Session 176: Exploring Bipolar Disorders

Session 176: Exploring Bipolar Disorders

Dr. Joy: Hey, y'all! Thanks so much for joining me for Session 176 of the Therapy for Black Girls podcast. Bipolar disorders are among the most commonly misunderstood disorders when it comes to mental illness. There's still a lot of confusion about how this disorder presents and it’s also often misdiagnosed, so we wanted to take some time to clear up some of the confusion and provide you with some accurate information about what a bipolar disorder can look like.

For this conversation, I was joined by yet another Xavierite, Dr. Valdesha DeJean. Dr. DeJean received her medical degree from Meharry Medical College. She completed her psychiatry residency training at Baylor College of Medicine's Menninger Department of Psychiatry, where she served as the first black female Chief Resident of the general residency training program. She has also been recognized as a Distinguished Fellow of the American Psychiatric Association. She's recently returned to her hometown of Atlanta and is currently working in private practice at the Georgia Psychological Treatment Center.

Dr. DeJean and I talked about the symptoms of both Bipolar I and Bipolar II disorder, some of the treatment options typically suggested, the concerns related to creativity and medication, how to support a family member who's been diagnosed, and she answered some community questions from some of you. If there's something that resonates with you while listening, please be sure to share with us on social media using the hashtag #TBGinSession. Here is our conversation.

Dr. Joy: Thank you so much for joining us today, Dr. DeJean.

Dr. DeJean: Thank you so much for having me.

Dr. Joy: Always excited to connect with another fellow Xavierite. You probably are the fourth or fifth Xavierite we've had on the podcast.

Dr. DeJean: Oh, that's awesome.

Dr. Joy: Yeah, and of course, there has been lots in the media recently about bipolar disorder. We talked about bipolar disorder on the podcast before, but really wanted to have you join us today to expound on that conversation. Can you start by telling us a little bit about the different types of bipolar disorders?

Dr. DeJean: Sure. There are two types of bipolar disorder that are main types and then there are some that are related to medical conditions. But when we talk about it in the community, most people are referring to either Bipolar I disorder or Bipolar II disorder. In general, what bipolar disorder is it’s a type of mood disorder that is characterized by two different types of mood states that you can be in at a single point in time. One being a severely depressed mood, the other being a manic episode. With both mood states, they can last four days or more for mania, and with the depression, two weeks or more.

Starting with depression, when you're in that mood state, that usually involves problems with sleep, extreme fatigue, not feeling motivated, not feeling like you want to engage socially, you may not find pleasure in activities as much, your thoughts may be more morbid, you may even have suicidal thinking. And sometimes you have concentration difficulties or memory problems.

Then when you're in a manic phase or episode, that usually involves–if you can imagine–the opposite of depression. You would have an extreme elation in your mood, extreme elevation of mood to the point of euphoria and so it seems excessively happy, associated with increased energy. When people are in this episode, they tend to feel extremely excited and confident, their self-esteem gets really inflated. When it's in the severe range, they can even get to the point where they're grandiose in their thinking and it could even get to the point of bordering on delusional.

For an example, one patient I had once had thoughts that he or she was famous, or may have thoughts that they might be married to someone famous or they may think they have special gifts or powers. During these periods, they can go days without sleep or sometimes they may just sleep for two to three hours and wake up the next day extremely energized. Their mind is racing full of thoughts–we call it flight of ideas, technically is the term for that–but the mind becomes extremely creative to the point that their speech becomes very rapid. And they're very talkative, sometimes to the point where you can't even comprehend what they're saying at times. They're also very distractible in these episodes and they begin to engage in a lot of projects. They can stay up all night painting, for an example, and they can become impulsive to the point where it can be impairing to their relationships.

Some people will spend excessive amounts of money to the point that they've compromised their financial integrity and other people may even have hypersexuality, where they become more flirtatious or they involve in sexual activity that's outside of their character to be involved in. So sometimes you may even see people have extramarital affairs during a manic episode, when that's not necessarily something that they would do.

Dr. Joy: And so that's Bipolar I disorder you're describing there?

Dr. DeJean: That's usually Bipolar I. The difference between Bipolar I and Bipolar II disorder is usually the duration of the symptoms. Whereas in Bipolar I, those symptoms can last for one week, in Bipolar II disorder, they tend to last about four days or more but that's the average. The difference between Bipolar I and II specifically, is the severity and intensity of those symptoms in terms of the manic symptoms. With Bipolar I disorder, we have manic episodes. With Bipolar II disorder, we have hypomanic episodes: they're less intense, they don't tend to cause as much problems in their social relationships or cause as much impairment there or cause as much impairment in the occupational setting, in their workplace. And that doesn't require hospitalization–Bipolar II–as it would in Bipolar I disorder.

In Bipolar I disorder, it could be so severe that someone may be so delusional, they may even become psychotic that they will require stabilization in a hospital setting. Sometimes for Bipolar II disorder, others may not even notice this change because it can seem subtle. The severity intensity is the major difference between the two.

Dr. Joy: Got it. Okay. Dr. DeJean, can you talk to us also about how someone might know that they're struggling? Like when somebody is maybe on the brink of being diagnosed, what might be some of the first symptoms that they might experience?

Dr. DeJean: Great question. The first early warning sign that most people tend to experience is a decreased need for sleep. And I want to make sure that I make a distinction: it’s not insomnia. Sometimes people think, oh, I have bipolar disorder because I can't sleep. It's not insomnia. Because with insomnia you want to get to sleep, but with bipolar disorder you have a decreased need for sleep. That's usually an early warning signal associated with extreme changes in mood so you can become extremely euphoric and extremely energized. If you know that's not your typical way of experiencing emotion and feeling states, that is a sign that something has changed for you.

I must also add that sometimes with bipolar disorder, you're not extremely euphoric; you may also be extremely irritable, so that is also a sign. If there's an extreme change in mood that's outside of character, those are the warning signs you want to look for early on.

Dr. Joy: I know, at least in my experience, sometimes what will happen is that other people are the ones who start to notice this change in you before you even recognize it in yourself.

Dr. DeJean: That is so true and a very good point to make. Because a lot of times, patients may not have insight into their illness and some people don't even remember the illness or the episodes when they're in it in that moment. A lot of times we do rely on people who love us to share that information and to get patients aware that something has shifted.

Dr. Joy: At least in my experience, it’s often other people who are aware that somebody might be struggling with these symptoms before they even become aware.

Dr. DeJean: That is so true. A lot of times, patients with bipolar disorder may not have insight when they're actually going through the episode so we oftentimes do rely on family to give input to the patient about the symptoms. Sometimes, they don't even remember the episodes after the episodes have occurred so that's a struggle at times, especially if they don't have insight. But we do rely on family to help identify those early warning signs.

Dr. Joy: And what are some of the common treatments for a bipolar disorder? Especially given the fact that the collection of symptoms, it seems like, could look so different from person to person.

Dr. DeJean: Yes. Typically, with bipolar disorder, the first line of treatment is to start a mood stabilizer. Examples of this that people may have heard of maybe like Lamictal or lithium or Depakote. Those are common ones that are prescribed in the community. Sometimes, you will need to add an antipsychotic medicine to the regimen to help stabilize the mood and some people may say, “Why are they giving me this medicine for psychotic symptoms when I'm not psychotic? I don't have schizophrenia.” But we are learning now that that medication can help also because it has mood stabilizing effects. And it's really important for diagnosis to be accurate because there's a different protocol of treatment for bipolar disorder as opposed to major depressive disorder.

With bipolar disorder, if you are in the depressed phase of the treatment, you can sometimes get antidepressants, but it's important not to be on an antidepressant without a mood stabilizer as a part of the regimen. Because antidepressant, by itself, can actually put the patient at risk for another manic episode. It can actually precipitate it. That's why it's important for diagnosis to make that distinction because we don't want people on an antidepressant if they actually have a diagnosis of bipolar disorder, and put them at risk of another manic episode.

Dr. Joy: Dr. DeJean, can you say more about that anti-depressant precipitating another manic episode? Like what's the mechanics there?

Dr. DeJean: Yes. We don't know fully the whole cause of bipolar disorder. There are a lot of theories out there but we know that there are some changes in the neurotransmitters that can cause bipolar disorder. What we do know is that if there is too much serotonin in the body… and that's what antidepressants increase, many of them. They increase serotonin so that surge of serotonin is likely to increase the risk of a manic episode. It makes sense a little bit when you think about it, because serotonin is to make us happy, so too much of that happiness can put on or precipitate the mania.

Dr. Joy: Got it. Okay, that makes sense, that does make sense. And so you said that you would likely start with a mood stabilizer and sometimes add an antipsychotic. Is this like a long-term kind of thing where you would likely be on both of them for a long time or what is the typical course of treatment?

Dr. DeJean: That is really dependent on the severity. It is a biological illness, so just as diabetes and high blood pressure, you want to make sure you keep the illness in remission because it has relapsing and remitting phases. Particularly for patients who have a lot of cycling in and out of the depression and the mania, we want to make sure those patients stay on medication long term because we don't want them to have impairment in their lives. We want them to be able to work and function socially.

There are rare cases in which patients who maybe they don't have a lot of manic episodes so maybe they don't have a lot of depression, maybe the last episode of depression or mania was 20 years ago. For those patients, sometimes they really don't want to be on medicine and so I try to honor and respect people's autonomy as much as we can and just talk about that. I usually will say, “Let's do some long-term psychotherapy to make sure you have some good coping skills and resilience there. And if you do, let's come to an agreement together. If you do have another episode without this medicine, then let's agree that if you continue to have more, we need to talk about long-term options that you will take indefinitely.”

I also want to make a point that if someone is acutely in a manic episode, the treatment is going to be a little bit different than just preventative and stabilization. If you're acutely in a manic episode, the first thing we're going to go to is an antipsychotic medication because that is the first line of treatment for acute mania.

Dr. Joy: Okay, so you wouldn't even start with the mood stabilizer then; you would start first with the antipsychotic?

Dr. DeJean: We’d start first with the antipsychotic. A lot of times the mood stabilizer may be added on in conjunction with it at the same time or later on. But, yes, the first thing we're going to reach for, for starting, is the antipsychotic because that is the treatment for acute mania. But a lot of times we are adding the mood stabilizer at the same time. It just depends on the psychiatrists and the way they think about the treatment.

Dr. Joy: Mm hmm. And I know a lot of times when we're talking about working with clients who've been diagnosed with a bipolar disorder, it really is like a team approach and like a lot of wraparound services. Can you talk about some of those other things in terms of like lifestyle changes and other supporting factors that you might talk with, with a client who is diagnosed with a bipolar disorder?

Dr. DeJean: Right, I love that. I love thinking about it from a biopsychosocial model. Meaning we're thinking about the biology of the medicines through medications, we're thinking about the psychological person involved. So we're thinking about how do we think about the way you see life, the way you view things, the way you view your illness, and so we address that with psychotherapy. And then thinking about social supports. Who can we get involved to help garner support for you at all times? Who are your closest friends that you feel comfortable talking to? Who are your family members who you can rely on that you trust to help you? And making sure that those people are involved in the treatment because they can help find the early warning signs.

Sometimes patients who have more severe bipolar disorder, we will put them in teams called the ACT teams. Certain cities have that where there's a team involving a social worker or a psychiatrist or a case manager, that they sometimes even come to the homes of the individuals to check on them periodically. It really depends on the severity of the illness, but those are the types of supports we want. We want to rally the support around them to make them as most successful as possible.

Dr. Joy: Kind of going back to the medication piece, I know that for a lot of times… maybe you can speak to the prevalence of this. It seems like people who excel creatively will often have a diagnosis of a bipolar disorder. And so sometimes when they meet with a psychiatrist and talk about medication and they start medication, they talk about their creativity being gone or they feel dull in some ways. Can you talk a little bit about that and then how, as a psychiatrist, you work with them to maybe mediate some of those side effects?

Dr. DeJean: Yes. I will say I don't hear a lot about that, but I hear enough to have to address it at times. A lot of times, I would say that piece about the creativity can be dependent on the dosage of medication. Sometimes, maybe the dosages (if a patient's coming to me on a regimen) may be a little bit higher than necessary, so we will try to lower the dosage and see if that will help with them feeling a little bit more creative. But for some people, I will say there are people who just say, “This is just not working for me.” Sometimes you can change the mood stabilizer from one to another to see if that will help.

And then there are people ultimately like, “No, I just want my creativity.” When we get into that, that's when I move into the psychotherapy or pharmacotherapy of speaking with the individual. We then explore. “Okay, let's look at this, let's have a risk-benefit analysis right now. When you are most creative, and I get that you value that…” And I normalize that and empathize with that patient. “When you're creative and you're manic, because you're at risk as a creative and you're not functioning as well because you're in a manic episode, what does your life look like? Is it impaired socially? How are those relationships at that time? Are you able to work?” Because we don't want to value creativity at the expense of impairment.

If they say, “Yes, everything's good, when I'm creative,” then we'll have to kind of check to see if there's a distorted way of thinking. Sometimes it's about let's grieve a little bit of the loss of that creativity so that we can have more functionality in your life, so we really take a look at this. And also, another point is that when you are in a manic episode, you are so creative. Your mind is beyond creative, it's productive and it feels elating and exciting for a lot of people. So of course, when you're in a normal phase or when you're maybe medicated, you're going to feel more muted, but it still could be at the same level of someone who's naturally artistic and who doesn't have the diagnosis. We have to make sure that we're not over estimating or under estimating the creativity when you are well.

Dr. Joy: Mm hmm. Yeah, because I wonder if that could be something that potentially happens. That people think their creativity only comes when they're manic, as opposed to like, “No, you can also access this when you're not having a manic episode.”

Dr. DeJean: Absolutely.

Dr. Joy: Yeah. So, Dr. DeJean, you talked a little bit about making sure that the diagnosis is correct, especially when we're talking about starting medications. What are some of the misdiagnoses you've seen? Like what are some of the things that people think maybe might be bipolar and it's not? Or people diagnosed them with something else and it actually is a bipolar disorder?

Dr. DeJean: That's such a great question because this is a problem–of misdiagnosis. It's not always easy to diagnose because sometimes people don't see those symptoms in themselves as you mentioned earlier. Maybe the family member sees it. There are four main common misdiagnoses I tend to see.

Sometimes, patients actually have borderline personality disorder, and it is misdiagnosed as a bipolar disorder. And I think the reason why this happens is people with borderline personality disorder tend to have a lot of mood swings. I think some clinicians, they hear mood swings and they're ready to diagnose bipolar disorder but it's important to take this information into context.

With borderline personality disorder, the mood swings can vary and range from one hour to a day. And usually someone gets back into a normal mood state for themselves, what we call euthymia. Mood swings tend to fluctuate within a day or hours with borderline personality disorder. However, with bipolar disorder, the moods are sustained episodic periods of changes, so the manic episode will last seven days or more and is usually followed by a crash into the depression, which will be two weeks or more. That is the main distinction that needs to be made with borderline personality disorder. They can also be impulsive (patients with borderline personality disorder) but the impulsivity is usually related to an intense emotional response to some type of situational trigger in their environment that's upset them or some type of interaction.

Another common misdiagnosis is PTSD or post-traumatic stress disorder. You can also have mood swings because of post-traumatic stress disorder and that's usually because something has reminded you of past trauma and has triggered an emotional response. An emotional dysregulation is a part of that illness as well.

ADHD is also commonly misdiagnosed for bipolar disorder and that's because patients tend to be more impulsive who have ADHD and they may be hyperactive. But again, it's important to look at if the changes are episodic in nature. Most of the time, people with ADHD, they're hyperactive most of the day until they go to sleep. And they can be distractible but this is not episodic in nature; it's just a part of the construct of their everyday functioning.

And then substance-induced mood disorders can also look like a bipolar disorder. If someone's using cocaine or amphetamines or uppers–drugs that really elevate the mood–they could very much look like they're in a manic episode. That's another common misdiagnosis.

Dr. Joy: So it really is incumbent upon the therapist or the psychiatrist, whoever's kind of getting this intake information, to make sure that they are grounding the symptoms in context with everything else happening in the person's life.

Dr. DeJean: Absolutely. And sometimes you do have to rely on family members to give some interview details so that you know exactly what you're dealing with if the patient doesn't remember it as well.

Dr. Joy: When you were talking about some of the common misdiagnoses, you talked about borderline personality disorder. You've talked about schizophrenia earlier and those, in addition to bipolar disorder, seem to be the mental health diagnoses that people really struggle with, just in terms of the general population, right?

I think most people kind of understand what happens with depression and anxiety. It feels like there tends to be at least some empathy towards people who maybe struggle with depression and anxiety. For some reason, it seems as though people who maybe struggle with a bipolar disorder or a borderline personality disorder, those diagnoses don't garner the same sympathy from people. We tend to get a lot of really harsh language, a lot of like, “Look at the damage they've done in people's lives,” that kind of thing. I'm curious to hear your thoughts about how we can maybe take some steps to better educate or to really get rid of some of that stigma related to these kinds of diagnoses.

Dr. DeJean: Oh, that's so important to think about. You know, one of the things about stigma that I've learned over these years is that it's not just about fear for some people. Because the fear generates helplessness: “I don't know what to do with this. I'm afraid. I don't know how to help this person,” so it's easier to dismiss it or to just push that person aside. Stigma is based on fear, it’s also based on lack of knowledge, but there's a huge piece to this that stigma is based on denial of vulnerability–of your own vulnerability.

And really, I've seen the most well-adjusted people develop schizophrenia or bipolar disorder. You would never imagine that this person will end up in this situation and the truth of the matter is, there's a risk percentage even in the population. So if we can really acknowledge our own vulnerability, then that could translate to more empathy for other people. Look at this pandemic, how it's changing us. Now 50% of Americans, after this pandemic, are going to end up with a mental health diagnosis. If you could say, “You know, if I had been in that set of circumstances in that person's life or I had that family history…” really putting yourself in their position, you’d have more compassion for that person.

But there are other things that also generate stigma. I think we have to look at the language we use, as you mentioned, in our culture, in our family, in our churches. How do we think about these things? How do we be inclusive? Because a lot of times, the diagnosis is demonized as something that’s spiritual rather than understanding it in truth to be a biological illness. Sometimes, people have said, “Don't take medicine,” so then you're more at risk of the expression of the illness. We're told that we should be good Christians or that you should be strong enough to pray it away. We have to think about the narrative and change that paradigm and the core belief systems to make sure they're accurate and they reflect compassion and empathy.

Another thing is, we need to speak up more when we are suffering. Even if it's just depression and it's not bipolar disorder, we need to normalize that for patients so that they can feel more comfortable opening up. We need to stop coding with stigma in the silence that we have so many times. And it's interesting, in a lot of my patients they don’t find out that there are other people that have bipolar disorder in their family until they get sick. And then they find out Aunt Susie, Uncle Joe had it and all these other people, and it was just everyone hid it. But when it came out, it made the patients feel better. We need to be transparent, we need to be authentic, so that we can help normalize this and not see it as something bad. It's just a part of your experience; it doesn't define who you are. Changing that narrative.

I'm thankful to the public figures and the famous people who have come out to speak out about mental illness. We saw that even Michelle Obama spoke out recently about being depressed. Those actions of people who are leaders in our community help us get closer to destigmatizing, not just bipolar disorder, but any mental health diagnosis.

Dr. Joy: Yeah, that's great information. Thank you so much for that. We already talked about family involved in reporting some of those symptoms, but once there is a diagnosis, what kinds of things can family members and friends do to support somebody who has been diagnosed with a bipolar disorder?

Dr. DeJean: I think the first thing they can do is to gently call it out, that they see something different in them and that they want to be there for them because they want the best for them. And to do it in a way that is least likely to make the person feel judged. A lot of times, people are just afraid to go to a psychiatrist, and I get it. It's like, “Well, what is this person going to do with it? Will they handle me with care and compassion?” A lot of times, just being willing and offering to accompany them to the visit can help reduce the anxiety about seeking mental health treatment. Also, being involved in the treatment team and the treatment planning, helping them research, going to support groups with them. I think those are all good steps that can be taken to make the patient feel heard and seen.

Dr. Joy: Yeah, and I think it is also important because we know that sometimes, especially with the mood swings, it is also important as a caregiver or as a friend or family member to make sure that you're checking in with yourself to make sure that you're taking care of yourself as you're helping to try to take care of this other person as well.

Dr. DeJean: Absolutely.

Dr. Joy: Dr. DeJean, are there… I know school is starting soon, people are kind of getting back into the workplaces. Are there some common accommodations that you maybe typically suggest or that you've seen work for clients who have a bipolar disorder, that they may want to talk with their employer or their schools about?

Dr. DeJean: Yes. Because of the episodic nature of bipolar disorder, there are oftentimes where we can fill out FMLA forms (Family Medical Leave Act form) for patients. If they are in an episode, we can protect them, like if they're in the middle of a manic episode, we can *(inaudible 0:31:58) them already available too, and we filled out a form saying, “This is episodic. They may need to leave work,” so that they're protected and they'll have that time off intermittently.

We can also make sure we say, “Hey, school’s starting, school is stressful this week. Maybe you take a couple of days off to protect your stress level from not having to manage work and dealing with the kids right now, so that you can focus on one thing at a time.” Those are types of measures. And making sure they're having time for psychotherapy, for any support groups, will also be important to make sure that they are able to still function well with the illness.

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Dr. Joy: We also have a couple of questions from some of our community members, so they wanted you to weigh in on some of these questions. The first question is, is this disorder genetic? How does it present in teens and young adults? This person is saying that they weren't diagnosed until they were 40.

Dr. DeJean: Yes, bipolar disorders very commonly run in families so the family histories will increase the risk about tenfold for bipolar disorder. A lot of times, there are people in the family that probably have it even if you don't know those family members. There are family factors that are genetic. We don't know the exact physiology or pathology of how exactly it works, we just know that there's changes in neurotransmitters in the brain and how they are operating, that puts you at risk for the illness. But we do know that it is genetic.

Dr. Joy: Dr. DeJean, would you say that it is important for us to go ahead and start having some conversations with our families, regardless of symptoms? Like you mentioned, sometimes we don't know that uncles and aunts and everybody had these diagnoses before a crisis happens, so would you suggest people starting some of these conversations with their families now?

Dr. DeJean: I think it would be great if families can open up. Some people may not be as open but I think that's important for anything. To know your genetic history through family members, for any potential illness. It will help you to be prepared for anything that can happen down the line. I think it'd be great to have those conversations.

Dr. Joy: Thank you. And then a second question from my community: how often is bipolar disorder misdiagnosed in the black community versus in other communities? And they also are curious to hear if you have any credible resources to share with people who are interested in learning more about the signs, symptoms and treatments of bipolar disorder.

Dr. DeJean: That's a great question. A lot of times, bipolar disorder is often misdiagnosed as schizophrenia or schizoaffective disorder in black Americans. And we've seen linked to issues with just cultural sensitivity and understanding different races of people, sometimes somebody has just general mood swings or ADD and they may be diagnosed with bipolar disorder. I don't have the exact statistics nor am I sure that there's any particular statistics on the rate, but it's certainly commonly misdiagnosed. A lot of times, African Americans are commonly misdiagnosed with psychotic disorders more than our white counterparts.

Dr. Joy: And you've already talked about how that could be complicated because of the medication that they would start them on. If they are misdiagnosed with schizophrenia and put on something, there could be more of the manic episodes like you've already said.

Dr. DeJean: Yes. If you're misdiagnosed and you’re put on medications, you're probably experiencing side effects to those medications or things aren't getting better because it's not being treated appropriately because of misdiagnosis.

In terms of resources, I think it's always good to make sure you get a second opinion. If there's any doubt, if you don't feel comfortable, it's okay to go and be an informed consumer regarding your healthcare and go to as many people as you feel that you need, to feel like you have certainty about your diagnosis. There are also resources in the community, like the Depression Bipolar Support Alliance. That's a national organization that has local chapters throughout the country, where you can go and meet with other people who have the same diagnosis. DBSA also known as Depression Bipolar Support Alliance.

There’s also the National Alliance on Mental Illness that's called NAMI, they also have chapters. And a lot of times, there are support groups even for parents or caregivers or family members who are having loved ones with the illness, that you can reach out to.

Dr. Joy: Thank you. And of course, we will include all of that in the show notes. Where can people find you, Dr. DeJean? What is your website address as well as any social media handles you want to share?

Dr. DeJean: I can be found at the Georgia Psychological Treatment Center. The website is www.GAPsychTreatment.Com. You're welcome to also call the office at (404) 426-5382. And I am not social media savvy, so I don't have…

Dr. Joy: Not a problem, not a problem, we'll include the website and the phone number. We really appreciate you spending some time with us today and sharing your expertise. Thank you so much.

Dr. DeJean: Thank you. Thanks for having me. I really appreciate the opportunity.

Dr. Joy: I'm so glad that Dr. DeJean was able to share her expertise with us today. To learn more about her work and to check out the resources she shared, be sure to visit the show notes at TherapyForBlackGirls.com/session176. And don't forget to share this episode with two other sisters in your life who just might appreciate the conversation.

If there's a topic you'd like to have covered on the podcast, please submit it at TherapyForBblackGirls.com/mailbox. And if you're looking for a therapist in your area, be sure to check out our therapist directory at TherapyForBlackGirls.com/directory. If you want to continue digging into this topic and connect with some other sisters in your area, come on over and join us in the Yellow Couch Collective, where we take a deeper dive into the topics from the podcast and just about everything else. You can join us at TherapyForBlackGirls.com/YCC.