Bipolar and Anger- How to Manage

What is bipolar disorder?

Bipolar disorder is a psychiatric disorder that causes extreme and unexpected shifts in mood . The patient usually goes from high periods, a manic or hypomanic state, to low periods, a depressive state, for no apparent reason.

Manic or hypomanic episodes may present with the following symptoms ^[1].:

• Increased activity
• Euphoria
• Moments of optimism or unusual tension
• Loss of concentration
• Exaggerated activities,such as spending in excess or taking part in high-risk activities
• Having a constant large flow of ideas
• Increasing talkativeness
• Poor sleep

Depressive episodes may present with the following symptoms ^[1]:

• Aloss of interest in life and surroundings
• Inability to feel pleasure
• Alteration of sleep
• Feelings of sadness, hopelessness,or emptiness
• Fatigue and lack of energy
• Feelings of guilt or worthlessness
• Change in appetite
• Suicidal thoughts

Irritability is also a common symptom of bipolar disorder ^[2], leading to anger in both hypomanic, manic, and depressive episodes.

Does bipolar disorder cause anger?

The level and severity of irritability and anger related to bipolar disorder can vary and depend on a person’s temperament or personality. Moreover, episodes of anger may not always be related to bipolar disorder – these are, after all, human emotions that everybody experiences at some point in their lives. However, individuals with bipolar disorder experience dramatic mood swings, which can affect their energy levels, decision-making skills, and sleep patterns ^[2], the combination of which can often cause irritability and lead to anger.

Those with high and mixed mood episodes are more vulnerable to symptoms of irritability, and this can lead to unexpected and irrational outbursts of intense anger and even bipolar rage. This can also bring up feelings of guilt and hopelessness due to the effects these episodes have on family, friends, and their environment.

Bipolar anger: Manic and depressive episodes

Anger can occur during both manic and depressive episodes.

During hypomanic and manic episodes, irritability may be related to other mood symptoms, such as overexcitement or hyperactivity. If the patient does not have the tools to cope with this irritability, it may quickly lead to angry outbursts directed towards other people, groups of people, animals, or property.

Bipolar anger or irritability can occur during depressive episodes, with this emotion directed towards oneself in the form of self-injurious or suicidal behavior. However, these low periods are less likely to cause irritability and anger than manic episodes ^[5].

Violent bipolar symptoms

Bipolar disorder is associated with increased violent behavior, especially during manic and mixed episodes or psychotic states ^[3]. This does not mean that all patients with bipolar disorder are prone to violent behavior. Recent studies have also shown that violent behavior in bipolar patients is often due to substance abuse or comorbid mental health disorders ^[4]. Furthermore, some studies have found that those patients with mood disorders, who are acutely ill or psychotic, may show more verbal and physical aggression and hostility, and even a higher rate of criminal behavior, compared to those with bipolar or depressiove disorders ^[4].

What causes anger in people with bipolar

Triggers for episodes of anger can depend on the person’s personality, history, or response to their symptoms from those around them.

For example, during high periods, a person might feel euphoric, excessively happy or energetic, and overconfident. When others cannot follow the person’s rhythm and try to reign them in, these high energy levels can end in frustration, anger, and even aggressive or inappropriate behavior. 

On the other hand, if someone is in a depressive or low period, and somebody persistently tries to help, this might lead to the person with bipolar disorder becoming irritated and lashing out in anger.

Other common examples of triggers that can lead to irritability and anger are:

• When in a manic episode, being falsely accused of being drunk, on drugs,or not taking medication.
• When things don’t go their
• Making mistakes
• Offhand comments made by other people.
• Traffic situations: heavy traffic, others driving too slow or too fast, someone driving too close, etc.
• People not understanding or challenging their reality.
• Other people being angry at them.
• Trauma and suppressed emotions.
• Negative or stressful life events.
• Arguments with partners, family, co-workers,or friends.
• Substance abuse.
• Death of a loved one.

There may also be instances where there is no apparent trigger for anger episodes. If a person with bipolar disorder is not receiving treatment or is experiencing rapid cycling between mood states, they are more prone to experience irritability, escalating into anger and rage.

Signs of anger in bipolar disorder

Signs of anger in bipolar disorder are similar to the common signs of typical anger or rage and include physical, emotional, cognitive, and behavioral warning signs ^[6].

Physical warning signs may include:

• Racing heart rate or tightness in the chest
• Sweating or shaking
• Tense muscles, clenched jaw, frowning or scowling, or turning red in the face
• Fast breathing
• Headache
• Upset stomach

Emotional warning signs may include:

• Feeling disrespected, humiliated, abandoned,or afraid
• Feelings of guilty, insecurity,or jealousy
• Fears of rejection

Cognitive warning signs may include:

• Thoughts of hurting someone or wanting to teach someone a lesson
• Thinking someone is rude on purpose
• Thinking about seeking revenge
• Thinking something terrible is happening

Behavioral warning signs may include:

• Clenched fists
• Trying to provoke fights
• Yelling
• Pacing
• Slamming doors
• Pounding or banging on things
• Blaming others

Ignoring these signs can cause anger or rage to escalate, leading to shouting, heated arguments, physical fights, aggression, assaulting people or animals, or property damage ^[7].

How to manage your anger

Episodes of bipolar anger or bipolar rage can be challenging to manage, as one may not be able to think clearly. Anger might even increase when the person is conscious of their inability to control their emotions and reactions.

However, coping strategies can be practiced to manage these outbursts of anger.

• Identify and make a list of triggers. This way,you can recognize situations, events, people, or places that might trigger outbursts before they appear and prepare for them or avoid them altogether if possible.
• Learn to recognize the thoughts, emotions,or physical feelings that lead to anger or rage. Be mindful of these signs and consider the situation: What is making you angry? Is there a reason for you to feel this way? How can you work through it?
• If an anger episode is unavoidable, remove yourself from the situation.
• If you cannot leave or avoid the situation, identify and implement adaptive coping mechanisms as soon as you notice the internal warning signs. These vary from person to personbut can include mindfulness, breathwork, meditation, listening to music, writing, or exercise.

Get extra support

There is no cure for bipolar disorder, but there are steps one can take to treat it and reduce its effects on one’s daily life.

Take care of yourself. Live a healthy and balanced lifestyle, which will reduce situations of stress and triggers. This includes getting good quality sleep, eating healthily, exercising regularly, and avoiding toxic relationships, environments, or addictive behaviors. Make sure you find the right balance between work and leisure and do not consume alcohol or recreational drugs. 

Early identification and treatment are crucial, especially if bipolar disorder can lead to bipolar anger, rage, and aggressive behavior ^[4]. Follow your doctor’s or psychiatrist’s instructions, go for regular check-ups, and take the prescribed medication as scheduled. Do not discontinue the medication; an alleviation of the symptoms means the medication is working, not that bipolar disorder is cured. As mentioned above, there is no cure, and even though dosages might change over time, patients with bipolar disorder will have to take medication for the rest of their lives.

Look into talk therapy, such as Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy (DBT), which can help you to understand and learn how to manage your emotions and develop healthy coping strategies. 

Finally, don’t underestimate the support the people around you can offer. Trust your family and friends, make a support plan, and let them know how they can help you. Appreciate your caregivers and listen to them. Joining a support group with others experiencing the same issues can help you feel less alone and more understood.