Challenges Of Managing Bipolar Anger

Anger is not an official diagnostic symptom of bipolar disorder, but people with this mental health condition may experience anger during mood episodes. Keep reading to learn more about bipolar disorder and anger, how the two may be linked, and anger management strategies. Those living with bipolar disorder, anger, or both may benefit from seeking the guidance and support of a licensed mental health professional.

What is bipolar disorder?

Bipolar disorders are a category of mental health conditions typically characterized by intense emotional states that can significantly impact a person’s ability to function in daily life. 

Anger is not listed as a specific symptom of bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), but people with bipolar disorder can experience anger in relation to other symptoms. 

Types of bipolar disorder and their symptoms

There are three types of bipolar disorder: Bipolar I, bipolar II, and cyclothymic disorder.

Bipolar I disorder

Bipolar I disorder is primarily characterized by manic episodes.

During a manic episode, people may experience symptoms like a decreased need for sleep, rapid speech, distractibility, impulsivity, and increased activity. These behaviors are usually different from how the person typically acts and can be so severe that the individual may not be able to function properly in their daily life. In some cases, manic episodes may require hospitalization to ensure the person’s safety.

People with bipolar I can also experience hypomanic episodes, which tend to be less severe than manic episodes. Hypomanic episodes normally last at least four days and do not typically lead to the type of disruptions that can accompany manic episodes.

Bipolar I can also involve periods of major depression. During these periods, which generally last at least two weeks, people may experience intense sadness. They may also have symptoms like fatigue, a sense of guilt or worthlessness, restlessness, difficulty concentrating, changes in sleep or appetite, and thoughts of suicide or death.

Bipolar II disorder

People with bipolar II disorder must have had at least one major depressive episode and at least one hypomanic episode, but they generally do not experience mania. Those with bipolar II may return to their baseline level of function between episodes.

Cyclothymic disorder

This can be seen as a milder form of bipolar disorder, and it typically involves frequent cycles between hypomania and depressive symptoms. The symptoms of this condition are usually less severe than those associated with bipolar I. For a diagnosis of cyclothymic disorder, hypomania and depressive symptoms must have occurred for at least two years, with mood swings having lasted for at least half of that time and never having stopped for more than two months.

Anger in people with bipolar disorder

Although not listed as diagnostic features of bipolar disorder, research has found that anger tends to be a prominent symptom of this condition. It can occur during hypomanic or depressive mood states, which may arise in any type of bipolar disorder. 

However, anger may be more common during mixed mood states, which is when someone experiences symptoms of both mania or hypomania and depression at the same time, or when these mood changes happen in rapid succession. 

Is anger typical in people with bipolar disorder?

“Irritable mood” is listed in the diagnostic criteria for bipolar disorder and may be misinterpreted as anger, but while it may not be considered “typical,” anger can be a common experience for people with bipolar disorder.

Some people with bipolar disorder report experiencing bipolar rage. This intense anger is described as not necessarily having a trigger and being difficult to shake. People experiencing bipolar rage may lose control, engage in verbal attacks, speak harsh words, or feel angry from the time they wake up in the morning until they go to bed at night. 

In an essay describing their experience with bipolar rage for the Anxiety & Depression Association of America, Dominique Castro wrote, “I was angry from the time I woke up in the morning until my head hit the pillow that night. I couldn’t shake it. I began blaming the people around me for these feelings. I had lost the ability to regulate my emotions. I could sense something was wrong, but did not realize it was because my mind had basically gone off the grid.”

Is there a link between bipolar disorder and anger?

Some studies show that anger and bipolar disorder may be linked. It may be worth noting that the research discussed below is not definitive and that more evidence is needed.

Can anger predict bipolar disorder?

In general, everyone experiences anger occasionally. However, research has found that, in some cases, anger may indicate problems with emotional regulation that could increase the risk of developing bipolar disorder, especially in those who have experienced bouts of unipolar depression. 

The authors of this study speculate that aggression reactivity can be a risk factor for people who have unipolar depression converting to a bipolar disorder diagnosis. Aggression reactivity was measured through statements on self-reporting questionnaires like, “When I feel sad, I do more risky things,” and, “When I feel bad, I feel like more breaking things.”

Anger in people with depression, combined with other clinical factors, like a lack of response to antidepressants or a family history of bipolar disorder, may indicate that the person could develop bipolar disorder in the future. 

While more research is needed in this area, the authors of this study propose that feelings of anger can be an “important target for early recognition of illness and intervention” for people with this mental health condition.

Possible triggers for bipolar anger

Anything that can trigger bipolar flare-ups can lead to bipolar anger. Everyone’s triggers are different, but some may include stress, seasonal changes, sleep disturbances, substance use, and significant life changes, like the death of a loved one or the end of a relationship. It may also be worth noting that depressive, manic, and hypomanic episodes do not always have a trigger and can occur seemingly at random.

Anger management strategies

The following habits may help individuals manage bipolar disorder symptoms, including anger. 

• Prioritize sleep. Keep a consistent sleeping schedule and pay attention to how much you’re sleeping and how you feel. Not getting enough sleep can trigger an episode, and sleeping more than usual, feeling tired, or having a lack of energy can be signs of a depressive episode.
• Establish a regular exercise routine. Exercise can help with symptoms of bipolar disorder and many other mental health disorders, and it often improves mood.
• Avoid using recreational substances, as they may trigger episodes.
• Relieve stress. Try relaxation techniques like yoga, deep breathing, meditation, or grounding exercises.

Getting professional help for this mental health condition

The biggest challenge in treating bipolar anger may be that it usually occurs alongside other symptoms of bipolar disorder and can complicate treatment. Living with bipolar disorder can be challenging, and it is a life-long condition that usually requires ongoing management, typically with prescription medication and professional mental health treatment. 

Psychotherapy tends to be a crucial part of treatment for bipolar disorder. Multiple types of talk therapy can be effective for bipolar disorder, including interpersonal and social rhythm therapy, cognitive behavioral therapy, and family-focused therapy.

Working with a mental health professional online

If you experience bipolar irritability or anger, working with a therapist can help you learn more about the condition, including what can trigger your symptoms and how you can manage them effectively. Therapy can help you establish a consistent routine, manage stress, and identify any unhealthy beliefs and behaviors that could be contributing to your symptoms.

Bipolar disorder can contribute to significant disruptions to your life, which can sometimes make it difficult to regularly attend in-person therapy sessions. With an online platform like BetterHelp, you can work with a qualified professional from the comfort of your home at a time that works for your schedule. Most people are matched with a therapist within 48 hours of signing up, and you can change to a new provider at any time for no additional fee until you find someone with whom you are comfortable working.

Research has found that online therapy can effectively treat a range of mental health conditions, including bipolar disorder. For example, a 2017 study determined that internet-delivered cognitive behavioral therapy could effectively manage bipolar disorder, as well as other conditions, like anxiety, depression, and substance use disorders. 

Takeaway

Although it is not a part of the diagnostic criteria of bipolar disorder, anger can be a common experience for those with this disorder. Some research has found that anger may predict the development of bipolar disorder in people with depression. If you are experiencing symptoms of bipolar disorder or need help learning to manage your anger effectively, connect with a therapist in person or online for support.