The rage associated with some bipolar episodes can be frightening. Here’s why and when it can happen, and how to deal with it, whether you’re experiencing the anger or it’s directed at you.
Nothing major was wrong in Michelle’s life. Of course, there were the usual tensions around money, kids, and work, but every so often, for no reason she could fathom, her mood plummeted and the world felt gray, stormy, and absent of joy or pleasure. These moods lasted a while, too, sometimes as long as two or three weeks.
For a number of days, Michelle (not her real name) was so depressed she could barely move. She managed to drag herself to work but left her desk several times a day because she felt so miserable that she was ready to burst into tears.
Then, it was as if the sun had burst through the clouds. Michelle woke up feeling energetic and excited about everything. French toast for breakfast! Plans to watch her favorite Netflix show! A tulip peeking out from still-frozen soil! She was full of energy, racing through her workday, cooking an incredible dinner, cleaning out closets, and finally going to bed at 3 a.m. “You’re like the Energizer Bunny, Mom!” her daughter told her.
After four more days like that, though, her good mood shifted. She was agitated, jittery, and quick to anger. She snapped at her boss and her kids and ranted at her husband for not bringing up the laundry she had left on the dryer the night before.
Michelle was living with bipolar disorder, formerly called manic-depressive illness or manic depression for the polar-opposite mood swings that mark the condition.
There are different types of bipolar disorder, the three main ones being bipolar I, bipolar 2, and cyclothymic disorder. According to the DSM-5, which mental health professionals use to diagnose mental health conditions, bipolar I is marked by manic episodes (at least one full-blown one) interspersed with either hypomanic (less severe mania) or major depressive episodes. People with bipolar 2 experience hypomania as well as major depression.
If you have cyclothymic disorder, a rarer form, you’ve had hypomanic and depressive episodes for at least two years but none severe enough to meet the criteria for bipolar I or 2.
Bipolar anger or rage can be a symptom of a mood swing. Uncontrolled, intense, and unpredictable, the anger seems to begin without a trigger, such as a threat or frustration. People in the middle of bipolar anger can scream at and verbally abuse others just because they’re there—and sometimes the person has no memory of doing so.
Here’s what you need to know about bipolar anger, what someone who’s going through it feels like, and how you can deal with anger directed at you.
What the Research Says
It has become increasingly clear that many people fall on “the bipolar spectrum,” which involves a wide range of symptoms that vary in severity and encompass both high and low moods. When experienced simultaneously, it is called a mixed episode.
According to Dean Frederick MacKinnon, M.D., associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine in Baltimore, “People who are actively in the mixed state of bipolar illness have the propensity to develop a rapid response to elevated levels of frustration. Their reaction and range of emotion is incongruous [out of proportion] with the actual level of the stressor. When energized by elevated mood states, they can get angry with little provocation.”
The three hallmarks of bipolar disorder that are correlated with bipolar anger include anxiety, irritability, and agitation, often referred to as AIA. Two controlled trials showed these symptoms were present in approximately two-thirds to three-fourths of people with bipolar 1 mania, and can be observed during depressive, manic, and mixed episodes.
Dr. MacKinnon explains that the emotion of anger, frequently mixed with anxiety, is the body’s response to a perceived threat in the environment.
“When you turn a steering wheel, you have control and know the car will go in a certain direction. But because social encounters are complex, an individual’s response, particularly when they are in the throes of a manic or mixed episode, is not predictable, and they can be easily triggered by a perceived slight,” he says. “The fight or flee impulse can be activated, and people are primed to argue, act aggressively, or explode in anger.”
Dr. MacKinnon, along with a number of researchers and clinicians, theorizes that some people with bipolar disorder may also have borderline personality disorder (BPD), the most frequently co-existing personality disorder. This disorder is characterized by features including inappropriate, intense anger or difficulty controlling anger, as well as anxiety and irritability. When a person with borderline personality disorder is also experiencing a bipolar mixed episode or severe mania, this can generate a massive amount of anger.
Another crossover diagnosis whose overlap is unclear with both of these is intermittent explosive disorder, a mental health condition marked by frequent impulsive anger outbursts or aggression.
Signs of Uncontrolled Anger
While anger is a normal human emotion, difficulty managing it can lead to hurdles in many aspects of your life.
What are signs that you may have chronic anger management problems, or the kind of uncontrollable anger associated with bipolar episodes? According to the Substance Abuse and Mental Health Services Administration (SAMHSA):
*You’re constantly angry or annoyed and are quick to overreact
*You have gotten into trouble at work or with the law
*The way you express your anger at loved ones, friends, neighbors or coworkers has caused serious relationship problems
*You frequently lash out verbally or physically, such as punching walls or hurting someone else
*You’ve been told that you have anger issues and need to get help
*People are afraid of your anger and try to avoid you when you’re in a “bad mood”
Healthy Ways to Manage Your Anger
Identify Your Triggers
Remember the acronym HALT, and if possible, don’t let yourself get hungry, angry, lonely, or tired, especially if these are known to trigger a bipolar episode.
If you’re angry because someone hurt your feelings, negated your perceptions, or did anything else that triggered your anger, decide the best way to handle it at that moment. This means knowing yourself and who you’re dealing with.
If you can do it calmly and appropriately, sometimes it’s better to express your feelings before they have a chance to escalate. Other times it’s best to let yourself simmer down and decide later whether it still needs to be addressed.
Redirect Your Energy
If you’re feeling ready to explode, give yourself a “time out.” Go for a walk, take a shower, or have a comfy place in your house where you can curl up with a cup of tea or a favorite pet. (A purring cat on your lap can be a wonderful anger eraser!)
Lean In to Your Support Team
Develop (by yourself or with a therapist or partner) quick techniques to calm yourself down. These may include slow deep breathing, squeezing a stress ball, using a short meditation app on your phone, or playing a quick, high energy computer game to release some aggression.
Take your “emotional temperature” when you feel yourself getting angry. Are you experiencing a “low grade” annoyance, a snowballing feeling of anger, or are you on your way to a feverish, boiling rage? Try to bring it down by using tools in your “anger toolbox.”
Reframe your anger by trying to think of it as annoyance or frustration rather than rage.
By Barbra Williams Cosentino, RN, LCSW
Medical Reviewer Jean Kim, MD