What is it? A relapse signature is a unique set of warning signs that precedes a relapse of your mental health condition. Whilst there are common signs and symptoms that many of us with bipolar experience, we all have our own individual signature. Learning about our relapse signature can empower us and help us prepare for the onslaught, to either avoid it or to better manage it.
Each time I have a full blown relapse with my bipolar disorder, I gain more insight into what being unwell looks like for me. I was misdiagnosed with Major Depressive Disorder for 17 years before my bipolar diagnosis, so I am accustomed to recognising my descent into depression. It’s second nature to me and I see the black dog coming from a mile away. Recognising the onset of hypomania though is relatively new. I experience a lot of subthreshold symptoms between episodes and “mini” relapses, but I have only had two major and debilitating relapses since my diagnosis in late 2016. I learned a lot about myself the first time, and even more the second time, slowly gaining a more nuanced and deeper understanding of myself and my condition. Importantly, my awareness has been helped significantly by talking to my psychologist, partner and family to hear about their observations. So far, this is what we think my relapse signature looks like:
It’s Go Time! Before any discernible changes in my mood, I have a marked change in my energy levels. I am much more energetic than usual, I need less sleep, I am fidgety and restless. This manifests in various ways. At work, I pace my office, I leave my desk often and take lots of short walks down the street. I rarely stay at home on the weekends and am generally more active all around. Although, this does not equate to being more productive!
Social Butterfly. Suddenly, I will have the urge to socialise more. I wander around the workplace and talk to different people. I message or call people who I haven’t spoken to in a while and I even socialise with people that I usually dislike. I am also more bubbly and gregarious, louder and more talkative. I will happily enjoy being in the spotlight and I might organise group outings.
Shop ‘Til You Drop. This aspect of my relapse signature has been a recent insight for me, and one that was pointed out (retrospectively) by my partner. He noticed that I went through a period of shopping every weekend, which is out of character for me. I purchased hundreds of dollars worth of clothes, makeup and craft supplies which I brought home and left untouched on our dining table.
Me, Myself and I. This is another warning sign that my partner picked up on, retrospectively. Early on in a relapse, I start becoming more self-centered. This eventually culminates in delusions of grandiosity and invincibility, but early on, I simply start focusing more on my own desires, impulses, and wishes. Coupled with an increase in agitation and irritability, I am uncharacteristically dismissive of others because I feel as though I have no time for their negativity and neediness. My focus also starts to shift away from things that are normally very important to me, like work, university and my relationships. I start neglecting my obligations and a pattern of chaos starts to emerge.
I Think Therefore I Am … Becoming Unwell. I start to notice some changes in my thinking pretty early on. I might have racing thoughts, which I liken to switching channels on a TV really fast before you’re able to see or hear what is playing. I have difficulty concentrating and focusing on tasks. I am easily distracted and I start becoming very disorganized. I start missing deadlines and I close the door to my office a lot to avoid noise and disruptions. Before I know it, I have to work lots of overtime to manage my workload.
Let’s Talk About Sex! Hypersexuality is one of my key symptoms that lets me know that I am unwell. My relapse signature reflects this, as I start to show more interest in sex. This includes being more flirtatious, thinking about sex more often, buying sex toys, demanding more sex from my partner and talking about sex more openly and more frequently with other people. My hypersexuality intensifies as my relapse progresses but I would say that these are early signs for me.
Flying high. It is much harder for me to identify any early changes in my mood. As I said, I often experience subthreshold symptoms and I am so accustomed to mood labiality that it is hard for me to distinguish gradual changes. I am only aware of changes when they are significant or sudden, and this is often when I am already in the midst of a relapse. It is much easier for me and my loved ones to identify overt behaviours like the ones listed above. What I do know is that I usually feel all the good bits first – the euphoria, the expansiveness, the enthusiasm and energy. The bad feelings come later – the wired, exhausted feelings, the intense irritability, the anger. I know that I will learn more about this aspect of myself with any future relapses.
So What? It wasn’t until I was in remission again that I started having really productive conversations with my psychologist and family about my relapse signature. Together, we identified all of our observations about my early warning signs. Each one of us had made unique observations, so it was a really critical step for me to talk to each one of them about it. My sister noticed the increased focus on sex and my psychologist noticed changes in my thinking patterns. My partner noted my increase in spending, departure from routine and self-centeredness. And I was aware of racing thoughts, difficulty concentrating, decreased need for sleep and increase in sociability. Each one of us had an important piece of the puzzle that together, makes up my relapse signature.
Now that I am stable again, I recognise that I need my support team to help me manage relapses in the future. We are all better equipped to address another relapse and the first step is identifying it. It’s important that my support team know exactly what they are looking out for, because by the time I get a sense of relapsing, my judgement is already slipping and I generally don’t want to return to stability, at least not in the early stages. I need my support people to recognise early warning signs so they can encourage me to see my doctor before the relapse takes hold and I start self-destructing.
In addition to discussing my relapse signature with them, I have talked to them about what to do. This involved updating my Wellness Plan which is a written document that includes an action plan to manage my bipolar. It lets them know how to approach me if they notice I am becoming unwell and it gives them permission to talk to one another about it, if necessary. New insights gained from this last relapse have allowed me to create a more nuanced and useful Wellness Plan which means future relapses should have a lesser impact on me and those around me.
Let me know in the comments below about your relapse signature! And watch out for future posts about my Wellness Plan and how to develop your own.
Image by Micaela Parente on Unsplash