Self-harm is mentioned below.
When I was at university I was a busy girl. I was attending school full-time, working three part-time jobs and skydiving on the side. There wasn’t a lot of time for dilly-dally.
And, of course, through this I was also getting treatment for bipolar disorder. This was at a time when treatment has started becoming successful but we were still tweaking things to try and get the most from the medication. As most lab rats know, this means upping the dose.
And, one day, I was at work and suddenly found myself needing to excuse myself to the lady’s room so I could slice open my ankle.
Drat.
Irritation and Anxiety
Irritation, and I mean severe, rip-your-head-off irritation, is one of the least recognized symptoms of bipolar disorder and I believe it is closely related to anxiety, another symptom that is rarely talked about. We talk about being “up” or “down” but not what those words really mean.
And severe irritation or anxiety can happen either in a depressed or a manic/hypomanic state. This is recognized in the DSM by the official symptom “psychomotor agitation” which indicates:
“. . . unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions. In more severe cases, the motions may become harmful to the individual, such as ripping, tearing or chewing at the skin around one’s fingernails or lips to the point of bleeding.”
And for me, part of this is self-harm.
Recognizing Irritation and Anxiety
At the time I was fairly new to the bipolar diagnosis and I didn’t realize I was having a mood stemming both from my disorder and a medication side effect, all I knew was that I had to cut myself – now. It would have been helpful if someone had warned me about this possibility but warnings are difficult to give as every patient is different.
Nevertheless, irritation and anxiety are serious symptoms and can do serious damage to yourself and your relationships with others (and say, your job) so they are important to recognize. Anxiety is also highly correlated with suicide.
To recognize irritation and anxiety watch for situations that are out of place for you like:
- Overly aggressive behavior
- Extreme annoyance over small infractions
- Abusive behavior
- Wanting to isolate yourself
- The feeling of “bugs crawling under your skin” (you’ll know it when you feel it)
- The desire to perform repetitive actions for no reason
- The desire to self-harm
Any of these should be reported to your doctor and certainly if you’re in danger of harming yourself or someone else they should be dealt with immediately. Do not wait to see if they go away. Waiting may be too late. And it’s much better to regret going to the doctor than to regret hurting yourself or someone else.
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Oh my gosh. I never thought about psychomotor agitation, but now my behaviour during hypomania makes a lot more sense. I pick at the skin on my face, and will occasionally cut myself (though I’ve worked hard to stop). I feel like I can’t stop moving around. I’ve felt those “bugs” too. Great post!
I have agitation at times and didn’t understand that it was due to my having bipolar. It explains why I’m, at times, ready to scream and hit something over being agitated about something/someone. I’ll have to tell my psychiatrist that I have agitation so we can deal with that symptom. Thanks for your input.
Overly aggressive behavior is also sometimes caused by ‘adrenaline system overreactivity’. Adrenaline system overreactivity can be treated with non-psychotropic drugs.
Overly aggressive behavior is sometimes misdiagnosed as a bipolar symptom, or misassociated with bipolar, autism and other disorders.
I’m going thru right now. I pick my nose till I bleed. Then wait a few hoursto do it again. You just helped me figure out that is my problem . Didn’t realize why I did it .
Hi Ash and Sheryl,
Happy I could help.
In my experience this isn’t something that doctors ask about so it isn’t something that patients know about. But knowledge is power, so hopefully this will help facilitate a change for you.
- Natasha
Hi Cathy,
Happy to help.
- Natasha
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I’ve struggled a lot with irritability in both depressive and hypomanic/manic episodes, and it’s something that’s never been asked about, recognized, or considered by my mental health professionals. It’s only in the last few years my partner and I have tackled it head on. I still have to continually insist to my psychiatrist that a drug that helps me with it (risperidone) is worth the side effects. She doesn’t seem to understand that I’d rather have relationships than not.
Anyway, I was reminded of a time I was in the psych ward, very irritable for days. I was called into a clinical team meeting with half a dozen doctors, psych nurses, OT, etc. One said, “Why are you so irritable?” “Because I’m depressed!” I snapped. They still didn’t understand. Sigh.
It really is up to individuals to understand the full impact of their condition, including a symptom like irritability which can so easily be mistaken for a personality trait. It isn’t, and it can be controlled, but we have to realize why it exists first and treat it appropriately.
Thanks for writing this to bring attention to a symptom which is often overlooked but so important to quality of life.
My partner has a comment too: she’s in a support group for significant others of people with bipolar, and says that one of the most common concerns partners have is bipolar irritability. It’s very hard to live with.