Schizophrenia is a highly misunderstood mental illness. Part of the reason is the incorrect way it’s portrayed in movies and television. The media, too, muddles things harmfully when it equates schizophrenia to violence. The word itself is also misused, which makes people question what it really means. Have you ever heard someone refer to another as “schizophrenic” as a put-down?

People, though, are questioning whether these portrayals are accurate (Schizophrenia Movies, Films and Documentaries). When we as a society ask questions, it means we want to understand each other. That’s a very good thing. Questions about schizophrenia lead to understanding and empathy.

Here, then, are answers to some frequently asked questions about schizophrenia.

Is Schizophrenia Real?

Yes. Schizophrenia is a real illness that affects real people (not just characters in movies). It’s rare, though, with just under 1% of the population living with the disorder.

Are People with Schizophrenia Dangerous?

Typically, no. This is a common misconception. Violent behavior isn’t a symptom of schizophrenia, and it’s not an effect, either. The idea of voices telling someone to kill isn’t a realistic one. Sometimes, if someone has what’s known as persecutory delusions (the belief that people are out to get him), he might lash out in what he thinks is self-defense. It’s almost always limited to hostility and aggression, and random assaults aren’t common. No other hallucinations or delusions have been shown to cause any kind of violence.

Repeated research studies have shown that when schizophrenia is linked to violent behavior, one (or both) of two things contributes to it: substance use, and a childhood history of conduct disorder or, if that wasn’t diagnosed, generally aggressive and destructive behavior.

The DSM-5 indicates that people with schizophrenia are far more likely to be victims of violence than to commit it.

Is Schizophrenia a Mental Illness?

Yes. Schizophrenia is a brain-based mental illness with specific symptoms and characteristics. It’s part of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), which is the encyclopedia of the mental health professions.

Is Schizophrenia a Personality Disorder?

No. A personality disorder isn’t a disorder of the brain itself. In mental illness, things go wrong with the brain either structurally, at the neurological and neurochemical level, or both.

Personality disorders aren’t brain-based. They involve persistent, long-term patterns of behavior that are outside of typical behavior in one’s culture.

While this might sound like it describes schizophrenia, schizophrenia is brain-based and thus isn’t a personality disorder.

Does Schizophrenia Get Worse with Age?

Usually, the symptoms of schizophrenia begin gradually and slowly worsen over time. How long they worsen before stabilizing varies from person to person.

The symptoms of schizophrenia behave differently. The psychotic symptoms (hallucinations and delusions) tend to lessen over time. Negative symptoms (diminished emotional expression, lack of motivation, apathy, and more) seem to remain the same, while cognitive symptoms remain the same or worsen. According to the DSM-5, about 80% of people with schizophrenia don’t have a good prognosis; the disorder isn’t likely to improve over time. Beyond this basic understanding, it’s difficult to predict what will happen to someone with schizophrenia as he grows older.

Why Do People with Schizophrenia Hear Voices?

Researchers are working very hard to answer this very question, for when they can pinpoint precisely what is happening in the brain that causes hallucinations like hearing voices, they’ll be much better able to treat it.

Right now, knowledge is limited, but we do have a basic understanding. In schizophrenia, hearing voices happens because something isn’t working right in the brain. Part of it seems to be problems in the way neurons are transmitted. Also, neurotransmitters, especially glutamate, dopamine, serotonin, and GABA, are imbalanced in the brain afflicted with schizophrenia.

The more we all—researchers, doctors, patients, families, and society as a whole—ask questions, the better we will understand. We’ll understand schizophrenia better, yes, but even more importantly, we’ll develop deeper understanding and empathy for those who live with it.

The best child bipolar disorder treatment varies depending on the individual child and situation. Sometimes treatment for a child with bipolar disorder is best done in a hospital while other times it’s best done at home. There are also many options for pediatric bipolar disorder treatment that should be considered before the best child bipolar disorder treatment is decided upon.

The Risks of Not Treating a Child with Bipolar Disorder

Not treating a child with bipolar disorder is something some parents consider but it is not without risk. Medscape notes that in the absence of compliance to treatment (or, certainly, no treatment), “the course of the illness can be more severe than it would be otherwise.”

Additionally, children with bipolar disorder are at a high risk of suicide and the risk between the ages of 10-25 is particularly high. Treatment of a child with bipolar disorder with lithium is thought to decrease this risk. Treatment with lithium has also been linked to a decreased risk of substance abuse, something that bipolar youth often grapple with.

Inpatient Bipolar Child Treatment

An emergency situation is commonly when medical help is sought and inpatient (residence in a healthcare facility) help may be needed to assess and diagnose a child for the child’s and the family’s safety. Inpatient treatment for a child with bipolar disorder is also typically required in situations when the child is acutely suicidal, homicidal or psychotic.

Medication Treatment for the Treatment of Childhood Bipolar Disorder

Most children with bipolar disorder are treated with medications, whether inpatient or outpatient (treatment while the child lives at home). These medications are typically lithium, anticonvulsants or atypical antipsychotics. These medications are often the best way to treat and control bipolar symptoms in children. That said, no medication has been Food and Drug Administration (FDA) approved for children under the age of 10. However, if a child is ill, medications may be used at a doctor’s discretion. Often a combination of medications must be used for full symptom remission.

All bipolar treatment for a child carries the risk of side effects and so the risk vs. the rewards of treatment should be carefully considered before medication is prescribed.

Lithium is often considered the best childhood bipolar disorder treatment because it is effective in approximately 60-70% of adolescents and children with bipolar disorder.

Psychotherapy for Bipolar Disorder in Children

Different types of psychotherapy have also been shown to be useful in childhood bipolar disorder treatment. These are often used alongside medication treatment. Therapies that appear to be useful include:

• Social rhythm therapy
• Interpersonal therapy
• Dialectical behavior therapy
• Cognitive behavioral therapy
• Family therapy
• Group therapy

Because childhood bipolar disorder affects the whole family, family therapy should always be a priority both for the sake of the child with bipolar and also the family.

Childhood Bipolar Disorder Treatment with Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) has been shown to be safe and effective in children and adolescents. Its upside is the speed of positive response (a week or less) but the downside is the possible side effect of memory loss around the treatment time. Because of this side effect, ECT is typically reserved for extremely severe or refractory cases of childhood bipolar disorder (cases that don’t respond to other treatments).

Deciding on the Best Childhood Bipolar Treatment

In short, when considering treatment for a child with bipolar disorder, the best option is only arrived at after a thorough assessment and diagnosis as the best treatment is individual.

Before 2013, schizophrenia was officially classified and diagnosed as one of five subtypes. Once someone met the criteria for schizophrenia, she was further diagnosed with a particular type. When the American Psychiatric Association published its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the authority on mental illness, it eliminated the subtypes of schizophrenia. While the subtypes are no longer used as part of the diagnosis of schizophrenia, the traits still exist. These characteristics of schizophrenia didn’t disappear.

The Five (Former) Subtypes of Schizophrenia

In the past, someone was diagnosed with schizophrenia if his symptoms met the minimum criteria for the disorder. Next, based on his specific symptoms, behaviors, appearance, and other traits, he would be diagnosed with a subtype. His diagnosis might, for example, be “schizophrenia, paranoid type.”

Schizophrenia can be confusing, even to professionals, and the idea of assigning people to specific diagnostic subtypes made the confusion even worse.

Someone’s subtype could change based on her predominant symptoms at any given time, and many times, people could have symptoms that fit into more than one type. On top of that, the classification of schizophrenia into five types raised a legitimate question: How many types of schizophrenia are there?

There is only one type. It’s called schizophrenia, and there is no “type” added. Therefore, the use of subtypes is not part of the DSM-5.

It’s still nice to know what the types of schizophrenia were. They’re characteristics that professionals still use to evaluate when diagnosing and treating this serious mental illness. If you or a loved one is living with schizophrenia, knowing these presentations of schizophrenia will help you understand what is going on.

5 Subtypes of Schizophrenia

The predecessor to the DSM-5, the DSM-IV-TR, instructed that one of the five subtypes be included with a diagnosis of schizophrenia:

• Paranoid
• Disorganized
• Catatonic
• Residual
• Undifferentiated

While there are no types of schizophrenia in the DSM-5, “catatonia” can be used as a specifier. This simply means that it’s noted that the person’s symptoms are catatonic in nature, but that’s simply a description. She does not have “schizophrenia, catatonic type.”

Currently, professionals view schizophrenia as one disorder. There are unique symptoms of schizophrenia that can be grouped together, but there are not five different types of this mental illness. Let’s take a look at the traits that describe a person’s unique experience with schizophrenia.

Characteristics of the Different Traits of Schizophrenia

When someone has schizophrenia, he will exhibit any of the following traits. The traits aren’t stable but can change over time.

Paranoid

• Hallucinations, especially auditory—voices talking to the person about others and about him
• Delusions—unrealistic beliefs that people are out to get her, that she’s superior, or other themes
• Hallucinations and delusions are often related
• The negative symptoms of schizophrenia aren’t usually present
• Anxiety
• Anger
• Aloofness
• Argumentative behavior
• Overall, the person’s appearance doesn’t indicate schizophrenia (as it does with the disorganized and catatonic traits)
• Often have intimate relationships/marriage/children

Disorganized

• Disorganized speech that is difficult to follow or even understand
• Disorganized, “odd” behavior
• Impaired performance on psychological and cognitive tests
• Disheveled, unkempt appearance
• Often wears inappropriate clothing for the weather
• Minimal hallucinations and delusions; when they occur, they’re not structured and organized as with paranoid traits
• Add excessive hallucinations and delusions, and this is often the way schizophrenia is portrayed in the media (Schizophrenia Movies, Films and Documentaries)

Catatonic

• Very slow motion or even immobility
• Refraining from speaking (selective mutism)
• Holding the body in one position for long periods of time
• Ignoring the presence of others
• Involuntary mimicking of others’ speech (echolalia)
• Bursts of hyperactivity, purposeless movement (echopraxia)

Undifferentiated

• The person meets the criteria for schizophrenia
• He doesn’t exhibit enough traits of each to be predominantly paranoid, disorganized, or catatonic

Residual

• No current experience of hallucinations or delusions (but there has been in the past)
• Presence of negative symptoms

The traits of schizophrenia, formerly conceptualized as subtypes of schizophrenia, help professionals recognize what someone is experiencing and can help in the creation of a treatment plan tailored to each individual. Further, knowing these traits will help others understand what someone with schizophrenia is going through, thus increasing empathy and the ability to offer support.

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If your child has bipolar disorder, you likely wonder what childhood bipolar disorder medication will do to your child. This is a very understandable question but, unfortunately, it has a bit of a fuzzy answer. Due to the lack of study and simply the limitations of medicine, bipolar medications’ effects on children just isn’t completely understood. That said, we do know what to watch for in terms of side effects and therapeutic effects of medications in bipolar children.

Should a Child Be Given Bipolar Medications?

Relatively few bipolar medications have been tested in children and the youngest age any testing has been done is 10 years old.

How Does Bipolar Medication Affect a Child’s Brain?

Unfortunately, this is the part of the story that we don’t understand. We know the basics of neurobiology of bipolar medication but all the effects are not known. When you give a child bipolar medication, you are altering his or her brain function and possibly structure in ways that fight the disease. These changes will alter various neurotransmitters depending on the type of medication. Common neurotransmitters that are altered include dopamine, serotonin and gamma-aminobutyric acid (GABA).

What Do Bipolar Medications Do to Treat Childhood Bipolar Disorder?

Of course, bipolar medication works to fight the symptoms of bipolar disorder in children. The way it does this varies depending on the medication. Common bipolar child medication types include:

• Mood stabilizers (lithium) – lithium is typically given in classic bipolar disorder that contains euphoric mania (elevated mood) or acute mania. This medication is known as good for long-term bipolar treatment as it’s known to stave off future episodes better than other medications and seems to have an antisuicide effect.
• Anticonvulsants – anticonvulsants are known to stabilize mood and some are more indicated for someone with more mania while others are indicated in those with more depression. For example, carbamazepine (Equetro) is more indicated for children with rapid-cycling bipolar disorder.
• Atypical antipsychotics (2nd generation antipsychotics) – these are often used to treat mania and induce mood stabilization. For example, quetiapine (Seroquel) is typically used to treat acute mania and mixed episodes and ziprasidone (Geodon) can also be used in this way but is also useful as a maintenance treatment.

The selection of medication for a child with bipolar will depend on the child’s specific symptoms and what he or she can tolerate. Also, more than one medication may be needed for full symptom control.

Bipolar Child Medication Side Effects

According to Medscape, the following are the more common bipolar child medications and their main side effects:

• Valproic acid (Depakote) – approved for children 12 years and older
  • Sedation
  • Platelet dysfunction
  • Liver disease
  • Alopecia (hair loss)
  • Weight gain
• Lithium (Lithobid) – approved for children 12 years and older
  • Gastrointestinal distress
  • Lethargy
  • Sedation
  • Tremor
  • Enuresis (inability to control urination)
  • Weight gain
  • Alopecia
  • Cognitive blunting
• Aripiprazole (Abilify) – approved for children 12 years and older
  • May cause prolactinemia (an excess of prolactin released into the bloodstream; a common and reversible cause of male infertility; less risk than risperidone)
  • Stevens-Johnson syndrome
  • Tardive dyskinesia (involuntary, repetitive body movements)
  • Dystonia (sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures)
  • Parkinsonism (tremor, bradykinesia [slow movement], rigidity and postural instability)
  • Hyperglycemia (high blood sugar)
• Carbamazepine (Equetro) – currently under study in a pediatric population
  • Suppressed white blood cells
  • Dizziness
  • Drowsiness
  • Rashes
  • Liver toxicity (rare)
• Asenapine (Saphris) – approved for children 10 years and older
  • Tiredness
  • Oral paraesthesia (abnormal sensation)
• Risperidone (Risperdal) – approved for children 10 years and older
  • Weight gain
  • Sedation
  • Orthostasis (low blood pressure)
• Quetiapine (Seroquel) – approved for children 10 years and older
  • Sedation
  • Orthostasis
  • Weight gain
• Olanzapine (Zyprexa)
  • Weight gain
  • Dyslipidemia (an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood)
  • Sedation
  • Orthostasis
• Ziprasidone (Geodon) – currently being used without specific pediatric approval
  • Akathisia (a feeling of inner restlessness and a compelling need to be in constant motion)
  • Nausea

Special Considerations for Bipolar Medication in Children

In addition to the above, according to Medscape, the following are special concerns to consider when treating a child with bipolar medication:

• Valproic acid
  • Elevated liver enzymes or liver disease
  • Drug interactions
  • Bone marrow suppression
• Lithium
  • Hypothyroidism
  • Diabetes insipidus, toxic in dehydration, polyuria, polydipsia, renal disease; drug-drug interactions and sodium intake may alter therapeutic serum levels
• Aripiprazole
  • Levels may need to be adjusted in patients who are concurrently receiving lamotrigine, topiramate, valproic acid, lithium or other serotonin-norepinephrine reuptake, selective serotonin reuptake, or cytochrome P450 inhibitors
  • Not to be used if there is an unstable seizure disorder
• Carbamazepine
  • Drug interactions
  • Bone marrow suppression
• Asenapine
  • Pediatric patients are more sensitive to dystonia with initial dosing when recommended escalation schedule not followed
• Risperidone
  • Galactorrhea (milky nipple discharge)
  • Extrapyramidal symptoms (physical symptoms, including tremor, slurred speech, akathisia, dystonia, anxiety, distress, paranoia and bradyphrenia [slowness of thought])
• Quetiapine
  • Dose should be decreased with hepatic impairment
  • May cause neuroleptic malignant syndrome (a life-threatening reaction characterized by fever, altered mental status, muscle rigidity and autonomic dysfunction or hyperglycemia [high blood glucose])
• Olanzapine
  • Metabolic syndrome (complications of obesity including abdominal obesity, raised triglycerides, reduced HDL, elevated blood pressure and raised plasma glucose)
  • Extrapyramidal symptoms
• Ziprasidone
  • Risk of sudden cardiac death due to torsades des pointes (uncommon variant of ventricular tachycardia [very fast heart rhythm]) due to prolonged QT prolongation, which makes this medication undesirable for individuals with a family history of cardiac sudden death related to cardiac conduction abnormalities

It should be noted that other side effects are also possible and any concerns should be discussed with the prescribing doctor as soon as possible.

When Considering Bipolar Medication for Children

While many of the side effects of bipolar medication for children can seem frightening and some are even life-threatening, it’s important to understand the risk vs. reward scenario for any individual child. Many of these side effects are extremely rare and a doctor can assess a child’s specific risk with regards to any medication.

I. What is Acquaintance Rape?

Acquaintance rape, which is also referred to as "date rape" and "hidden rape," has been increasingly recognized as a real and relatively common problem within society. Much of the attention that has been focused on this issue has emerged as part of the growing willingness to acknowledge and address issues associated with domestic violence and the rights of women in general in the past three decades. Although the early and mid-1970s saw the emergence of education and mobilization to combat rape, it was not until the early 1980s that acquaintance rape began to assume a more distinct form in the public consciousness. The scholarly research done by psychologist Mary Koss and her colleagues is widely recognized as the primary impetus for raising awareness to a new level.

The publication of Koss' findings in the popular Ms. magazine in 1985 informed millions of the scope and severity of the problem. By debunking the belief that unwanted sexual advances and intercourse were not rape if they occurred with an acquaintance or while on a date, Koss compelled women to reexamine their own experiences. Many women were thus able to reframe what had happened to them as acquaintance rape and became better able to legitimize their perceptions that they were indeed victims of a crime. The results of Koss' research were the basis of the book by Robin Warshaw, first published in 1988, entitled I Never Called it Rape.

For current purposes, the term acquaintance rape will be defined as being subjected to unwanted sexual intercourse, oral sex, anal sex, or other sexual contact through the use of force or threat of force. Unsuccessful attempts are also subsumed within the term "rape." Sexual coercion is defined as unwanted sexual intercourse, or any other sexual contact subsequent to the use of menacing verbal pressure or misuse of authority (Koss, 1988).

II. Legal Perspectives on Acquaintance Rape

The electronic media have developed an infatuation with trial coverage in recent years. Among the trials which have received the most coverage have been those involving acquaintance rape. The Mike Tyson/Desiree Washington and William Kennedy Smith/Patricia Bowman trials garnered wide scale television coverage and delivered the issue of acquaintance rape into living rooms across America. Another recent trial which received national attention involved a group of teenaged boys in New Jersey who sodomized and sexually assaulted a mildly retarded 17-year old female classmate.

While the circumstances in this instance differed from the Tyson and Smith cases, the legal definition of consent was again the central issue of the trial. Although the Senate Judiciary Committee hearings on the Supreme Court nomination of Judge Clarence Thomas were obviously not a rape trial, the focal point of sexual harassment during the hearings expanded national consciousness regarding the demarcations of sexual transgression. The sexual assault which took place at the Tailhook Association of Navy Pilots annual convention in 1991 was well documented. At the time of this writing, events involving sexual harassment, sexual coercion, and acquaintance rape of female Army recruits at the Aberdeen Proving Grounds and other military training facilities are being investigated.

As these well-publicized events indicate, an increased awareness of sexual coercion and acquaintance rape has been accompanied by important legal decisions and changes in legal definitions of rape. Until recently, clear physical resistance was a requirement for a rape conviction in California. A 1990 amendment now defines rape as sexual intercourse "where it is accomplished against a person's will by means of force, violence, duress, menace, or fear of immediate and unlawful bodily injury." The important additions are "menace" and "duress," as they include consideration of verbal threats and implied threat of force (Harris, in Francis, 1996). The definition of "consent" has been expanded to mean "positive cooperation in act or attitude pursuant to an exercise of free will. A person must act freely and voluntarily and have knowledge of the nature of the act or transaction involved." In addition, a prior or current relationship between the victim and the accused is not sufficient to imply consent. Most states also have provisions which prohibit the use of drugs and/or alcohol to incapacitate a victim, rendering the victim unable to deny consent.

Acquaintance rape remains a controversial topic because of lack of agreement upon the definition of consent. In an attempt to clarify this definition, in 1994, Antioch College in Ohio adopted what has become an infamous policy delineating consensual sexual behavior. The primary reason this policy has stirred such an uproar is that the definition of consent is based on continuous verbal communication during intimacy. The person initiating the contact must take responsibility for obtaining the other participant's verbal consent as the level of sexual intimacy increases. This must occur with each new level. The rules also state that "If you have had a particular level of sexual intimacy before with someone, you must still ask each and every time." (The Antioch College Sexual Offense Policy, in Francis, 1996).

This attempt to remove ambiguity from the interpretation of consent was hailed by some as the closest thing yet to an ideal of "communicative sexuality." As is often the case with groundbreaking social experimentation, it was ridiculed and lampooned by the majority of those who responded to it. Most criticism centered on reducing the spontaneity of sexual intimacy to what seemed like an artificial contractual agreement..

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III. Social Perspectives on Acquaintance Rape

Feminists have traditionally devoted much attention to issues such as pornography, sexual harassment, sexual coercion, and acquaintance rape. The sociological dynamics which influence the politics of sexual equality tend to be complicated. There is no single position taken by feminists on any of the aforementioned issues; there are differing and often conflicting opinions. Views on pornography, for example, are divided between two opposing camps. Libertarian feminists, on one hand, distinguish between erotica (with themes of healthy consensual sexuality) and pornography (material that combines the "graphic sexually explicit" with depictions which are "actively subordinating, treating unequally, as less than human, on the basis of sex." (MacKinnon, in Stan, 1995). Socalled "protectionist" feminists tend not to make such a distinction and view virtually all sexually-oriented material as exploitative and pornographic.

Views on acquaintance rape also appear quite capable of creating opposing camps. Despite the violent nature of acquaintance rape, the belief that many victims are actually willing, consenting participants is held by both men and women alike. "Blaming the victim" seems to be an all too prevalent reaction to acquaintance rape. Prominent authors have espoused this idea in editorial pages, Sunday Magazine sections, and popular journal articles. Some of these authors are women (a few identify themselves as feminists) who appear to justify their ideas by drawing conclusions based on their own personal experiences and anecdotal evidence, not wide-scale, systematic research. They may announce that they too have probably been raped while on a date to illustrate their own inevitable entanglement in the manipulation and exploitation which are part of interpersonal relations. It has also been implied that a natural state of aggression between men and women is normal, and that any woman who would go back to a man's apartment after a date is "an idiot." While there may be a certain degree of cautionary wisdom in the latter part of this statement, such views have been criticized for being overly simplistic and for simply submitting to the problem.

There has been a recent flurry of these literary exchanges on acquaintance rape between women's rights advocates, who have been working to raise public awareness and a relatively small group of revisionists who perceive that the feminist response to the problem has been alarmist. In 1993, The Morning After: Sex, Fear, and Feminism on Campus by Katie Roiphe was published. Roiphe alleged that acquaintance rape was largely a myth created by feminists and challenged the results of the Koss study. Those who had responded and mobilized to meet the problem of acquaintance rape were called "rape-crisis feminists." This book, including excerpted in many major women's magazines, argued that the magnitude of the acquaintance rape problem was actually very small. Myriad critics were quick to respond to Roiphe and the anecdotal evidence she gave to her claims.

IV. Research Findings

The research of Koss and her colleagues has served as the foundation of many of the investigations on the prevalence, circumstances, and aftermath of acquaintance rape within the past dozen or so years. The results of this research have served to create an identity and awareness of the problem. Equally as important has been the usefulness of this information in creating prevention models. Koss acknowledges that there are some limitations to the research. The most significant drawback is that her subjects were drawn exclusively from college campuses; thus, they were not representative of the population at large. The average age of the subjects was 21.4 years. By no means does this negate the usefulness of the findings, especially since the late teens and early twenties are the peak ages for the prevalence of acquaintance rape. The demographic profile of the 3,187 female and 2,972 male students in the study was similar to the makeup of the overall enrollment in higher education within the United States. Here are some of the most important statistics:

Prevalence

• One in four women surveyed was victim of rape or attempted rape.
• An additional one in four women surveyed was touched sexually against her will or was victim of sexual coercion.
• 84 percent of those raped knew their attacker.
• 57 percent of those rapes happened while on dates.
• One in twelve male students surveyed had committed acts that met the legal definitions of rape or attempted rape.
• 84 percent of those men who committed rape said that what they did was definitely not rape.
• Sixteen percent of the male students who committed rape and ten percent of those who attempted a rape took part in episodes involving more than one attacker.

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Responses of the Victim

• Only 27 percent of those women whose sexual assault met the legal definition of rape thought of themselves as rape victims.
• 42 percent of the rape victims did not tell anyone about their assaults.
• Only five percent of the rape victims reported the crime to the police.
• Only five percent of the rape victims sought help at rape-crisis centers.
• Whether they had acknowledged their experience as a rape or not, thirty percent of the women identified as rape victims contemplated suicide after the incident.
• 82 percent of the victims said that the experience had permanently changed them.

V. Myths About Acquaintance Rape

There are a set of beliefs and misunderstandings about acquaintance rape that are held by a large portion of the population. These faulty beliefs serve to shape the way acquaintance rape is dealt with on both personal and societal levels. This set of assumptions often presents serious obstacles for victims as they attempt to cope with their experience and recovery.

Myth	Reality
A woman who gets raped usually deserves it, especially if she has agreed to go to a man's house or park with him.	No one deserves to be raped. Being in a man's house or car does not mean that a woman has agreed to have sex with him.
If a woman agrees to allow a man to pay for dinner, drinks, etc., then it means she owes him sex.	Sex is not an implied payback for dinner or other expense no matter how much money has been spent.
Acquaintance rape is committed by men who are easy to identify as rapists.	Women are often raped by "normal" acquaintances who resemble "regular guys."
Women who don't fight back haven't been raped.	Rape occurs when one is forced to have sex against their will, whether they have decided to fight back or not.
Intimate kissing or certain kinds of touching mean that intercourse is inevitable.	Everyone's right to say "no" should be honored, regardless of the activity which preceded it.
Once a man reaches a certain point of arousal, sex is inevitable and they can't help forcing themselves upon a woman.	Men are capable of exercising restraint in acting upon sexual urges.
Most women lie about acquaintance rape because they have regrets after consensual sex.	Acquaintance rape really happens - to people you know, by people you know.
Women who say "No" really mean "Yes."	This notion is based on rigid and outdated sexual stereotypes.
Certain behaviors such as drinking or dressing in a sexually appealing way make rape a woman's responsibility.	Drinking or dressing in a sexually appealing way are not invitations for sex.

VI. Who are the Victims?

Although it is not possible to make accurate predictions about who will be subjected to acquaintance rape and who won't, there is some evidence that certain beliefs and behaviors may increase the risk of becoming a victim of date rape. Women who subscribe to "traditional" views of men occupying a position of dominance and authority relative to women (who are seen as passive and submissive) may be at increased risk. In a study where the justifiability of rape was rated based on fictional dating scenarios, women with traditional attitudes tended to view the rape as acceptable if the women had initiated the date (Muehlenhard, in Pirog-Good and Stets, 1989). Drinking alcohol or taking drugs appears to be associated with acquaintance rape. Koss (1988) found that at least 55 percent of the victims in her study had been drinking or taking drugs just before the attack. Women who are raped within dating relationships or by an acquaintance are seen as "safe" victims because they are unlikely to report the incident to authorities or even view it as rape. Not only did a mere five percent of the women who had been raped in the Koss study report the incident, but 42 percent of them had sex again with their assailants.

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The company one keeps may be a factor in predisposing women to an increased risk of sexual assault. An investigation of dating aggression and the features of college peer groups (Gwartney-Gibbs & Stockard, in Pirog-Good and Stets, 1989) supports this idea. The results indicate that those women who characterized the men in their mixed-sex social group as occasionally displaying forceful behavior towards women were significantly more likely themselves to be victims of sexual aggression. Being in familiar surroundings does not provide security. Most acquaintance rapes take place in either the victim's or the assailant's home, apartment, or dormitory.

VII. Who Commits Acquaintance Rape?

Just as with the victim, it is not possible to clearly identify individual men who will be participants in acquaintance rape. As a body of research begins to accumulate, however, there are certain characteristics which increase the risk factors. Acquaintance rape is not typically committed by psychopaths who are deviant from mainstream society. It is often expressed that direct and indirect messages given to boys and young men by our culture about what it means to male (dominant, aggressive, uncompromising) contribute to creating a mindset which is accepting of sexually aggressive behavior. Such messages are constantly sent via television and film when sex is portrayed as a commodity whose attainment is the ultimate male challenge. Notice how such beliefs are found within the vernacular of sex: "I'm going to make it with her," "Tonight's the night I'm going to score," "She's never had anything like this before," "What a piece of meat," "She's afraid to give it up."

Nearly everyone is exposed to this sexually biased current by various media, yet this does not account for individual differences in sexual beliefs and behaviors. Buying into stereotypical attitudes regarding sex roles tends to be associated with the justification of intercourse under any circumstances. Other characteristics of the individual seem to facilitate sexual aggression. Research designed to determine traits of sexually aggressive males (Malamuth, in Pirog-Good and Stets, 1989) indicated that high scores on scales measuring dominance as a sexual motive, hostile attitudes towards women, condoning the use of force in sexual relationships, and the amount of prior sexual experience were all significantly related to self-reports of sexually aggressive behavior. Furthermore, the interaction of several of these variables increased the chance that an individual had reported sexually aggressive behavior. The inability to appraise social interactions, as well as prior parental neglect or sexual or physical abuse early in life may also be linked with acquaintance rape (Hall & Hirschman, in Wiehe and Richards, 1995). Finally, taking drugs or alcohol is commonly associated with sexual aggression. Of the men who were identified as having committed acquaintance rape, 75 percent had taken drugs or alcohol just prior to the rape (Koss, 1988).

VIII. The Effects of Acquaintance Rape

The consequences of acquaintance rape are often far-reaching. Once the actual rape has occurred and has been identified as rape by the survivor, she is faced with the decision of whether to disclose to anyone what has happened. In a study of acquaintance rape survivors (Wiehe & Richards, 1995), 97 percent informed at least one close confidant. The percentage of women who informed the police was drastically lower, at 28 percent. A still smaller number (twenty percent) decided to prosecute. Koss (1988) reports that only two percent of acquaintance rape survivors report their experiences to the police. This compared with the 21 percent who reported rape by a stranger to the police. The percentage of survivors reporting the rape is so low for several reasons. Self-blame is a recurring response which prevents disclosure. Even if the act has been conceived as rape by the survivor, there is often accompanying guilt about not seeing the sexual assault coming before it was too late. This is often directly or indirectly reinforced by the reactions of family or friends in the form of questioning the survivor's decisions to drink during a date or to invite the assailant back to their apartment, provocative behavior, or previous sexual relations. People normally relied upon for support by the survivor are not immune to subtly blaming the victim. Another factor which inhibits reporting is the anticipated response of the authorities. Fear that the victim will again be blamed adds to apprehension about interrogation. The duress of reexperiencing the attack and testifying at a trial, and a low conviction rate for acquaintance rapists, are considerations as well.

The percentage of survivors who seek medical assistance after an attack is comparable to the percentage reporting to police (Wiehe & Richards, 1995). Serious physical consequences often emerge and are usually attended to before the emotional consequences. Seeking medical help can also be a traumatic experience, as many survivors feel like they are being violated all over again during the examination. More often than not, attentive and supportive medical staff can make a difference. Survivors may report being more at ease with a female physician. The presence of a rape-crisis counselor during the examination and the long periods of waiting that are often involved with it can be tremendously helpful. Internal and external injury, pregnancy, and abortion are some of the more common physical aftereffects of acquaintance rape.

Research has indicated that the survivors of acquaintance rape report similar levels of depression, anxiety, complications in subsequent relationships, and difficulty attaining pre-rape levels of sexual satisfaction to what survivors of stranger rape report (Koss & Dinero, 1988). What may make coping more difficult for victims of acquaintance rape is a failure of others to recognize that the emotional impact is just as serious. The degree to which individuals experience these and other emotional consequences varies based on factors such as the amount of emotional support available, prior experiences, and personal coping style. The way that a survivor's emotional harm may translate into overt behavior also depends on individual factors. Some may become very withdrawn and uncommunicative, others may act out sexually and become promiscuous. Those survivors who tend to deal the most effectively with their experiences take an active role in acknowledging the rape, disclosing the incident to appropriate others, finding the right help, and educating themselves about acquaintance rape and prevention strategies.

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One of the most serious psychological disorders which can develop as the result of acquaintance rape is Posttraumatic Stress Disorder (PTSD). Rape is just one of many possible causes of PTSD, but it (along with other forms of sexual assault) is the most common cause of PTSD in American women (McFarlane & De Girolamo, in van der Kolk, McFarlane, & Weisaeth, 1996). PTSD as it relates to acquaintance rape is defined as in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition as "the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity" (DSM-IV, American Psychiatric Association, 1994). A person's immediate response to the event includes intense fear and helplessness. Symptoms which are part of the criteria for PTSD include persistent reexperiencing of the event, persistent avoidance of stimuli associated with the event, and persistent symptoms of increased arousal. This pattern of reexperiencing, avoidance, and arousal must be present for at least one month. There must also be an accompanying impairment in social, occupational, or other important realm of functioning (DSM-IV, APA, 1994).

If one takes note of the causes and symptoms of PTSD and compares them to thoughts and emotions which might be evoked by acquaintance rape, it is not difficult to see a direct connection. Intense fear and helplessness are likely to be the core reactions to any sexual assault. Perhaps no other consequence is more devastating and cruel than the fear, mistrust, and doubt triggered by the simple encounters and communication with men which are a part of everyday living. Prior to the assault, the rapist had been indistinguishable from non rapists. After the rape, all men may be seen as potential rapists. For many victims, hypervigilance towards most men becomes permanent. For others, a long and difficult recovery process must be endured before a sense of normalcy returns.

IX. Prevention

The following section has been adapted from I Never Called it Rape, by Robin Warshaw. Prevention is not just the responsibility of the potential victims, that is, of women. Men may try to use acquaintance rape myths and false stereotypes about "what women really want" to rationalize or excuse sexually aggressive behavior. The most widely used defense is to blame the victim. Education and awareness programs, however, can have a positive effect in encouraging men to take increased responsibility for their behavior. Despite this optimistic statement, there will always be some individuals who won't get the message. Although it may be difficult, if not impossible, to detect someone who will commit acquaintance rape, there are some characteristics which can signal trouble. Emotional intimidation in the form of belittling comments, ignoring, sulking, and dictating friends or style of dress may indicate high levels of hostility. Projecting an overt air of superiority or acting as if one knows another much better than the one actually does may also be associated with coercive tendencies. Body posturing such as blocking a doorway or deriving pleasure from physically startling or scaring are forms of physical intimidation. Harboring negative attitudes toward women in general can be detected in the need to speak derisively of previous girlfriends. Extreme jealousy and an inability to handle sexual or emotional frustration without anger may reflect potentially dangerous volatility. Taking offense at not consenting to activities which could limit resistance, such as drinking or going to a private or isolated place, should serve as a warning.

Many of these characteristics are similar to each other and contain themes of hostility and intimidation. Maintaining an awareness of such a profile may facilitate quicker, clearer, and more resolute decision-making in problematic situations. Practical guidelines which may be helpful in decreasing the risk of acquaintance rape are available. Expanded versions, as well as suggestions about what to do if rape occurs, may be found in Intimate Betrayal: Understanding and Responding to the Trauma of Acquaintance

SOURCES: American Psychiatric Association, (1994).Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Francis, L., Ed. (1996) Date rape: Feminism, philosophy, and the law. University Park, PA: Pennsylvania State University Press.

Gwartney-Gibbs, P. & Stockard, J. (1989). Courtship aggression and mixed-sex peer groups In M.A. Pirog-Good & J.E. Stets (Eds.)., Violence in dating relationships: Emerging social issues (pp. 185-204). New York, NY: Praeger.

Harris, A.P. (1996). Forcible rape, date rape, and communicative sexuality. In L. Francis (Ed.)., Date rape: Feminism, philosophy, and the law (pp. 51-61). University Park, PA: Pennsylvania State University Press.

Koss, M.P. (1988). Hidden rape: Sexual aggression and victimization in the national sample of students in higher education. In M.A. Pirog-Good & J.E. Stets (Eds.)., Violence in dating relationships: Emerging social issues (pp. 145168). New York, NY: Praeger.

Koss, M.P. & Dinero, T.E. (1988). A discriminant analysis of risk factors among a national sample of college women. Journal of Consulting and Clinical Psychology, 57, 133-147.

Malamuth, N.M. (1989). Predictors of naturalistic sexual aggression. In M.A. Pirog-Good & J.E. Stets (Eds.)., Violence in dating relationships: Emerging social issues (pp. 219- 240). New York, NY: Praeger.

McFarlane, A.C. & DeGirolamo, G. (1996). The nature of traumatic stressors and the epidemiology of posttraumatic reactions. In B.A. van der Kolk, A.C. McFarlane & L. Weisaeth (Eds.)., Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 129-154). New York, NY: Guilford.

Muehlenhard, C.L. (1989). Misinterpreted dating behaviors and the risk of date rape. In M.A. Pirog-Good & J.E. Stets (Eds.)., Violence in dating relationships: Emerging social issues (pp. 241-256). New York, NY: Praeger.

Stan, A.M., Ed. (1995). Debating sexual correctness: Pornography, sexual harassment, date rape, and the politics of sexual equality. New York, NY: Delta.

Warshaw, R. (1994). I never called it rape. New York, NY: HarperPerennial.

Wiehe, V.R. & Richards, A.L. (1995). Intimate betrayal: Understanding and responding to the trauma of acquaintance rape. Thousand Oaks, CA: Sage.

“Schizophrenia is a disease that affects perception and undermines the part of our brain that knows what is real and what is not.” —Dr. R. Douglas Fields

Schizophrenia is a mental illness that a great many people have heard of but not many—including medical professionals—fully understand. And rightly so, for schizophrenia is complex. Perhaps the best way to understand what schizophrenia means is to break it up and examine the pieces.

Psychiatrists, neurologists, and other medical professionals specializing in the brain have, through research and observation, concluded that schizophrenia is a

• Disease of the brain
• Medical illness
• Mental illness, psychotic disorder

As a brain disease, medical illness, and psychotic disorder, schizophrenia significantly disturbs thoughts, emotions, speech, and behavior. It also affects perception and how someone takes in, interprets, and interacts with the world around him/her.

The American Psychological Association, in its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) seeks to explain schizophrenia in more detail.

Schizophrenia in the DSM-5

The DSM-5 definition of schizophrenia doesn’t so much as define the disorder in succinct terms as it does describe its features. Because of its complexity, there isn’t a single cut-and-dried definition of schizophrenia.

Schizophrenia is an intricate illness of the brain that is very individualized. It is different for every person that lives with it. Further complicating things is that schizophrenia has five subtypes (paranoid, disorganized, catatonic, undifferentiated, and residual), and each of these is experienced uniquely by individuals.

That said, this mental and medical illness does have defining symptoms, features, and diagnostic. There are positive and negative symptoms of schizophrenia, as well as cognitive symptoms. Schizophrenia has neurological signs, too, as well as certain behaviors that point to the illness.

The DSM-5 refers to schizophrenia as a constellation of symptoms rather than as a single, definitive disorder. Further, the markers of schizophrenia exist as a range, and they vary in intensity from person to person, and even in the same person over time (Are Schizophrenia Symptoms in Males and Females Different?).

Schizophrenia is described in the DSM-5 as having these traits:

• Positive symptoms such as hallucinations and delusions (Schizophrenia vs. Psychosis: What’s the Difference?)
• Negative symptoms like a reduction in expression and emotion
• Cognitive symptoms like diminished problem-solving, thinking, and reasoning
• Disorganized speech
• Disorganized or catatonic behavior
• A decrease in functioning in important life areas
• Possible neurological problems such as movement/motor skills, sensory integration, and more
• Behaviors such as mumbling aloud in public, doing things that make sense in the person’s inner world but not in the real world

The DSM-5 specifies that these symptoms of schizophrenia must be present for more than six months, occur in groups (the presence of hallucinations alone, for example, does not constitute schizophrenia), and not happen as part of a different disorder or substance use.

These characteristics are a description of what schizophrenia is. What does schizophrenia mean?

The Meaning of Schizophrenia: Is It a “Split Mind?”

The word schizophrenia is derived from the Greek word meaning “severed mind” or “split mind.” The word refers to

• The fragmentation of mental functioning
• A separation between thinking and feeling
• A split between what is real and what is not

Unfortunately, this connection to “severed mind” or “split mind” has caused confusion and misperceptions. People have taken this to mean “multiple personalities” or “split personalities.” These experiences, more accurately described as alternate identities, are a big part of dissociative identity disorder (DID). DID is drastically different from schizophrenia, and the confusion isn’t helpful to either one.

Another sad consequence of the word “schizophrenia” is that it has traditionally been interpreted as frightening and, often, violent. The DSM-5 works to change the stigma that schizophrenia is a violent illness and clearly states that most people with schizophrenia aren’t aggressive and are instead more frequently victims of violence.

What does schizophrenia mean? While it’s confusing, we can be certain that schizophrenia does not mean violence.

Schizophrenia is a Serious Mental Illness

One definition of schizophrenia is a serious mental illness (SMI) that messes with perception, thoughts, feelings, cognitive processing, and behavior. Some professionals prefer to use the term SMI rather than the official name schizophrenia.

The term SMI is considered by some to be clearer and more logical.

• “Schizophrenia” is actually a group of symptoms and features rather than a single illness
• The illness is unique to each individual—no two people experience it the same
• It doesn’t carry the emotional, often negative, connotation that “schizophrenia” does

One thing that is consistent for everyone living with it: schizophrenia interferes in life. It decreases someone’s functioning in one or more life areas such as

• Work
• School
• Relationships
• Social activities
• Self-care

This illness is indeed very serious and disruptive; therefore, to find ways to lessen its impact on people, researchers in the field continue to make new discoveries. As we increase our understanding of what schizophrenia is, we increase the possibility of effective new schizophrenia medications and treatments.

If you suspect your child has bipolar disorder, a child bipolar symptoms checklist can be useful. You can use it to identify how many bipolar disorder symptoms you child has. It’s important to remember, though, that your child can have many of these pediatric bipolar disorder symptoms and still not warrant a diagnosis of bipolar. That said, if your child has many of the bipolar symptoms on this checklist, it’s worth checking with a professional, such as a psychiatrist, to rule out any possible mental illnesses. Print out the checklist and share it with your child’s doctor.

A Checklist for Bipolar Symptoms in Children

There are many possible childhood bipolar disorder symptoms. According to the Juvenile Bipolar Research Foundation, the following could be on a bipolar child symptoms checklist:

• My child has very irritable moods and/or throws age-inappropriate, protracted, explosive tantrums.
• My child is physically aggressive and/or curses in anger.
• My child shows severe mood changes and disruptive behavior with each major mood.
• My child shows excessive worry or anxiety.
• My child has difficulty waking in the morning.
• My child is hyperactive at night and/or has trouble getting or staying asleep.
• My child has nightmares or night terrors and/or wets the bed.
• My child craves sweet-tasting food.
• My child is easily distracted and/or fidgets and/or is intolerant of delays.
• My child can focus on things of innate interest.
• My child has poor handwriting.
• My child has difficulty organizing tasks and/or making transitions and/or estimating time.
• My child has trouble with auditory processing and/or short-term memory.
• My child is extremely sensitive to touch and/or sound and/or complains of extreme body temperature.
• My child is easily excitable.
• My child has periods of high, frenetic energy. In these periods, my child often:
  • Has many ideas at once
  • Interrupts others
  • Has excessive and rapid speech
  • Has exaggerated ideas about his or herself and his or her abilities
  • Exaggerates
  • Shows precocious sexual curiosity/displays sexual behavior
  • Takes excessive risks
• My child complains of being bored.
• My child has periods of low energy where the child is withdrawn. My child experiences periods of doubt or low-self-esteem and /or feels easily humiliated and/or shamed, criticized or rejected.
• My child relentlessly pursues his or her own needs and is demanding of others.
• My child is willful and refuses to be subordinated; argues with adults and/or is bossy and/or breaks the rules and/or angers in response to limit-setting.
• My child blames others for his or her mistakes and/or lies to avoid consequences.
• My child has difficulty maintaining friendships.
• My child has intentionally destroyed property.
• My child makes threats toward his or herself and/or others.
• My child has made threats of suicide.
• My child is fascinated with gore, blood and violent imagery.
• My child has experience hallucinations (typically auditory or visual).
• My child hoards or avidly collects food or objects.
• My child has concern with dirt, germs or contamination.
• My child is very intuitive and/or creative.

Note when considering whether a child has any of the given bipolar symptoms, it is only when the symptom shows up often or very often that it should be considered a possible symptom. Also, a subset of the above bipolar symptom checklist items can indicate another mental illness such as attention-deficit/hyperactivity disorder (ADHD). This is why it’s critical to get a formal diagnosis from a qualified professional such as a psychiatrist.

Bipolar and the desire for excessive sleep are common. This leaves people with bipolar disorder sleeping all day. This is particularly the case during a bipolar depressive episode but can also be a lingering symptom when others have remitted. Sleeping too much is associated with impairments in functionality throughout one’s life. Learn more about excessive sleep, also known as hypersomnia.

Excessive Sleep – Hypersomnia

Hypersomnia is defined as:

“A condition in which one sleeps for an excessively long time but is normal in the waking intervals.”

So when doctors talk about excessive sleep in bipolar disorder, they tend to refer to it as hypersomnia. (Although The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, renames hypersomnia “hypersomnolence disorder”.)

Hypersomnia has been studied and its effects can be seen at any age. According to the background provided in a 2015 study:

“Adolescents with hypersomnia report more emotional disturbance, unhappiness and interpersonal problems, adults with hypersomnia are 13.4 times more likely to abuse substances, and older adults with excessive daytime sleepiness report significant impairment in daily activities and productivity. Individuals with hypersomnia are more likely to be taking medications, spending more on healthcare, and receiving government subsidies. A recent meta-analysis of 16 prospective studies documented that long habitual sleep was associated with increased rates of all-cause mortality, with long sleep conferring a 1.3× increased risk in the rate of subsequent death.”

Hypersomnia and Bipolar – Sleeping Too Much

In major depression, hypersomnia is common, with about 30% of people experiencing it. However, in bipolar disorder excessive sleep is even more common. Across studies, 38–78% of people with bipolar disorder experience hypersomnia and it is highly recurrent. While hypersomnia is associated with bipolar depressive disorders, 25% of people not in a mood episode (euthymic) still experience it and this is associated with future depressive symptoms.

Bipolar and Excessive Sleep Solutions

Excessive sleep is a very difficult part of bipolar disorder to treat. Hypersomnia is considered a symptom of bipolar disorder and, thus, treatment of the bipolar disorder should treat the hypersomnia as well.

However, one might consider treating lingering hypersomnia with the medication armodafinil (Nuvigil) which is considered a “wakefulness-promoting agent.” This medication may improve wakefulness during the day and may also help treat bipolar depression.

It’s common for those with bipolar disorder to experience insomnia and other sleeping problems, whether or not their mood episodes are being successfully treated with medication. When a person with bipolar can’t sleep, it’s very important to get treatment as sleep disturbances can lead to a decrease in functioning and an unstable mood. In fact, sleep disturbances have even been linked to suicidal feelings. And, of course, if this insomnia is chronic, then so is the mood disruption. If you have bipolar and aren’t sleeping, read on.

Non-Medication Approaches to Bipolar Insomnia Reduction

While insomnia medication for those with bipolar is available, a non-medication approach to bipolar insomnia treatment is often worth trying first as it has no risk of side effects or of being habit-forming.

The primary non-medication approach to the treatment of insomnia in bipolar disorder is called cognitive behavioral therapy for insomnia (CBT-I) and it involves:

• Analysis and goal-setting
• Motivational interviewing
• Sleep education
• Challenging behaviors and thoughts

Bipolar and Insomnia Analysis and Goal-Setting

This is the first step in dealing with insomnia. It involves asking questions of the patient to assess what he or she are doing that may be contributing to sleep disturbances. Questions center around:

• Routines before bed
• Nighttime contributors (such as leaving a cell phone on)
• Behaviors during the day (such as caffeine intake)
• Thoughts and emotions about sleep

Goals regarding improving sleep are then identified.

Motivational Interviewing for Bipolar Insomnia

Once the above are ascertained, a discussion of the pros and cons of changing behaviors, thoughts and emotions are weighed. For example, if a person leaves his or her cell phone on at night, that person will be asked if the advantages of changing that behavior are worth it.

Sleep and Circadian Rhythm Education to Improve Lack of Sleep in Bipolar

One of the issues people have with sleep is that they don’t know enough about how it works to optimize their experiences with it. This phase of the treatment for sleep deprivation focuses on education about how things like environmental factors, social rhythms and sleep times affect one’s quality of sleep.

For example, while people tend to like going to bed and waking up at different times (especially on the weekends as compared to the weekdays), people learn that this actually increases the risk of insomnia.

Bipolar Insomnia Treatment Through Cognitive Behavioral Therapy for Insomnia

The above steps are a prelude to CBT-I. As the name suggests, this type of therapy focuses on both behavior and cognitive changes.

Behavioral changes include:

• Stimulus control – focuses on making the sleep-wake cycle consistent and strengthening associations between the bed and sleep.
• Restricting time in bed – excessive time in bed actually increases the risk of insomnia so it’s better to be in bed only when sleeping.
• Regularizing sleep and wake times – going to bed at the same time and getting up at the same time every day may be the most important part of insomnia treatment. This creates sleepiness in the evenings, particularly when naps are avoided.
• Creating a wind-down routine – it’s critical to have 30-60 minutes at the end of the day to do sleep-promoting activities in dim light to help signal to the body that it’s time to sleep. Electronic devices need to be avoided.
• Initiating wake-up activities – this includes: not hitting the snooze button, opening the curtains upon waking and spending 30-60 minutes in bright light upon waking, among other things.

When changing behaviors around sleep it’s always important to watch for hypomania, mania or rapid cycling symptoms

When changing thoughts and feelings around sleep, the cognitive portion of CBT-I, the main goal is to reduce bedtime worry, rumination, and vigilance. This is done through techniques like:

• Therapy
• Diary writing
• Scheduling a limited “worry time”

Cognitive behavioral therapy for insomnia may seem complicated but it can be very effective and have long-lasting results.

Bipolar Insomnia Medication

The above behavioral and cognitive alterations used to treat insomnia are often preferred by patients as there is no risk of addiction. However, sometimes bipolar insomnia medication is needed. For more on sleep medication, see Bipolar Disorder and Sleep Problems: What to Do.

Unfortunately, people with bipolar disorder report sleep problems frequently. This is likely due to the way the circadian rhythm (body clock) of a person with bipolar disorder is dysregulated. In fact, some people consider bipolar disorder a disorder of the circadian rhythm. The circadian rhythm regulates sleep, appetite, cognitive functions and metabolism, among other physiological processes. It’s also notable that day-to-day activities often vary dramatically for one with bipolar and this is also thought to be due to circadian rhythm dysregulation.

It is no surprise, then, if a circadian rhythm is off, bipolar and sleep problems occur. These sleep problems lead to decreased quality of life and impaired functioning. Learn about the type of sleep problems people with bipolar disorder have and how to address them below.

Bipolar Sleep Patterns

The average person may experience sleep disturbance now and then – this is normal. But someone with bipolar disorder may experience nearly constant sleep disturbance. People with bipolar disorder often have trouble with:

• Falling asleep
• Waking up and feeling refreshed; daytime wakefulness
• Staying asleep throughout the night (sleep continuity)
• Quality of sleep
• Sleep timing
• Nightmares

The sleep patterns in bipolar disorder can make mood episodes worse, and yet altering these patterns also runs the risk of, at least initially, causing mild hypomanic symptoms.

The First Step in Addressing Bipolar Sleep Pattern Problems

The first step in addressing bipolar disorder and sleep problems is to regulate the sleep-wake cycle. This means one must:

• Go to bed at the same time every night
• Get up at the same time every morning

This, obviously, also means that you get the same amount of sleep every night (at least eight hours). It’s important that no change be made to this schedule – that means no sleeping in on the weekends.

In a series of patients who underwent treatment for insomnia, it was found that regulating bedtimes and wake times was often sufficient to bring about an increase in sleep quality.

People find it difficult to regulate their sleep in this way. People often naturally want to change their sleep hours in order to go out with friends, work a late night shift or get up early to go to the gym twice a week. And while these alterations might be okay for the average person, these changes will absolutely sabotage an attempt at better sleep.

For more on bipolar and insomnia, see Solutions for Bipolar and Insomnia: I Can’t Sleep.

Bipolar Disorder and Sleep Medication

There are sleep medications available for those with bipolar disorder. Some of these are specifically approved for sleep while others are used off label (approved for another use but used to treat sleep problems).

Classes of medications used to treat sleep problems in bipolar disorder include:

• Antidepressants – Some antidepressants are sedating. These are not habit-forming and include trazodone (Desyrel) and mirtazapine (Remeron).
• Antipsychotics – not habit forming; typically quetiapine (Seroquel) is used.
• Benzodiazepines, long-acting – these can be habit-forming and include clonazepam (Klonopin).
• Benzodiazepines, short-acting – these can be habit-forming and include lorazepam (Ativan) and alprazolam (Xanax).
• Melatonin receptor agonists – ramelteon (Rozerem; not habit-forming; approved for long-term use)
• Non-benzodiazepines (also known as sedative-hypnotics) – these can be habit-forming and include medications like eszopiclone (Lunesta) or zolpidem (Ambien).
• Over-the-counter sleep aids – antihistamines; possibly habit-forming, including diphenhydramine under various brand names like Sleep-Eze and Benadryl and doxylamine under various brand names including Unisom.
• Supplements and herbs – these come with various risks and include melatonin and valerian root (Natural Herbs, Supplements for Bipolar Disorder).

See more bipolar sleep medications.

Additionally, the medication armodafinil (Nuvigil), which is considered a wakefulness-promoting agent, may help with daytime sleepiness and may also be effective in treating bipolar depression.