Bipolar depression and anger are more common than you might think; combined, they can have a devastating impact on your life and relationships. People with bipolar disorder often describe feeling irritable, getting irate over nothing, or blowing up completely over the smallest things. Others experience rage and violent impulses, which can put themselves and other people at risk. Everyone has the capacity for rage and anger, but it can be more extreme in bipolar depression. Learn more about bipolar depression and anger, and how you can control unwanted outbursts.

Bipolar Depression and Anger: What’s the Connection?

Bipolar depression and anger often go hand-in-hand, and many doctors see anger or extreme irritability as a hallmark symptom of bipolar depression. Anger in bipolar disorder can occur due to chemical shifts in the brain, hormonal imbalances that contribute to the disorder, or the emotional strain of living with bipolar. Dealing with a chronic and sometimes debilitating mental illness can make you feel like life isn’t fair. Anger can be a healthy expression of those emotions, but it can also be destructive.

We’re not just talking about physical anger here. Anger isn’t always obvious. It may present itself as an outburst or even a verbal or physical attack on another person, or it may manifest in irritability and silence. Many people don’t know that anger is a symptom of bipolar disorder and so they feel guilty and ashamed of their feelings, even if they don’t act on them.

Anger in any form can cause people to withdraw from social events and loved ones, but it can also pre-empt other serious issues such as violence, emotional abuse, and self-harm – therefore it should not be taken lightly. If you have bipolar disorder and anger is a symptom, you should consult your doctor immediately.

Anger As a Symptom of Bipolar Depression: What Can You Do?

Here are some of the things you can do to minimize anger as a symptom of bipolar disorder:

1. Understand the cause
   
   The first thing you need to recognize is that anger isn't always a sign of bipolar depression – it can also be symptomatic of a manic or hypomanic episode in bipolar disorder, which may be treated differently. The majority of people with bipolar disorder know whether they’re manic or depressed, but in people who experience rapid cycling, less extreme highs and lows (as experienced in cyclothymia – a milder form of bipolar disorder) or mixed states (experiencing symptoms of mania or hypomania and depression simultaneously), the distinction isn’t so clear.
   
   If you're experiencing anger as a symptom of bipolar depression, you should track your moods and symptoms so that you can consult your doctor. You may be asked if there are any specific triggers to your feelings of anger, or in general, triggers to your bipolar depression overall.
    
2. Know that anger isn’t always bad
   
   In dialectical behavioral therapy (a form of cognitive behavioral therapy often used to treat bipolar disorder), patients are reminded that anger isn’t always bad – it can be a perfectly healthy emotion. Anger drives us forward and motivates us to change. It helps us call out injustices in the world and try to put them right.
   
   However, to be a positive force, anger must be controlled and managed. This may mean finding healthy coping mechanisms for when anger strikes (such as going for a walk or exercising), engaging your brain in calm activities or seeking treatment from your doctor.
    
3. Seek therapy
   
   If you think you have a problem with bipolar depression and anger, you should seek advice from your doctor about what kinds of therapy might help. Physical exercise (such as kickboxing or cardio workouts) can help you channel the physical impulses anger creates, while talking therapy can help you get to the root of your anger and help you find healthy outlets. If anger is having a severe impact on your life, your doctor may look at adjusting your medication.
   
   It’s important to remember that everyone has the capacity for rage, and that anger isn’t necessarily a sign of bipolar disorder – nor does having bipolar disorder mean you will experience anger as a symptom. Anger can be incredibly unbalancing, and it can have a serious effect on the lives of people living with bipolar disorder, so you should always consult your doctor if you experience the symptoms described in this article.

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Read about the devastation that bipolar disorder can cause for family members and loved ones.

Bipolar Disorder Can Be Burden on Family

Mood disorders affect not only the lives of the victims themselves, but also the entire social setting in which he/she moves; marriage, family, friends, job, society at large. The root cause of all these impacts is the degraded ability the victim has to "perform" in these different areas of his/her life. Thus a seriously depressed person will become morose, incommunicative, withdrawn, and unable to participate actively in what is going on. He/she will often become a "wet blanket," sapping out whatever joy there might be in any occasion, and most will agree that they don't enjoy having this person around. It therefore can become a rather heavy burden upon family and friends to have to compensate, on the one hand, for the loss of the "social" contribution that would customarily be expected from the victim in the normal family setting, while at the same time making an extra input of care, encouragement, supervision, and listening to him/her. A manic person is the opposite; he/she will be obtrusive, aggressive, argumentative, convinced of his/her infallibility, vain, arrogant, and quick to give orders to others. Such people can be a real pain to be around. In the family setting, a manic person is often rocking the boat, causing arguments, being peremptory, making irresponsible expenditures and commitments, and unilaterally breaking agreements.

It is impossible even to estimate the amount of emotional pain, stress and loss family members experience in trying to deal with, ultimately to help, a mentally ill person in the household. In many cases, their lives are seriously disrupted, becoming a kind of living hell. Perhaps nothing is more awful than to see, day in and day out, someone you love severely degraded by an illness you don't fully understand, to do everything you can think of to help, and have none of it work. And, in addition, to have to deal with the stigma associated with such an illness, not only by society at large but also in your own mind, however far back you may have pushed it. And thanks to the outrageously inadequate framework provided in our society for mentally ill persons and their families, you won't get much institutional help, short of hospitalization, which ought to be only the last resort.

How Bipolar Behavior Effects Family, Friends

As the illness becomes more serious, degraded performance shades into incapacity. Thus the depressive will linger in bed, begin to be routinely late for work, be unable to make decisions or handle the workload on the job, and eventually will be perceived as an unsatisfactory employee. Likewise the manic will make quick but bad decisions based on little or no knowledge or data, will take serious risks with business assets, become insubordinate or otherwise disrupt the normal chain of command, and will be perceived as unreliable, though energetic, and therefore an unacceptable risk.

The loss of a permanent, well-paying job is one of the worst things that can happen to someone with mental illness. First, it means a direct loss of income, perhaps the main source of income in the family. Second, it may mean the loss of medical insurance, which may be badly needed in the weeks and months ahead. Third, it means an unsatisfactory performance rating in one's personnel file, which may come back to haunt the victim again and again as he/she tries to find further employment. Fourth, it is a serious blow to the self-esteem of a depressive, whereas a manic may not even consider the loss worth notice.

Most people do not have sufficient savings to face a prolonged period without income, and available funds are usually quickly exhausted. All too quickly, the rent or mortgage becomes overdue, and eviction follows. These difficulties are all magnified and accelerated if the victim is the principal wage-earner for a family. In such cases, the role and value of the victim as an effective spouse or parent erodes quickly, and a separation or divorce often ensues. To make matters worse, there is almost no effective public assistance available to a seriously mentally ill person and his/her family. To obtain, for instance, social security disability status can take months or even a year, and the benefit, once it starts, is minimal - adequate if the ill person is the "guest" of another family member, but totally inadequate for even bare survival of an individual. This downward spiral is the reason so many mentally ill people end up as street people in our big cities, unable to help themselves in any way that will lead to improvement or remission of the illness.

It is impossible to even guess the tremendous amount of hardship, stress, pain, and despair that our current system produces for people having the misfortune to become mentally ill. One of the most important things that can be done within the existing system is to learn how to recognize mood disorders at an early age before the grim scenario given above has a chance to unfold. Once recognized, the illness urgently needs prompt, effective treatment. I stress again that "mere" mood disorders can be life-threatening. If necessary, the victim should be hospitalized, and thus placed in an environment where daily needs can be met, safety can be assured, and optimal treatment given. The expense for such treatment in a private hospital can be very large, and can rapidly exhaust one's insurance. The quality of treatment in free public hospitals may be seriously substandard.

The effects of reactive attachment disorder (RAD) in adults can be significant, interfering with someone’s ability to fully experience relationships, a positive sense of self, and mental health in general. Reactive attachment disorder is a trauma disorder of infancy and early childhood. Severe neglect prevents an infant from forming an attachment to a caregiving adult. The basic human need for protection, safety, and trust goes unmet and sometimes causes reactive attachment disorder (Effects of RAD in Teens and Children).

While according to the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), reactive attachment disorder must be diagnosed between the developmental ages of nine months and five years, its effects are long-lasting, often extending into adulthood. Reactive attachment disorder in adults can involve significant psychopathology - dysfunction in thoughts, feelings, and behaviors.

Risks of Reactive Attachment Disorder in Adults

Infants and young children with reactive attachment disorder face long-term risks that have consequences in their adulthood. Reactive attachment disorder in adults can mean poor adjustment in many areas of life. RAD also causes low self-esteem and sense of self-efficacy; the lack of support and attachment from birth results in adults who don’t believe in themselves and their ability to live well. This is especially true for those who haven't received treatment for reactive attachment disorder.

Perhaps the biggest risk reactive attachment disorder has in adults is with relationships. The first attachment relationship is important in paving the way for future relationships. Without forming a bond with a caregiving adult, the person often has great difficulty forming and/or maintaining future social and intimate relationships.

Reactive attachment disorder in adults can also put someone at risk for other mental disorders. Anxiety disorders, depressive disorders, dissociative disorders, and personality disorders are commonly experienced by people with reactive attachment disorder or other attachment problems.

Signs and Symptoms of Reactive Attachment Disorder in Adults

Certain behaviors, as well as inner emotional experiences, indicate reactive attachment disorder in adults. These signs and symptoms include:

• Detachment
• Withdrawal from connections
• Inability to develop and maintain significant relationships, romantic or otherwise
• Inability to show affection
• Resistance to giving and receiving love despite craving it
• Control issues
• Anger problems
• Impulsivity
• Sense of distrust
• Inability to fully grasp emotions
• Feelings of loneliness and emptiness
• Lack of a sense of belonging

Reactive Attachment Disorder in Adults Doesn’t Mean a Life of Loneliness

The effects of reactive attachment disorder in adults can cause distress and have a negative impact on overall mental health. RAD in adults, though, doesn’t mean hopelessness. It is possible to treat the effects of reactive attachment disorder. With support, someone who was diagnosed with RAD as an infant or young child can rebuild emotions and gradually learn the reciprocal behaviors and feelings of relationships.

Reactive attachment disorder can have long-term effects and cause dysfunction into adulthood. These effects are results of the trauma of extreme neglect; reactive attachment disorder in adults isn’t indicative of inherent shortcomings and defects. Separating the severe attachment problem from the person is an important part of healing. Reactive attachment disorder in adults is a mental health disorder that can be helped.

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Do bipolar disorder symptoms look different in males? Although it would be easier if everyone experienced the same symptoms and responded the same way to treatment, bipolar disorder is different for everyone. What's more, certain biological differences affect how bipolar disorder symptoms manifest in men, compared to how symptoms of bipolar manifest in women. Let's examine bipolar disorder symptoms in males and why they often get ignored.

What Are the Bipolar Disorder Symptoms for Males?

Bipolar disorder symptoms in males are more common than they are in females. According to the National Institute of Mental Health, 2.9% of men in the U.S. experience significant shifts in mood that meet the diagnostic criteria for bipolar disorder, compared with 2.8% of women. The symptoms of bipolar disorder are the same across both genders, although biological and environmental gender differences do have a part to play.

Common bipolar disorder symptoms in males and females include:

• Mania, defined as at least one “manic” episode that’s characterized by abnormal levels of energy, grandiose ideas, racing thoughts, less need for sleep, hypersexuality, impulsive spending and fast, erratic speech. Men are more likely to become aggressive during mania and are more prone to hypersexuality.
• Hypomania, a milder form of mania that lasts for at least four days at a time. The symptoms of hypomania are similar to mania but less severe.
• Major depression, usually defined by intense sadness, hopelessness, guilt, lack of interest in once-enjoyed activities, changes to eating and sleeping habits and suicidal thoughts. Depression is typically present in bipolar I and II disorders. Sadly, suicide is 3.5 times more common in men than in women, with the rate being highest in middle-aged white men ("Bipolar Facts and Statistics: Bipolar Disorder is Real").

It is common for people with bipolar disorder to have periods of normality between episodes. Some individuals experience “rapid cycling,” where moods fluctuate quickly with no “normal” periods in-between. Mixed states, where both depression and mania/hypomania are present, affect around 20-40% of people with bipolar disorder.

Bipolar Disorder Symptoms in Men: Why Are They Different?

Research indicates that gender plays a role in the experience of bipolar disorder because the illness so strongly impacts emotional and psychological states. Here are some of the ways bipolar disorder symptoms affect men differently than women.

• Denial: Denial is a feature of bipolar disorder, specifically denial that anything is “wrong” or that behavior is abnormal or dangerous. According to Henry A. Montero, a board-certified Licensed Mental Health Counselor (LMHC), men may be more inclined to deny the emotional element of the disorder because they are “taught not to show emotion.”
• Aggression: Anger and aggression can affect both sexes, and they are not necessarily symptomatic of bipolar disorder. While most people presume that a man’s tendency to violence is innate, research shows that aggression in males stems from both environmental and biological factors, much more so that it does in women ("Do Mood Stabilizers Help Manage Bipolar Anger?").
• Hypersexuality: Hypersexuality is defined as excessive “sexual fantasies, urges, and actual sexual action and behavior." According to the Depression Alliance, hypersexuality is most common in men between the ages of 15 and 25.

Bipolar disorder symptoms in males are not always obvious. Although research suggests that women have a slightly higher risk of developing the disorder, the outcome can be more dangerous for men – with many afraid to speak out about their symptoms or accept help for the condition.

If you or someone you know displays symptoms of bipolar disorder, it’s important to consult a qualified doctor. Bipolar can’t be cured, but there are plenty of treatments and medications that help many people with bipolar live healthy and fulfilling lives.

See also:

Bipolar Depression Symptoms in Men Hard to Deal With

Signs the Man You’re Dating Has Bipolar Disorder

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List of very important things to in supporting a loved one with bipolar disorder, depression, or other mood disorder.

Supporting Someone with Bipolar - For Family and Friends

• Don't regard this as a family disgrace or a subject of shame. Mood disorders are biochemical in nature, just like diabetes, and are just as treatable.
• Don't nag, preach or lecture to the person. Chances are he/she has already told him or herself everything you can tell them. He/she will take just so much and shut out the rest. You may only increase their feeling of isolation or force one to make promises that cannot possibly be kept. ("I promise I'll feel better tomorrow honey". "I'll do it then, okay?")
• Guard against the "holier-than-thou" or martyr-like attitude. It is possible to create this impression without saying a word. A person suffering from a mood disorder has an emotional sensitivity such that he/she judges other people's attitudes toward him/her more by actions, even small ones, than by spoken words.
• Don't use the "if you loved me" approach. Since persons with mood disorders are not in control of their affliction, this approach only increases guilt. It is like saying, "If you loved me, you would not have diabetes!"
• Avoid any threats unless you think it through carefully and definitely intend to carry them out. There may be times, of course, when a specific action is necessary to protect children. Idle threats only make the person feel you don't mean what you say.
• If the person uses drugs and/or alcohol, don't take it away from them or try to hide it. Usually this only pushes the person into a state of desperation and/or depression. In the end, he/she will simply find new ways of getting more drugs or alcohol if he/she wants them badly enough. This is not the time or place for a power struggle.
• On the other hand, if excessive use of drugs and/or alcohol is really a problem, don't let the person persuade you to use drugs or drink with him/her on the grounds that it will make him/her use less. It rarely does. Besides, when you condone the use of drugs or alcohol, it is likely to cause the person to put off seeking necessary help.
• Don't be jealous of the method of recovery the person chooses. The tendency is to think that love of home and family is enough incentive to get well, and that outside therapy should not be needed. Frequently the motivation of regaining self-respect is more compelling for the person than resumption of family responsibilities. You may feel left out when the person turns to other people for mutual support. You wouldn't be jealous of their doctor for treating them, would you?
• Don't expect an immediate 100% recovery. In any illness, there is a period of convalescence. There may be relapses and times of tension and resentment.
• Don't try to protect the person from situations, which you believe they might find stressful or depressing. One of the quickest ways to push someone with a mood disorder away from you is to make them feel like you want them to be dependent on you. Each person must learn for themselves what works best for them, especially in social situations. If, for example, you try to shush people who ask questions about the disorder, treatment, medications, etc., you will most likely stir up old feelings of resentment and inadequacy. Let the person decide for themselves whether to answer questions, or to gracefully say, "I'd prefer to discuss something else, and I really hope that doesn't offend you".
• Don't do for the person that which he/she can do for him/herself. You cannot take the medications for him/her; you cannot feel his/her feelings for him/her; and you can't solve his/her problems for him/her. So don't try. Don't remove problems before the person can face them, solve them, or suffer the consequences.
• Do offer love, support and understanding in the recovery, regardless of the method chosen. For example, some people choose to take medications, some choose not to. Each has advantages and disadvantages (more side-effect versus higher instances of relapse, for example). Expressing disapproval of the method chosen will only deepen the person's feeling that anything they do will be wrong.

In trying to support a person with bipolar disorder, how do you make sense of the ups, downs and sometimes downright craziness?

Bipolar in the Family: Difficult on Everyone

When one member of a family has bipolar disorder, the illness affects everyone else in the family. Family members often feel confused and alienated when a person is having an episode and is not acting like him or herself. During manic episodes or phases, family and friends may watch in disbelief as their loved one transforms into a person they do not know and cannot communicate with. During episodes of depression, everyone can become frustrated, desperately trying to cheer up the depressed person. And sometimes a person's moods are so unpredictable that family members may feel that they're stuck on a rollercoaster ride that's out of control.

It can be tough, but family members and friends need to remember that having bipolar disorder is not the fault of the afflicted person. Supporting their loved one can make all the difference - whether it means assuming extra responsibilities around the house during a depressive episode, or admitting a loved one to the hospital during a severe manic phase.

Coping with bipolar disorder is not always easy for family and friends. Luckily, support groups are available for family members and friends of a person with bipolar disorder. Your doctor or mental health professional can give you some information about support groups in your area.

Understanding, Recognizing Symptoms of Bipolar Disorder

Never forget that the person with bipolar disorder does not have control of his or her mood state. Those of us who do not suffer from a mood disorder sometimes expect mood-disorder patients to be able to exert the same control over their emotions and behavior that we ourselves are able to. When we sense that we are letting our emotions get the better of us and we want to exert some control over them, we tell ourselves things like "Snap out of it," "Get a hold of yourself," "Pull yourself out of it." We are taught that self-control is a sign of maturity and self-discipline. We are indoctrinated to think of people who don't control their emotions very well as being immature, lazy, self-indulgent, or foolish. But you can only exert self-control if the control mechanisms are working properly, and in people with mood disorders, they are not.

People with mood disorders cannot "snap out of it," much as they would like to (and it's important to remember that they want desperately to be able to). Telling a depressed person things like "pull yourself out of it" is cruel and may, in fact, reinforce the feelings of worthlessness, guilt, and failure already present as symptoms of the illness. Telling a manic person to "slow down and get a hold of yourself" is simply wishful thinking; that person is like a tractor-trailer careening down a mountain highway with no brakes.

So the first challenge facing family and friends is to change the way they look at behaviors that might be symptoms of bipolar disorder - behaviors like not wanting to get out of bed, being irritable and short-tempered, being "hyper" and reckless or overly critical and pessimistic. Our first reaction to these sorts of behaviors and attitudes is to regard them as laziness, meanness, or immaturity and be critical of them. In a person with bipolar disorder, this almost always makes things worse; criticism reinforces the depressed patient's feelings of worthlessness and failure, and it alienates and angers the hypomanic or manic patient.

This is a hard lesson to learn. Don't always take behaviors and statements at face value. Learn to ask yourself, "Could this be a symptom?" before you react. Little children frequently say "I hate you" when they are angry at their parents, but good parents know that this is just the anger of the moment talking; those are not their child's true feelings. Manic patients will say "I hate you" too, but this is the illness talking, an illness that has hijacked the patient's emotions. The depressed patient will say, "It's hopeless, I don't want your help." Again, this is the illness and not your loved one rejecting your concern.

Now a warning against the other extreme: interpreting every strong emotion in a person with a mood disorder as a symptom. The other extreme is just as important to guard against. It's possible to jump to the conclusion that everything the person with the diagnosis does that might be foolish or risky is a symptom of illness, even to the point where the person is hauled into the psychiatrist's office for a "medication adjustment" every time he or she disagrees with spouse, partner, or parents. A vicious cycle can get going wherein some bold idea or enthusiasm, or even plain old foolishness or stubbornness is labeled as "getting manic," leading to feelings of anger and resentment in the person with the diagnosis.

When these angry feelings get expressed, they seem to confirm the family's suspicion that the person is "getting sick again," leading to more criticism, more anger, and so on. "He's getting sick again" sometimes becomes a self-fulfilling prophecy; so much anger and emotional stress get generated that a relapse DOES occur because the person with the illness stops taking the medication that controls his or her symptoms out of frustration and anger and shame: "Why bother staying well, if I'm always treated as if I were sick?"

So how does one walk this fine line between not taking every feeling and behavior at face value in a person with bipolar disorder and not invalidating "real" feelings by calling them symptoms? Communication is the key: honest and open communication. Ask the person with the illness about his or her moods, make observations about behaviors, express concerns in a caring, supportive way. Go along with your family member to doctors' appointments, and share your observations and concerns during the visit in his or her presence. Above all, do not call the therapist or psychiatrist and say, "I don't want my (husband, wife, son, daughter, fill in the blank) to know that I called you, but I think it's important to tell you that..." There's nothing more infuriating or demeaning than to have someone sneaking around reporting on you behind your back.

Remember that your goal is to have your family member trust you when he or she feels most vulnerable and fragile. He or she is already dealing with feelings of deep shame, failure, and loss of control related to having a psychiatric illness. Be supportive, and yes, be constructively critical when criticism is warranted. But above all, be open, honest, and sincere.

Bipolar Mania, Depression, Suicide and Family Safety

Never forget that bipolar disorder can occasionally precipitate truly dangerous behavior. Kay Jamison writes of the "dark, fierce and damaging energy" of mania, and the even darker specter of suicidal violence haunts those with serious depression. Violence is often a difficult subject to deal with because the idea is deeply embedded in us from an early age that violence is primitive and uncivilized and represents a kind of failure or breakdown in character. Of course, we recognize that the person in the grip of psychiatric illness is not violent because of some personal failing, and perhaps because of this there is sometimes a hesitation to admit the need for a proper response to a situation that is getting out of control; when there is some threat of violence, toward either self or others.

People with bipolar disorder are at much higher risk for suicidal behavior than the general population. Although family members cannot and should not be expected to take the place of psychiatric professionals in evaluating suicide risk, it is important to have some familiarity with the issue. Patients who are starting to have suicidal thoughts are often intensely ashamed of them. They will often hint about "feeling desperate," about "not being able to go on," but may not verbalize actual self-destructive thoughts. It's important not to ignore these statements but rather to clarify them. Don't be afraid to ask, "Are you having thoughts of hurting yourself?" People are usually relieved to be able to talk about these feelings and get them out into the open where they can be dealt with. But they may need permission and support in order to do so.

Remember that the period of recovery from a depressive episode can be one of especially high risk for suicidal behavior. People who have been immobilized by depression sometimes develop a higher risk for hurting themselves as they begin to get better and their energy level and ability to act improve. Patients having mixed symptoms - depressed mood and agitated, restless, hyperactive behavior - may also be at higher risk for self-harm.

Another factor that increases risk of suicide is substance abuse, especially alcohol abuse. Alcohol not only worsens mood, but it also lowers inhibitions. People will do things when drunk that they wouldn't do otherwise. Increased use of alcohol increases the risk of suicidal behaviors and is definitely a worrisome development that needs to be confronted and acted upon.

Bottom Line

Making peace with the illness is much more difficult than healthy people realize. But the harder lesson is learning that there is no way that anyone can force a person to take responsibility for his or her bipolar disorder treatment. Unless the patient makes the commitment to do so, no amount of love and support, sympathy and understanding, cajoling or even threatening, can make someone take this step. Even family members and friends who understand this at some level may feel guilty, inadequate, and angry at times dealing with this situation. These are very normal feelings. Family members and friends should not be ashamed of these feelings of frustration and anger but rather get help with them.

Even when the patient does take responsibility and is trying to stay well, relapses can occur. Family members might then wonder what they did wrong. Did I put too much pressure on? Could I have been more supportive? Why didn't I notice the symptoms coming on sooner and get him or her to the doctor? A hundred questions, a thousand "if only's," another round of guilt, frustration, and anger.

On the other side of this issue is another set of questions. How much understanding and support for the bipolar person might be too much? What is protective, and what is overprotective? Should you call your loved one's boss with excuses as to why he or she isn't at work? Should you pay off credit card debts from hypomanic spending sprees caused by dropping out of treatment? What actions constitute helping a sick person, and what actions are helping a person to be sick? These are thorny, complex questions that have no easy answers.

Like many chronic illnesses, bipolar disorder afflicts one but affects many in the family. It's important that all those affected get the help, support, and encouragement they need.

Some people ask whether posttraumatic stress disorder (PTSD) is a mental illness. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the manual that medically defines all mental illnesses, PTSD is an official mental illness.

What Is a Mental Illness?

According to The American Heritage® Stedman's Medical Dictionary, “mental illness" is defined as:

Any of various disorders characterized chiefly by abnormal behavior or an inability to function socially, including diseases of the mind and personality and certain diseases of the brain. Also called mental disease, mental disorder.

In the case of those who have PTSD, they experience significant, abnormal behavior. Examples of this might be diving to the floor when a car backfires or feeling as though they are reliving the traumatic events, even to the point of hallucinating (Understanding PTSD Nightmares And Flashbacks).

PTSD in the Diagnostic and Statistical Manual of Mental Disorders

Posttraumatic stress disorder has been a recognized mental illness since 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). It was considered quite controversial at the time, but since then doctors and researchers agree that PTSD is a mental illness.

While some people may argue that the physical and emotional effects of PTSD are reasonable experiences after a traumatic event, and, thus, do not constitute a disease, this perspective is not shared by medicine.

Posttraumatic Stress Disorder in the DSM-5: Criteria Clusters

Between the DSM-IV and the DSM-5, there have been some changes to the criteria for PTSD. Currently, there are considered to be eight criteria for a PTSD diagnosis. The first of the PTSD criteria include:

• Directly experiencing the traumatic event(s)
• Witnessing, in person, the event(s) as it occurred to others
• Learning that the traumatic event(s) occurred to a close family member or friend
• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures

The second PTSD criterion consists of symptoms involving re-experiencing:

• Thoughts or perception
• Images
• Dreams
• Illusions or hallucinations
• Dissociative flashback episodes
• Intense psychological distress or reactivity to cues that symbolize some aspect of the event

The third criterion for a PTSD diagnosis involves the avoidance of stimuli that remind the person of the traumatic event:

• Avoidance of thoughts, feelings, or conversations associated with the event
• Avoidance of people, places, or activities that may trigger recollections of the event

The fourth of the PTSD criteria involves persistent negative thoughts, mostly associated with the traumatic event:

• Inability to remember an important aspect of the event(s)
• Persistent and exaggerated negative beliefs about oneself, others, or the world
• Persistent, distorted cognitions about the cause or consequences of the event(s)
• Persistent negative emotional state
• Markedly diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions

The fifth of the PTSD diagnosis criteria involves an increase in arousal (often noted as feeling “keyed up”) and reactivity:

• Irritable behavior and angry outbursts
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Concentration problems
• Sleep disturbance

The remaining three PTSD diagnosis criteria are:

• The duration of symptoms is more than 1 month
• The disturbance causes clinically significant distress or impairment in functioning
• The disturbance is not attributable to the physiological effects of a substance or other medical condition

The number of symptoms that are required for a PTSD diagnosis depends on the criteria cluster.

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Many people struggle with bipolar depression, as it is often the most debilitating part of the illness. While mania or hypomania is exhausting and sometimes dangerous, people also report feelings of euphoria, increased productivity and surplus energy that can actually be enjoyable at the time – though this isn't always the case. Depressive periods in bipolar disorder are often referred to as a "crash," partly because they can come on suddenly, and partly because they are doubly hard to deal with after an upswing. If you're struggling with bipolar depression, you'll be relieved to know that there are things that can help.

Struggling with Bipolar Depression: What Can You Do?

If you’ve been struggling with bipolar depression for a long time, you may feel that you’ve already used everything in your arsenal and there’s no hope that you’ll ever get better. It can take years to come to terms with a bipolar diagnosis, however. And understanding your illness can go a long way to helping you avoid certain triggers and set you on the path to the right bipolar disorder treatment.

There is plenty you can do to minimize the symptoms of both depression and mania/hypomania in bipolar disorder. Here, we will share some common ways in which people with bipolar disorder manage the condition.

5 Tips for People Struggling with Bipolar Depression

If you're struggling with bipolar depression, these five tips may be useful in helping you manage your symptoms more effectively. Although these tips may not be actionable in the grip of a depressive episode, they may help you minimize the impact of a bipolar depression crash.

1. Learn to identify early symptoms

Although bipolar depression isn’t always preventable, knowing when depression is sneaking up on you can help you minimize the impact on your life. According to the BP Hope website, right before you’re about to sink into a depressive state is the time to act against your early symptoms. When this happens:

• Resist the urge to retreat
• Reach out to those you love
• Schedule an emergency therapy session
• Try to maintain as many healthy habits (such as exercise and good sleep) as you can

Warning signs that you’re slipping into bipolar depression may include:

• Sleeping more than usual
• Feeling extremely tired
• Muscle aches
• Not wanting to socialize
• Withdrawing from people and activities you usually enjoy
• Intense sadness and tearfulness

2. Write notes to yourself

When you’re depressed, everything can feel hopeless, and you may forget what it feels like to feel “well.” During a good or neutral phase, write yourself a letter or stick post-it notes around your house to remind yourself of these three things:

1. This is temporary
2. There is hope and help available
3. You won’t always feel like this

It may sound silly, but it helps to reinforce positive thoughts. You could also include notes from friends or loved ones.

3. Build structure into your life

Changes to routine and sleep patterns are major triggers in people with bipolar disorder. Therefore, if you feel yourself struggling with bipolar depression, you should try your best to maintain your usual routine. You can do this by eating at the same time each day, taking your medication at a designated time (you could set the alarm on your phone if you think you will forget when you're supposed to take them) and by maintaining a healthy sleep schedule.

4. Plan for a crisis

If you can feel yourself beginning to struggle with bipolar depression, it's important to act quickly. Having the tools on hand to balance out your moods can be incredibly helpful in this situation, so take the time to prepare these when you are feeling well. You may decide to create a physical wellness box filled with your favorite things, a list of things to do or people to call when depression strikes, or an emergency action plan for crises. You should also let someone know how you feel in case they need to take responsibility for your care.

5. Collaborate with your doctor

It’s easy to feel mistrustful of doctors or feel that they don’t understand your condition. Even if there’s no right answer or your bipolar disorder treatment hasn’t been successful so far, that doesn’t mean your doctor isn’t trying everything they can to help you. That said, if you don’t feel comfortable with your physician, you shouldn’t be afraid to ask to see someone new. You will need to work closely with your doctor to manage your illness, so it’s important to find someone you like and can talk to easily.

Communicating with your doctor and following their advice on medication schedules, therapy sessions, and other treatment is vital if you want to learn to manage your bipolar episodes. Whether you’re struggling with bipolar depression, hypomania or mania, you shouldn’t be afraid to pick up the phone and ask for help or book an extra appointment– just like you would for a “physical” illness or injury.

article references

When your friend or loved one has bipolar disorder, here are the worst things you can tell them.

Supporting Someone with Bipolar - For Family and Friends

Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is the one thing they needed to hear. While some of these thoughts have been helpful to some people (for example, some people find that praying is very helpful), the context in which they are often said mitigates any intended benefit to the hearer. Platitudes don't cure depression.

• "What's your problem?"
• "Will you stop that constant whining?"
• "What makes you think that anyone cares?"
• "Have you gotten tired yet of all this me-me-me stuff?"
• "You just need to give yourself a kick in the rear"
• "But it's all in your mind"
• "I thought you were stronger than that"
• "No one ever said life was fair"
• "Pull yourself up by your bootstraps"
• "Why don't you just grow up?"
• "Stop feeling sorry for yourself"
• "There are a lot of people worse off than you"
• "You have it so good - why aren't you happy?"
• "What do you have to be depressed about?"
• "You think you've got problems..."
• "Well at least it's not that bad"
• "Lighten up"
• "You should get off all those pills"
• "You are what you think"
• "Cheer up"
• "You're always feeling sorry for yourself"
• "Why can't you just be normal?"
• "You need to get out more"
• "Get a grip"
• "Most folks are about as happy as they make up their minds to be"
• "Get a job"
• "You don't 'look' depressed"
• "You're just looking for attention"
• "Everybody has a bad day now and then"
• "Why don't you smile more?"
• "A person your age should be having the time of their life"
• "The only one you're hurting is yourself"
• "You can do anything you want if you just set your mind to it"
• "Depression is a symptom of your sin against God"
• "You brought this on yourself"
• "Get off your rear and do something"
• "Snap out of it"
• "You're always worried about your problems"
• "Just don't think about it"
• "Go out and have some fun"
• "Just try a little harder"
• "I know how you feel - I was depressed once for several days"
• "You'd feel better if you went to church"
• "Shit or get off the pot"
• "What you need is some real tragedy in your life to give you perspective"
• "This too shall pass"
• "Go out and get some fresh air"
• "We all have our cross to bear"
• "You don't like feeling that way? So change it"
• "You're a real downer to be around"
• "You are embarrassing me"
• "You'd feel better if you lost some weight"
• "You're too hard on yourself. Quit being such a perfectionist"
• "Don't take it out on everyone else around you"
• "You are going to lose a lot of friends if you don't snap out of this"
• "You're dragging me down with you"
• "You're just being immature"
• "You are your own worst enemy"
• "That is life - get used to it"
• "My life isn't fun either"
• "You don't care about the rest of us - you're so self-absorbed"

When your friend or loved one suffers from bipolar disorder, what are the best things you can tell them?

Supporting Someone with Bipolar - For Family and Friends

Cliches and platitudes usually aren't much help to someone who is depressed. Being depressed is not the same thing as just being sad about something. This list, compiled from a Usenet group, offers some useful statements you can make to a friend or loved one who is depressed.

It is most tempting, when you find out someone is depressed, to attempt to immediately fix the problem. However, until the depressed person has given you permission to be their therapist, (as a friend or professional), the following responses are more likely to help. Acknowledge the depression for what it is, and give permission for them to feel depressed.

• "I love you"
• "I care"
• "You're not alone in this"
• "I'm not going to leave/abandon you"
• "Do you want a hug?"
• "You are important to me"
• "If you need a friend..."
• "It will pass, we can ride it out together"
• "When all this is over, I'll still be here"
• "You have so many extraordinary gifts - how can you expect to live an ordinary life?"
• "I'm sorry you're in so much pain. I am not going to leave you. I am going to take care of myself so you don't need to worry that your pain might hurt me"
• "I listen to you talk about it, and I can't imagine what it's like for you. I just can't imagine how hard it must be"
• "I can't really fully understand what you are feeling, but I can offer my compassion"
• "I'm sorry you're having to go through this. I care about you and care that you are hurting"
• "I'll be your friend no matter what"
• "I cannot understand the pain you're in, I cannot feel it. But hold onto my hand while you walk through this storm, and I'll do my very best to keep you from slipping away"
• "I'm never going to say, 'I know how you feel' unless I truly do, but if I can do anything to help, I will"