Tuesday, May 6, 2008

Bipolar Behavior: Irritability

I had intended to write about bipolar anger and rage. Unfortunately, most bipolar books barely use these words. Rather, the word "irritability" is listed in their indexes.

In their seminal book, Manic-Depressive Illness, written by Frederick K. Goodwin, M.D., and Kay Redfield Jamison, Ph.D., they write, "Research on mood symptoms in mania demonstrates that most patients are depressed, labile (liable to emotional change), or expansive as often as they are euphoric; they are irritable even more often."

In a section entitled Learning to Discriminate Moods, they write: "Problems in learning to discriminate normal from abnormal moods are common throughout the psychotherapy of bipolar patients...Many common emotions range across several mood states...For example, irritability and anger can be a part of normal human existence or alternately can be symptoms of both depression and hypomania."

They may explain why irritability is a symptom of depression and hypomania (in this 939-page book; I have the first edition), but it's too difficult for me to go to all the different sections where it's listed to try and distill it. However, they do quote Emile Kraepelin, M.D., who defined the term "manic-depressive psychosis" in the 1920s in Germany, and he does write about irritability and rage in hypomania.
"Mood is predominantly exalted and cheerful, influenced by the feeling of heightened capacity for work. The patient is in imperturbable good temper, sure of success, "courageous," feels happy and merry, not rarely overflowingly so...

"On the other hand there often exists a great emotional irritability. The patient is dissatisfied, intolerant, fault-finding...he becomes pretentious, positive, regardless, impertinent and even rough, when he comes up against opposition to his wishes and inclinations; trifling external occasions may bring about extremely violent outbursts of rage."
If irritability, anger, and rage are such prevalent symptoms of bipolarity, then why aren't they more prominently discussed in bipolar literature? And more importantly, why aren't we taught specific skills for identifying this behavior and changing it?

When doctors write about specific behavioral symptoms as part of bipolarity, but also write, "Bipolar mood disorder is the result of a chemical imbalance," to me it suggests we aren't responsible for our own behavior, nor can we change it. But, in my experience that isn't true.

What do you think? Do you experience bipolar irritability, anger, and rage? What skills has your doctor taught you to identify it and control it?

(to be continued)

23 comments:

Anonymous said...

I do experience the anger, irritability and rage. I've been taught no coping strategies only because I don't think I've discussed this with my doctor. I feel a great deal of shame around this, and that's most likely why I don't like to talk about it. My family members shoudldn't have to deal with this, and yet I realize I need to work on it. I'm currently trying meditation, but it's too soon to tell it's effectiveness in dealing with it, as my anger comes in more when I'm in a depression, and currently I'm hypomanic. Thanks for bringing this up, I think the issue is huge, and needs to be explored.

Anonymous said...

That was me, 'Canadian Coco'

Bipolar Wellness Writer said...

Dear Canadian Coco,
Thanks for your candor. Yes, it is difficult to discuss those things that "shame" us, but of course, those are the issues we truly need to talk about. I also know it's easier said than done, but maybe admitting it here will give you the courage you need to talk about it with your doctor.

I'll try to do some research on anger in a depressive mood and write about it tomorrow.

Susan
P.S. Welcome to my blog!

bart said...

indeed, irritability exists in many forms and across many expressions of mood... for my part i find myself irritated mostly because i can't understand a given situation or find myself incapable of coping with and information overload or being expected to juggle attention across multiple activities...

during my addiction phase there was additional anger and rage, misdirected and ultimately frustrating, for myself and those around me...

hope this helps...

Bipolar Wellness Writer said...

Dear Bart,
I think it helps in general for us to share information about our symptoms in a supportive community. This blog is the first "support group" (virtual or otherwise) I've ever belonged to. It's been extraordinarily helpful to find that I'm not alone, that we've all experienced similar or different symptoms, and are seeking methods of coping.

Susan

JayPeeFreely said...

With what you know of my past story, can you see how maybe my behavior was mislabeled - in order to affirm someone else's desire - instead of properly examining whether my irritability and anger were just apart of a much, much larger problem?

See, I began to feel like I was a BIP in late 1999/early 2000. I watched an interview with Carey Fisher, star wars gal, and it resonated in some ways. I started examining myself, not always, mind you, but now and again.

Then I got caught up in what I was doing, and who I was doing it with, and the rest is well, the rest of the story...

Last night, I had irritability at some sales rep brought in to promote a paper promo/subscription find. He talked to me from the get go like i was an idiot. "Do you understand getting more subscribers can earn you more money?" was the first question/comment he led with. (Not realizing that if I add anymore customers I won't be able to drive my car - I actually busted the suspension on my last car with 250 papers at 4lbs. per on Sunday.)

Was I wrong to be keyed up, or was it actually normal? (Most there would not realize what has gone on, since I try not to ruminate on my past, and so, I guess I am an idiot...since I am not doing anything better.)

Anyways, I like the addition of this particular information to the list of things to watch for.

Have a fine Navy day, Susan.

P.J. said...

I am very irritable when in a low mood. I get angry quickly, too. I haven't been 'taught' how to deal with this, I've only come to my own coping technique - when feeling frustrated, over-whelmed and irritated, I give myself a time out. Timing depends on how I do that. If I am in a fast paced environment at the time (like when I worked at a restaurant) I go to s dark room (like the bathroom) and just focus on my breathing for 2-3 minutes, just enough to calm down a refocus. I try to do this when I am angry at the kids, too. If I do have some time, I go lie down. Even a 10-15 minute rest or nap does wonders for me. Just to shut the world and it's irritations out for a while rejuvinates me. And, whichever method I choose, I say a little prayer asking God to help me relax and let it go.

Bipolar Wellness Writer said...

Dear JayPeeFreely,
I believe that sometimes irritability is just a part of "normal" life. In your case, a sales rep who has no idea you have a college education and could "think him under the table" is treating you like an "idiot," and it takes a lot of self-discipline to tolerate such rude behavior from him.

Other times, I think it's part of "an illness" when a person gets irritable for no apparent reason.

Whatever the causal factor, it's always difficult to deal with. And it would nice for all of us to develop skills to make it easier!

Susan

Bipolar Wellness Writer said...

Dear P.J.,
Thanks for sharing. It sounds like a good plan. Since we both know the parenting method of giving our children a "time-out" when they can't control their behavior, it's not a bad idea for adults either.

In a chapter on discipline that I wrote for my book, The Mommy Guide, a parenting expert suggested using distraction, and anticipating and averting problems to prevent temper tantrums.

Sometimes, I think that works well with adults too. And, prayer is another way to accomplish the same objective, and add a spiritual element.

Susan

Nancie said...

Dear Susan,

I do find myself at times irritable when I am depressed or hypomanic. When I am depressed I don't have the energy to do a lot of things and I get irritated with people who don't understand what I am going through and expect more of me. Or I get irritated with the slow process of getting well.

When I am hypomanic, I get irritated when things are not turning out as I think they ought to. When I am stressed up, I am also more easily irritable.

I see irritability as something I need to work on and manage better. I usually say a prayer and ask God to help me to cool down. I realized that in the past I tend to say and do the wrong thing when I am irritated and I often regret later. Now I am learning slowly to manage it.

Btw, thanks for your sweet email. As my WordPress blog is no longer working, my blog is now with Blogger at:

http://lifewithbipolardisorder.blogspot.com/

Thanks for linking me on your blog. Do update my link to the above. Thanks.

Take care.

Nancie

Bipolar Wellness Writer said...

Dear Nancie,
To be honest, I think that years ago when I was depressed, I felt so bad that I couldn't meet people's expectations, that I just didn't know what to say.

My irritability comes more with hypomania. And the quote was right on, for me, when it talked about getting irritable when someone disagreed with my plans.

Alas...we are all constantly working to deal with these symptoms. But that's a good thing.

I've changed your blog address, and hopefully everyone else will as well.

Susan

Jazz said...

Hi, Susan!
You know, all the books I ever read on bipolar said exactly what you did: irritability. None of them talked about rage, and I never realized that was part of it until I started reading bipolar blogs. Now a lot of my behavior when I was in college makes a lot more sense!

Bipolar Wellness Writer said...

Dear Jazz,
Welcome to my blog. I don't understand it either, and quite honestly, reading about irritability, anger, and rage without any idea about how to "control it," has never been very helpful to me!

Susan

Jazz said...

Yes, the literature out there all seems very adept at describing our symptoms, but not very helpful as far as what to do about them...other that the medication merry-go-round, of course, which seems to me a bit of a cop-out. I think it's healthier to learn to deal with symptoms--not mask them.

Bipolar Wellness Writer said...

Jazz,
I tend to agree, but then I'm medication-resistant so nothing ever worked. Still, I wouldn't have taken anything if I knew then what I know now!

Susan

KJ said...

This is an interesting post for me. J and I were just discussing how easily his temperment changes and what can be done about it. He is much worse on meds but still his irritability, anger, and rage has been a problem in our family life. I think I have been pretty judgemental about it (or protective because I have children) but reading everyone's posts has made me a lot more empathetic. Thanks all!

Bipolar Wellness Writer said...

Dear KJ,
I believe it's important to know that irritability, anger, and rage are bipolar symptoms, but I don't think it excuses the behavior.

I remember a period when I was on tons of medication and my son must have been 10 or 12. And I was really angry at him for something, and I shouted at him. I didn't say anything terrible to him; it was more the volume and tone.

Within moments I calmed down and apologized--profusely--and repeatedly. But, I truly felt awful (and still do when I look back at these moments). It didn't happen with regularity, but it happened more than I feel comfortable admitting.

I had never been that way before taking medication, and while I'm mostly off medication--I still do find myself getting irritable and angry way more often than before I went on medication.

But I have tried my darnest--to be particularly cautious of over-reacting to my son, who's now 18.

Having four children, I can see this would be a huge issue for you.

Whenever I read about adult children of bipolar mothers (or fathers), and they talk about how "out of control" a parent was, it seems like everything would have turned out differently if the other parent (the well one) had been more protective.

So, while you may have learned something from the people who commented on this topic, I take my hat off to you for protecting your children.

While J's mood changes are not his fault--nor where they mine, because I wasn't aware of the symptoms then, the end result is the same. It can have devastating consequences if it's not dealt with and controlled. And I believe that children must always be protected from "abnormal" behavior.

Susan

Anonymous said...

I have had the irritability/edgy piece most of my life. Mine is not in response to any event in my life, but more of its own entity. I used to call it my inner monster because that's what it felt like. It lived in my chest and was my constant companion. Sometimes it was stronger than others, but always there. I am grateful that currently my medicine mix has taken care of it and for the first time in my life the "monster" has been knocked out. I agree though that it is not talked about enough in relation to bipolar.

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emcolo said...

I have bipolar schitzo-affective disorder and I stopped taking harmful medications thankfully 15 years ago. I still have the bipolar, but I don't have the problems and side-effects I Had from lithium. That drug amongst others is very damaging to the body and toxic in the bloodstream as well. I recommend the natural and herbal remedies. In my opinion there is a cure for all forms of mental illness including bipolar, but the powers-to-be will keep that a secret of course. There is a lot of money to be made in the medical fields and since 2 to 3 million alone in the Unitd States suffer from this lifelong tragedy of an illness, I doubt they will come forth. If they are exposed many heads will roll so to speak.

Wellness Writer said...

Dear emcolo,
I'm sorry it took so long for me to get to this comment. I couldn't agree more. I'm undergoing a terrible depression right now, and can't really write more. But, thanks for your comment. I'll check out your blog when I'm feeling better.

Susan

NYC Sorcerer said...

For me to deal with my "irritable" phases, the first thing I have to do is actually realize I'm in one, which is sometimes hard to do. Luckily, I have a good friend who knows I'm bipolar and together we came up with a code word to key me in to the fact that I might be overreacting or experiencing an episode. We use the word tomato. It's kind of silly, but if I'm being extremely hyper or irritable, my friend will throw the word tomato into the conversation and it's a sign that I need to take a look at my mood. Once I'm aware that I might be experiencing a phase I can then take action to correct it, either be calling my therapist, touching base with my psychiatrist to adjust my meds, getting some alone time, trying to meditate, or even going to the gym to work out some of the extra energy. I think that once you realize you're in a hypomanic phase, you can take action. The key is to recognize it.

Wellness Writer said...

Dear NYC Sorcerer,
Thanks for your comment. The tomato reference makes me smile, and sounds like a good idea. In fact, everything you've said is good advice. Best of luck with all this!

Susan