a93a931f6a60a535d76b44eee2d941e3[1]I always seem to have trouble making good decisions. I have a lot going on in my mind at any given time. I have to disable everything and think of all the possible outcomes instead of trusting my gut instinct. There is truth in the saying “when it rains it pours.” Only in my case it “poors.”

Lately I have been on a losing streak. I am not only referring to material things but in general, everything. I am making some positive changes in my life, one is to stop smoking again. I quit almost three years ago and started up for about seven months. I am done. I am done throwing my money away as well as my health. Sometimes I don’t care but those thoughts don’t last.

I have two adult children and my first grand-baby on the way in July. I have a responsibility to these children to be the best I can be and that is to be healthy and available. Their father passed away so I must do what is right and loving. Smoking is selfish and their father passed away with lung cancer at age Fifty-five. Too young.

Decision making has a great deal to do with impulsive behavior. One of the criteria for a manic episode is that the person is that the person engages in risky behavior. This can be anything from gambling or money spending to sexual behavior. Again, the extent of the behavior depends on the person and the severity of the disorder, but Impulsivity is generally present in some form across all phases of bipolar disorder, including between episodes.

I have Bipolar 1 and find that I am making almost all of these poor choices. I may have hit my bottom but I am not sure just yet. What that usually means to me is that I am going into a depressive episode which hasn’t happened in probably a year or so. I am fortunate in that aspect.

One of the critical thinking skills that can be affected by bipolar disorder is decision making. This goes along with other aspects of cognitive functioning such as memory, attention, some motor skills and social skills. People are affected in different ways and to different extents depending on the severity of the disorder. Decision making in people with bipolar disorder also depends on whether the person is manic, depressed or between episodes.

Making a decision is a fight between logic and emotion. Logic requires significant amounts of energy and thoughtfulness. It takes time.

There are several steps in making any decision.

Identify exactly what the decision entails and the desired end goal.
Gather relevant information.
Examine the options available using both logic and emotion.
Weigh each alternative option based on the best way to reach the end goal.
Make a decision based on the best option.
Turn the decision into action when ready
Evaluate that decision and its consequences..
Trust your gut feeling about a situation.

During mania, the mind is moving very quickly. Thus decisions are made very quickly – and impulsively. Because of this, decision making is often poor; “stopping to think hard about a decision can be incredibly difficult. People may not consider the consequences of their actions.” I know that I don’t. I make snap uneducated decisions mostly when manic.

During depression, there is very little planning. There is also very little hope for the future. “In this state, there is little energy left to think and plan ahead, so decisions are made in the now, without forethought. This combination of hopelessness and Impulsivity increases the risk for suicide.”

Suicide is one of the greatest risks for someone with bipolar disorder. When they are in a normal or manic episode, they usually will not consider it; however, when in a depressed episode, feelings of helplessness and hopelessness can become overwhelming, and suicidal thoughts given serious consideration.

The National Institute of Mental Health (NIMH) reports that more than 90% of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.

The National Mental Health Association (NMHA) reports that 30-75% of suicide victims have suffered some kind of depression.

Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate is 10 to more than 20 times that in the general population.

Between 6-20% of bipolar patients die by suicide compared with 25-56% attempting suicide.
Risk factors for suicide include the following:

· Being in a bipolar depressive episode
· Having threatened suicide before
· Having attempted suicide before
· Having family members who have attempted suicide
· Having knives or firearms in the home

Some warning signs of suicide include:
Talking about death or suicide
Making comments about feeling helpless or hopeless
Saying things like, “I’d be better off dead,” or “You’d be better off without me”
Deep feelings of guilt, shame, or remorse
Sudden switch from depression to calmness or abnormal happiness
Giving away of possessions
Risk-taking behaviors
Sudden accidents (these could be suicide attempts)
Putting affairs in order
If your loved one is in a bipolar depressive episode, they are at risk for suicide. If they are showing signs of suicidal behaviors, do not leave them alone if it is at all possible. People often talk about suicide before they attempt it, so pay close attention to what they are saying.

Take all threats of suicide seriously. Try to get your loved one to seek help or at least call the suicide hotline at 1-800-SUICIDE.

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