Bipolar disorder: responding to challenges to identity

This qualitative interview study explored the experiences of adults diagnosed with bipolar disorder. Grounded theory methodology was used to analyze transcripts of the interviews conducted. It was found that a central process in the experience of dealing with bipolar disorder is responding to challenges to identity. For people diagnosed with bipolar disorder, there are many sources of information that may challenge identity. These include symptoms, diagnosis, medications, and psychotherapy. Challenging information may be intrapersonal (observations of own feelings and actions) or interpersonal (observations of others’ behaviors and reactions). Experiencing a challenge to identity creates a need to take some action to maintain or reestablish a sense of a coherent identity. This study found two ways that people respond to information that challenges identity. They may discount the information to protect identity or they may consider and use the information to gradually restructure identity. The study examines factors that influence decisions about how to respond to challenging information, strategies for protecting identity, and the process of restructuring identity. The process of responding to challenges to identity is an iterative process. The actions taken to respond to challenges provide feedback to the process, itself, affecting whether future incoming information will be seen as challenging. Over time, there is usually a shift from more frequently responding by discounting information to protect identity toward more often using information to restructure identity. The restructuring process involves integrating self-views with challenging information, thereby reducing the discrepancy and, therefore, the challenge. This results in a more stable identity, less often challenged by incoming information. Because less energy is then needed to respond to challenges to identity, that energy is more available for getting on with life. The dissertation then discusses the implications of this model for future research and its implications for clinical practice of psychotherapy.