j.....m             2 year separation.  SHE left five years later.
i...n                2 year separation.
p......r             2 year separation. (F MLCer)
y........e           2 year separation
S........9          2 years BD to reconnection - 1 year BD to 1st reconnection; stayed 4 months, back to OW; then gone 9 months before returning home again.
h.......d           2.5 years BD to reconnection
b.........y         2.5 year separation
t........d           2.5 year separation
w.......n          2.5 year separation
c.d                 2.5 years BD to reconnection; turning point was Retrouvaille
v.....a             3 year affair; H had to call sheriff to evict OW
b....n              3 years BD to reconnection; H never left home
w.......g          3 years BD to reconnection
m.....d            3 years BD to reconnection
r.......l             3 years BD to reconnection
g.......r            3.5 years BD to reconnection; 10 month separation
c.........m        3.5 years BD to reconnection; 32 month separation

45 return stories; average time of replay/separation = 18 months

Forum post from a female MLCer

I should point out that an MLCer MIGHT also pretty much stop talking to whomever they were closest to. They may get a whole new circle of friends. Or they might push everyone away.

I stopped talking to my sister, who has always been my best friend. But by the time that happened, I'd pushed my husband so far away he couldn't have known that was happening. We lived apart and I'd been out of touch with him for a long time except regarding the house or kids. There was ZERO communication with him unless I HAD to and I would go to great lengths to avoid that. I didn't like the man. I know now that what I really didn't like were the things he made me see about myself.

I should also note that when I stopped talking to my sister was when things were beginning to change INSIDE of me. I was getting the first inkling that my story (my rewriting of the marital history) wasn't going to hold water much longer. The cracks were starting to appear. That's when I stopped talking to EVERYBODY.

In my case, through the initial period of deep MLC (March 2002-2004), I'd spun such brilliant BS that everyone thought I was right to want a separation/divorce. In March '04, my husband left for the second time. I was crashing hard and fairly regularly. I still managed for another year to outrun reality though it did creep in occasionally. My husband stopped fighting for me when he left the second time. That was the biggest jolt. By summer 2005, I was coming apart at the seams. Completely. I'd exhausted myself with the things of the world that had enticed me, I was looking at families and missing my own. For the first time, I started to see that there had been good times. I had REALLY forgotten them. MLC stole a big chunk of the good things about my marriage. I did not see us as my husband saw us. So you spouses really are holding something precious that no one else has; you're holding the real truth about your marriage and your life together. You're the only one who is going to understand when your spouse comes back. You're all that's going to be familiar and if you're not there ...

After a while, I started seeing how I had contributed to the bad times. By October 2005 I was completely broken and flat on my face in repentance. Thinking of it still makes me cry.

I was a mean MLCer. I convinced myself and everyone around me that my husband was the biggest SOB that ever walked. I BELIEVED it. I twisted every argument we'd ever had.  I had all my family in support of my efforts.  Eventually, and it took a long time, I convinced my husband we were really through.  He stood for over 2 years, though.  Alone.  Without a message board or a clue about MLC. He just believed in me and in us.

It wasn’t until he had to let go to save his own sanity that I started waking up.

If you’re new to MLC, I'll say this: If you don't humble yourself at this time, if you let pride make you bitter and vengeful, your MLCer will never feel able to ask your forgiveness. And THAT ALONE IS PARAMOUNT to her coming out of MLC a better and stronger person. You see, the hardest thing for her will be forgiving herself and she can never do that unless she can come back and talk with you.

Love her or not, leave her or not, you've got to be the person your MLCer can come to and apologize. This is when you're going to have your feet held to fire and you'll find out if your love really is unconditional.

While she's lost, you have work of your own to do. Work on yourself.