Anger: Part of Bipolar or Not?

Patient Expert

My blogging comrade-in-arms Natasha Tracy just posted a piece on anger. I have written on the topic before, but nothing, I recall, for HealthCentral. Let’s amend that right now …

Tracy starts off her piece by noting that the DSM does not list anger as a symptom for bipolar. Should it? she asks. Years ago, when I first explored the topic for an article on mcmanweb, I made a similar observation.

Then I reviewed all the reader comments on every page on my site. Knock me over with a feather. The stories from loved ones invariably referred to their affected partners’ anger as if it were bipolar symptom number one. The patients told a different story. Except for one comment, you would think anger never existed.

Are we that lacking in insight into our own behavior? As an aside, I would love to see someone do a study where they asked both patients and their partners to separately produce their own lists of bipolar symptoms and behaviors, then compare the two.

Back to the topic …

Extending my query farther, I checked the DSM and the psychiatric literature to see if anger existed as an illness in its own right. I came up blank. After some head-scratching, the reason became clear: Anger is natural.

Basically, it doesn’t matter how maladaptive or destructive this behavior is, the fact that everyone engages in it somehow normalizes it. This comes as cold comfort to those on the receiving end. We live in a crazy world.

Mixed states ...

“I get road rage a lot,” I used to joke, “and I don’t even drive.” I would bring this up in the context of mixed states, where we simultaneously experience both depressive and manic (or hypomanic) symptoms. Mixed states are far more common than once thought. Modern estimates place its frequency in the 40 percent range.

Think of dysphoric (as opposed to euphoric) manias and hypomanias, or agitated (as opposed to vegetative or sad) depressions. The brain is in turmoil, pulled in two directions. We feel extreme discomfort in our own skin, like we want to grab the world by the neck and wring it.

Other considerations …

Manic and hypomanic episodes are characterized by difficulty in controlling impulses. Engaging in risky behavior is one obvious example. Might angry outbursts be another?

Men tend to manifest depression differently than women. Rather than feeling sad and weepy, they can be grouchy and irritable and aggressive. Could anger be part of the package?

Or are we getting a bad rap?

Every one of us with bipolar is well-aware of the double-standards we must endure. If we express joy - we’re manic. If we express frustration - we’re manic. Heaven help if we show our real feelings. There are times when anger is an appropriate response to someone eles's manifestly terrible behavior, but no one is going to give us a free pass.

We learn our lessons quickly. We learn how to wear our masks. Of all things, except when we really do lose control of our brains, our behavior may exhibit far more restraint than the general population. Someone needs to study this.

Wrapping this up …

Anger is a condition all of us have to deal with. At the same time, it is both natural and destructive. The surge of emotion we feel inside may be perfectly normal, but expressing it in the wrong setting can prove extremely maladaptive. Bipolar adds many layers of complexity.

Our illness tends to make us thoughtful and insightful. Do your own thinking. Come up with your own insights. Namaste …