Bipolar Disorder, Imposter Syndrome, and the "Fraud" Feeling During Stability

This podcast episode addresses a unique and under-discussed phenomenon in bipolar disorder: the feeling of being a fraud or faking one's illness during periods of stability. Dr. Tracey Marks, a psychiatrist, introduces this concept through a viewer's question, highlighting the profound guilt and self-doubt experienced by individuals who, despite a history of severe episodes, question the reality of their past suffering when they are feeling well. This "imposter reaction" is posited as a potential explanation for why many patients discontinue their medications upon achieving stability, believing they no longer need treatment.

The episode delves into the psychological mechanisms underlying this feeling, distinguishing it from classic imposter syndrome. While traditional imposter syndrome involves a failure to internalize accomplishments, the bipolar "imposter reaction" is characterized by a lack of internalization or ownership of the illness itself. It's described as a deeper sense of "this isn't me," functioning as a defense mechanism against the perceived "insult" of the illness. This disconnect is further explained through the concept of ego-dystonia, where past thoughts and behaviors during an episode feel entirely foreign and irreconcilable with one's current stable self-perception, leading to the conclusion that the illness must have been fabricated or exaggerated.

Dr. Marks also explores the roles of depersonalization and derealization, which can occur during or linger between bipolar episodes. Derealization involves feeling unreal or detached from one's surroundings, while depersonalization is a sense of being unreal or detached from one's own body, thoughts, and actions. Even subtle forms of these dissociative experiences can contribute to the feeling that past symptoms were not real. Additionally, a history of psychosis, where perceptions are severely altered, can lead to a similar disconnect once the psychotic state resolves, making past thoughts seem like a "role" played rather than a genuine experience.

To cope with this challenging "fraud" feeling, Dr. Marks offers several practical strategies. She recommends keeping detailed records of episodes, including patterns and timing, not only to recognize early signs and potentially prevent future episodes but also to serve as a tangible reminder of the illness's scope and cyclical nature. While acknowledging that this isn't a perfect solution, she suggests the feeling may diminish over time with prolonged experience of the illness's pattern. Grounding exercises are also highly recommended, particularly for those experiencing depersonalization. Techniques like wearing a rubber band on the wrist or the "5-4-3-2-1" sensory awareness exercise help reorient individuals to the present moment, pulling them out of their heads and into their immediate environment.

do you ever feel like when you've been doing well you've been faking your illness the whole time?

when I have a stable episode it makes me feel like a fraud like what if I'm living a lie what if I've wasted everyone's time like my GP fighting for me to get seen it makes me feel guilty but deep down in my heart I know I'm not well

I've never had a patient tell me that they felt like a fraud or they wasted my time but of course why would someone tell me this

this could explain why I see so many people with bipolar disorder stop their medications when they're feeling well

real impostor syndrome is when someone fails to internalize their accomplishments and their skills and they think that they don't deserve their current position likewise with bipolar disorder there's a lack of internalization or taking ownership of the illness

it's a deeper sense of this isn't me it's a defense mechanism that you can use to deal with the insult the illness brings to you

when you try and match up who you believe you are and who that person was and we call this ego distonic it's when your thoughts and behaviors don't match your current emotional state

depersonalization is defined as feeling unreal and detached from your body's thoughts Sensations and actions so it's like you're observing yourself in your thoughts

the whole I was faking it thing can be another way of saying I can't relate to this person who was going through the motions and doing all those things but the only way I can make sense of of how I could have been that way is that I must have made it up

you can keep a record of your episodes... to remind yourself of the scope of your illness and recognize that it's something that comes and goes

grounding techniques help you manage overwhelming Feelings by reorienting you to the present

it's called the 54321 exercise you name five things that you can see in the room with you you name four things that you can feel... three things that you can hear... two things that you can smell... and then you name one good thing about yourself