Concept of the Month -- March 2003

"Bipolar" Disease or the Ups and Downs of the Antisocial Person's Unrealistic Expectations?

Over the years, I have witnessed an increase in the diagnosis of "Bipolar Disorder" (formerly called "manic-depressive" illness) in people who primarily have an antisocial personality disorder. What I believe has happened is that well-intentioned professionals who do not regularly interview or treat antisocial individuals are deceived. The antisocial person thinks in extremes. He is number one or he is a zero. There is no middle ground. He has very unrealistic expectations of himself and others. So long as he can prop up a very shaky image of himself as a powerful and unique person, he seems on top of the world. When that image is threatened and things are not working out as he ordained, he slides into a depression. For the antisocial person, the "best" antidote to feeling like a nothing is to show you are somebody -- thus another assertion of his power and control, often with others being injured in the process. The antisocial person's peaks and swamps of emotion are very different from a person who suffers from a mood disorder and who may genuinely merit the diagnosis of "bipolar."

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