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Bipolar Disorder, Anger, and Self-Loathing

Bipolar Disorder, Anger, and Self-Loathing



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Anyone who has a basic working knowledge of bipolar disorder knows all about the extreme highs (mania) and extreme lows (acute depression) that a person with the disorder experiences. Anyone who knows someone with bipolar, or has studied the disease, knows about some of the other common symptoms, as well.

There are literally hundreds of symptoms to manage, including hyper sexuality, uncontrollable anger, and even self-medication (such as with drugs or alcohol). One symptom, however, that doesn’t get discussed often is self-loathing. Bipolar disorder creates an incredible amount of self-hatred. It’s like a voice in someone’s head that incessantly beats them down.

Self-Loathing and Bipolar Disorder

Most of us understand the basics of self-loathing. We all know people who have doubted themselves at some point in their lives and self-loathing is the extreme of that. People with bipolar disorder often hate themselves.

In other words, we believe we are worthless, incapable, and can’t succeed. We are angry because of our misery.

And, if it wasn’t bad enough that we believe it about ourselves, society reinforces that belief. We live in a society that very much dislikes open displays and/or discussions of anger.

What is Observed as Bipolar Anger is Often Self-Loathing

When the average person observes someone with bipolar who is angry, they assume the anger is directed at them. Angry people in our culture is looked upon as being bad. Anger is considered a negative emotion because we tend to classify emotions in this way. Adding moral judgement to feelings often creates more problems than it solves.

Since most people are uncomfortable with anger, they become anxious around angry people, considering them a threat. Add on our culture’s misconceptions about both bipolar disorder and anger and it’s unsurprising when negative outcomes occur.

A person in crisis is going to be perceived as bad, no help will be forthcoming, and that self-hatred will be reinforced. Those who witness the outburst often distances themselves from the person suffering. This further isolates an already desperate individual, often sinking them deeper into depression and preventing them from getting well.

The fact remains that most people don’t live with bipolar disorder. It is, thankfully, relatively uncommon, affecting about 4% of the population. Given America’s lack of mental health education, it isn’t remotely surprising that these ”misunderstandings” occur.

If we are honest with ourselves, we must admit that these “misunderstandings” are purely due to our own ignorance, which is far to often due to not wanting to understand.

Just for a moment, imagine how much better the lives of people living with bipolar disorder would be if we did.


Bipolar Disorder, Anger, and Self-Loathing - Psychology

Bipolar disorders are debilitating mood disorders characterized by periods of mania/hypomania and periods of depression.

Learning Objectives

Summarize the similarities and differences in diagnostic criteria, etiology, and treatment options among the various bipolar disorders

Key Takeaways

Key Points

  • Manic episodes are a distinct period of elevated or irritable mood, which can take the form of euphoria and lasts for at least a week. Features include an increase in energy, decreased need for sleep, and irrational or risky decision-making.
  • Depressive episodes include persistent feelings of sadness, anxiety, guilt, anger, isolation, hopelessness, and/or a variety of other symptoms. Major depressive episodes are required to last for at least two weeks for diagnosis.
  • A mixed affective episode is a condition during which symptoms of mania and depression occur simultaneously. The majority of suicides occur during these episodes.
  • There are four subtypes of bipolar spectrum disorder: bipolar I, bipolar II, cyclothymia, and other specified bipolar and related disorder. Each features a different combination of mania, depression, hypomania, or mixed states.
  • Evidence suggests that both genetic and environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions.
  • Bipolar disorders are often treated with a combination of medication (typically anticonvulsants or antipsychotics) and psychotherapy.

Key Terms

  • psychotherapy: The treatment of people diagnosed with mental and emotional disorders using dialogue and a variety of psychological techniques.
  • lithium: A naturally occurring substance used as medication in the treatment of bipolar disorders.
  • psychotic: Of, related to, or suffering from a severe mental disorder marked by impaired emotions and thoughts and loss of contact with reality.
  • hypomania: A mild form of mania, especially as a phase of several mood disorders, characterized by euphoria or hyperactivity.
  • mania: A state of abnormally elevated or irritable mood, arousal, and/or energy levels.

Defining Bipolar Disorders

Bipolar disorder (commonly referred to as manic-depression) is a mood disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis. Both manic and depressive episodes are so intense that they interfere with everyday life. Between cycles of manic and depressive states, the individual will often experience normal functioning. The risk of suicide among those with the disorder is high at greater than 6% over 20 years, while self harm occurs in 30%–40% of patients. Other mental health issues such as anxiety disorders and substance use disorders are commonly associated.

DSM-5 Diagnostic Criteria

While all of us feel highs and lows and may even experience euphoria and depression, bipolar disorder is a much more severe, debilitating clinical disorder. The “bipolar spectrum” refers to the range in which these alternating moods may occur and includes bipolar I, bipolar II, cyclothymia, and other specified bipolar and related disorder. For all of these diagnoses to be made, the symptoms must indicate a major change from the person’s typical mood.

Bipolar I

A diagnosis of bipolar I requires the occurrence of one or more manic or mixed episodes that last for at least a week (though less if hospitalization is required). A manic episode is a distinct period of elevated or irritable mood, which can take the form of euphoria. People with mania commonly experience an increase in energy and a decreased need for sleep, with many often getting as little as three or four hours of sleep per night. Some can go days without sleeping. A person experiencing mania may exhibit pressured speech, racing thoughts, low attention span, high distractibility, or poor judgment they may engage in risky behavior or become aggressive. As mania becomes more severe, individuals begin to behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future. Many people experience psychotic symptoms.

A mixed episode is a condition during which symptoms of mania and depression occur simultaneously. Typical examples include weeping during a manic episode, experiencing racing thoughts during a depressive episode, or thinking grandiose thoughts while at the same time feeling like a failure. Mixed states are often the most dangerous period of mood disorders, during which the risks of substance abuse, panic disorder, suicide attempts, and other complications significantly increase.

A major depressive episode is not required for diagnosis of bipolar I, although it frequently occurs. The depressive phase includes persistent feelings of sadness, anxiety, guilt, anger, isolation, hopelessness, disturbances in sleep and appetite, fatigue, loss of interest in usually enjoyable activities, problems concentrating, loneliness, self-loathing, apathy, and/or indifference. A major depressive episode persists for at least two weeks.

Bipolar II

In order for bipolar II to be diagnosed, the person must not have experienced a full manic episode however, one or more hypomanic episodes and one or more major depressive episodes are required to merit diagnosis. Hypomanic episodes are a milder version of mania, defined by a mild to moderately elevated mood, optimism, pressure of speech or activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning as mania does, and may even increase productivity. Bipolar II can be more difficult to diagnose because the hypomanic episodes may simply appear as a period of successful high productivity. Hypomania also tends to be reported less frequently than a distressing, crippling depression, and so people with bipolar II are often misdiagnosed with major depressive disorder.

Cyclothymic Disorder

Cyclothymia is a milder version of bipolar. A diagnosis requires that a person experience hypomanic episodes with periods of a milder form of depression, known as dysthymia, for at least 2 years. Neither the hypomanic or dysthymic episodes can meet the criteria for bipolar I or II. There is a low-grade cycling of mood which typically appears to the observer as a personality trait and interferes with functioning.

Other Specified Bipolar and Related Disorder

Previously known as bipolar disorder NOS (not otherwise specified), this is a catch-all category that is diagnosed when the disorder does not fall within a specific subtype of bipolar (for example, if the time requirements for symptoms are not met but the symptoms are still pervasive and disruptive). These disorders can still significantly impair and adversely affect the quality of life of the patient.

Disruptive Mood Dysregulation Disorder

While not officially on the spectrum of bipolar disorders, the DSM-5 recently added the diagnosis of disruptive mood dysregulation disorder (DMDD). A psychiatric mood disorder in children, it is characterized by persistently irritable or angry mood with recurrent, severe temper outbursts. The symptoms of DMDD resemble those of other childhood disorders, notably attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and bipolar disorder in children. Children with DMDD are at risk for depression in later childhood and adolescence.

Etiology

It is estimated that roughly 1% of the adult population suffer from bipolar I, a further 1% suffer from bipolar II or cyclothymia, and somewhere between 2% and 5% percent suffer from “sub-threshold” forms of bipolar disorder. Bipolar disorders have been shown to have a strong genetic and biological basis. The possibility of getting bipolar disorder when one parent is diagnosed with it is 15%–30% risk when both parents have it is 50%–75%. The rate of concordance for bipolar disorder is higher among identical twins than fraternal twins (67% vs. 16%, respectively), suggesting that genetic factors play a strong role in bipolar disorder (Merikangas et al., 2011).

People with bipolar disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin (Thase, 2009). These neurotransmitters are important regulators of the bodily functions that are disrupted in mood disorders, including appetite, sex drive, sleep, arousal, and mood. Medications that are used to treat bipolar disorders (such as lithium ) work to block norepinephrine activity at the synapses.

Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder and that individual psychosocial variables may interact with genetic dispositions. Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar disorder MRI studies report significant differences in brain composition between individuals with bipolar disorder and individuals without.

Brain composition and bipolar disorder: MRI studies indicate many compositional differences between brains of individuals with bipolar disorder and individuals without. This supports the idea that bipolar disorder is a confluence of both environmental and biological factors.

Treatment

Bipolar disorder is often treated with mood-stabilizing medications and psychotherapy. Typically, these two are used in conjunction. The medication with the best evidence thus far is lithium, which is effective for many people in treating acute manic episodes and preventing relapses (more so for manic than for depressive episodes). Other potentially effective medications include anticonvulsants and antipsychotics.

Hospitalization may be required, especially with the manic episodes present in bipolar I. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental-health team or an assertive community treatment (ACT) team, supported employment, patient-led support groups, and intensive outpatient programs.

Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing symptoms before full-blown recurrence, and practicing the factors that lead to maintenance of remission. Cognitive behavioral therapy, family-focused therapy, and psychoeducation have the most evidence for efficacy in regard to relapse prevention.


Anger and aggression in psychiatric outpatients

Background: This study sought to evaluate the degree of anger and aggression experienced by psychiatric outpatients and to determine whether anger is as prominent an emotional state in these patients as are depression and anxiety. We also sought to determine which Axis I and Axis II disorders were associated with increased rates of subjective anger and aggressive behavior.

Method: 1300 individuals presenting to a psychiatric outpatient practice underwent semistructured interviews to evaluate current DSM-IV Axis I (N = 1300) and Axis II disorders (N = 687). Levels of subjective anger and aggression during the preceding week were assessed in each patient, and the odds ratios were calculated for each disorder. A multiple regression analysis was performed to determine which psychiatric disorders independently contributed to the presence of subjective anger and aggressive behavior.

Results: Approximately one half of our sample reported currently experiencing moderate-to-severe levels of subjective anger, and about one quarter had demonstrated aggressive behavior in the preceding week. This level of anger was found to be comparable to the levels of depressed mood and psychic anxiety reported by our sample. Major depressive disorder, bipolar I disorder, intermittent explosive disorder, and cluster B personality disorders independently contributed to the presence of both anger and aggression.

Conclusion: Anger and aggression are prominent in psychiatric outpatients to a degree that may rival that of depression and anxiety it is therefore important that clinicians routinely screen for these symptoms.


Why do people engage in self-injury?

Just as there are healthy ways to relieve stress, such as exercise, there are also unhealthy ways to cope with negative feelings. For some people, self-injury is a coping mechanism.

Along with self-injury, some people with bipolar and other psychiatric disorders may be more apt to abuse drugs or alcohol than people without mood disorders. Some experts believe that risky behaviors are related to the patient trying to self-soothe unpleasant mood states, particularly if they feel overwhelmed by distressing emotions.

Like drugs and alcohol, self-injury tends not to be an effective way to try to relieve emotional discomfort. That's why it's important that people with mood disorders -- especially when traumatic events or abuse have occurred in childhood -- talk with their doctors about effective strategies to help manage emotional distress.


Types of Bipolar Disorders

Bipolar disorder, as discussed in this quiz, is often characterized by extreme moods, they will often come in waves or episodes, the positive episodes are known as manic episodes, and the low episodes are called depressive episodes. Although this quiz is testing for general symptoms of bipolar disorder, there are two types of bipolar disorder, bipolar disorder 1 and bipolar disorder 2.

Bipolar disorder 1 is characterized by at least one manic episode, but no occurrence of a major depressive episode is required for diagnosis with type 1 bipolar disorder. Bipolar disorder 1 is often more extreme in the manic episode that it may require hospitalization for full treatment.

Bipolar disorder 2, on the other hand, is characterized by a major depressive episode that lasts at least two weeks and at least one manic episode. However, manic episodes with bipolar disorder are often not as severe as they are with bipolar 1, they are sometimes referred to as hypomanic episodes, and do not usually result in hospitalization.

Whether you or a loved one are experiencing signs or symptoms of bipolar 1 or bipolar 2, it may be worth discussing the disorder and symptoms you resonated with from the quiz, with a licensed mental health professional after completing this bipolar quiz. Everyone will experience symptoms of bipolar differently, and can benefit from seeking help for the disorder, outside of the resources mentioned on this quiz page.

What is Bipolar Disorder?

Bipolar disorder is a condition that causes extreme mood swings characterized by intense emotional episodes (mania or hypomania) followed by inexplicable emotional &lsquodowns&rsquo (depression).

When you go into depression with mental disorders, you may feel hopeless and sad. You lose your interest in pleasurable activities and feel exhausted most of the time.

But as soon as your mood shifts to mania or hypomania, you begin to experience a significant increase in motivation. You feel euphoric, full of energy, restless, and nervous. This quiz will discuss a variety of those symptoms which may occur with mood disorders.

For those with bipolar disorder, bipolar disorder can feel like an endless cycle of euphoria and depression. While you can appreciate, and perhaps even enjoy, the periods of mania the frequent emotional ups and downs can become exhausting at some point with bipolar.

The mood changes that characterize bipolar disorder can affect your sleep, behavior, decisions, and social interactions. In other words, this condition can eventually impact your personal and professional life. That is why this bipolar disorder test or quiz is in place to help understand potential symptoms of bipolar disorder. Bipolar disorder is treatable, once diagnosed.

Although bipolar disorder will last all of someone's life, people who have this condition can learn to manage mood swings and other related symptoms by following a specific treatment plan for bipolar disorder. Bipolar disorder is not something you have to deal with alone, there are people out there who can help!

Signs of Bipolar Disorder

To understand what people with bipolar disorder are going through and what is acknowledged in this quiz, we need to look at the symptoms that characterize the manic and depressive episodes.

During the manic phase, patients may experience:

  • High levels of energy
  • Excessive, rapid, and sometimes incoherent speaking
  • Grandiosity and an increased sense of self-esteem
  • Restlessness
  • Lack of focus
  • Impulsive decision making
  • Tendency to engage in numerous projects
  • Excessive risk-taking
  • Substance abuse
  • Lack of sleep
  • Intrusive, repetitive thoughts.

During the depressive phase, patients may experience

  • Depressive mood
  • Lack of energy
  • Lack of motivation
  • Poor quality sleep
  • Physical and mental exhaustion
  • Persistent sadness
  • Feelings of worthlessness and hopelessness
  • Suicidal ideation
  • Difficulty in making decisions.

Depending on the severity of the condition, each phase can last between one week and two-three months. Those with bipolar may or may not realize they are experiencing an episode with the disorder. That is one reason why this bipolar quiz may be a good place to start for testing and understanding the disorders. Whether you are experiencing bipolar 1 or 2, treatment for the disorder will be beneficial.

How is Bipolar Disorder Treated?

Since bipolar disorder is a severe psychiatric condition, mental health professionals will often recommend a combination of both medication and therapy. This quiz is not treatment, please reach out for help today after taking the quiz.

Psychotherapy

Individual and group therapy can have a significantly positive impact on the symptoms of bipolar disorder.

Approaches like dialectical behavior therapy, cognitive-behavioral therapy, solution-centered therapy, or family-oriented therapy provide some of the most widely used strategies for treating bipolar disorder. Bipolar disorder can be treated in a variety of ways via therapy.

With the help of a licensed counselor or therapist, you can acquire healthy coping strategies that help you maintain emotional stability and manage sudden mood swings. After this bipolar disorder test, be sure to reach out to a professional about the symptoms you experience with bipolar disorder or other potential disorders not mentioned in the quiz.

Most experts agree that drug therapy is a first-line treatment for bipolar disorder. In other words, it&rsquos almost impossible to achieve recovery in the absence of pharmacological interventions.

Medication lowers the intensity of manic and depressive symptoms, thus cultivating emotional stability. This allows patients to focus on implementing lifestyle changes that help them manage their condition better.

In the most severe cases of mania or depression, hospitalization may be necessary.

Lifestyle changes

As always, your day-to-day habits can influence your ability to handle the emotional instability associated with this condition.

Adopting a healthy lifestyle can be an essential part of your overall recovery and reduce symptoms mentioned in the quiz. This can include giving up on psychoactive substances, adopting a regular sleep schedule, and regular exercise. Those with bipolar symptoms mentioned in the quiz frequently report that meditation and yoga are helpful.

Again, regardless of the symptoms you are experiencing and whether or not you scored symptomatic in the quiz, there is help our there to improve your mental health and decrease the symptoms mentioned in the quiz.