Bipolar Anger: Causes & How to Cope

What Is Bipolar Disorder?

Bipolar disorder impacts approximately 2.5% of the population.⁵It is a classification of mental health disorders, including bipolar I, bipolar II, and cyclothymic disorder.⁶According to the American Psychiatric Association, “People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood).”⁶ The condition is currently treatable but without any known cure. Treatment is commonly conducted through a  regimen of medication and talk therapy.⁵

What Is Bipolar Anger?

Bipolar anger is a symptom not commonly associated with any type of bipolar disorder classifications.^1,2,3 In extreme cases, studies have shown an association between anger and bipolar disorder. In these cases, patients were hospitalized with mania and brief pyschotic disorder with comorbid factors.^2,3

To better understand how bipolar anger occurs, it is vital to recognize symptoms of bipolar disorder contained in the DSM-5, which are as follows:⁵

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Pressured speech
• Increased talkativeness
• Racing thoughts
• Distractibility
• Increased goal-directed activity or psychomotor agitation
• Engaging in potentially harmful activities

Common symptoms associated with bipolar depression include:⁵

• Depressed mood most of the day, nearly every day
• Loss of interest or pleasure in all, or almost all, activities
• Significant weight loss
• Decreased or increased appetite
• Engaging in purposeless movements
• Mental fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

Many people with bipolar disorder experience bipolar disorder cycles. Individuals cycle between depression and mania in different ways. There are also periods of mixed features in which one may feel particularly unstable—pulled between depression and mania. Also, one experiences a “normal” mood during periods of stability.⁷
Stress is a significant factor associated with the onset of this cycle.⁸

Not adhering to treatment is another risk factor for uncontrollable cycles of mood episodes.⁸
Comprehensive treatment for bipolar disorder requires a combination of talk therapy and medically assisted treatment. When individuals discontinue or misuse medication or do not see their counselor regularly, there is an increased risk of more intense bipolar cycles.

Why Do Bipolar People Get So Angry?

Dramatic mood swings are the diagnostic hallmark of bipolar disorder.⁷ These mood swings frequently disrupt one’s sleep, energy, thoughts, and decision-making skills lead to irritability.⁷ This irritability may lead to aggressive outbursts. These outbursts of anger may be minor or severe and can occur without any provoking stimulus. The experience is unpleasant for individuals diagnosed with bipolar disorder and those in their life.

It is important to note that trying to avoid an anger outburst may not be as simple as thinking through a situation and taking deep breaths.  With rapid cycling bipolar disorder judgment is compromised, and it can be a challenge to think clearly. Anger outbursts may occur spontaneously. It is common for bipolar individuals to become even angrier due to their lack of control. The anger may appear to be out of line with the prompting stimulus, or lack thereof.

Signs of Uncontrolled Anger

Signs of uncontrollable anger associated with bipolar disorder are similar to those of traditional anger and rage and those with other diagnosable conditions such as intermittent explosive disorder (IED). There are many common warning signs that one is becoming angry. These warning signs provide an opportunity to enact adaptive coping skills to return to a healthy baseline.

Physical warning signs of bipolar anger include:⁹

• Racing heart rate
• Tightness in the chest
• Sweating or shaking
• Clenched jaw
• Fast breathing
• Headache
• Upset stomach
• Tense muscles
• Frowning or scowling
• Turning red in the face

Emotional warning signs of bipolar anger include:⁹

• Feeling disrespected or humiliated
• Feeling guilty
• Feelings of insecurity
• Feelings of jealousy
• Fears of rejection
• Feeling abandoned or afraid

Cognitive warning signs of bipolar anger include:⁹

• Thoughts of hurting someone
• Wanting to teach someone a lesson
• Thinking someone is rude on purpose
• Thinking about seeking revenge
• Thinking something terrible is happening

Behavioral warning signs of bipolar anger include:⁹

• Clenched fists
• Yelling
• Pacing
• Slamming doors
• Pounding or banging on things

Should these warning signs go unheeded, the explosion may lead to the following forms of repressed anger:¹⁰

• Temper tantrums
• Tirades
• Heated arguments
• Shouting
• Slapping, shoving or pushing
• Physical fights
• Property damage
• Threatening or assaulting people or animals

Ultimately, the explosion may lead to individuals being hurt or killed and the offender receiving social and legal repercussions, including compromised relationships, financial penalties, and time in prison.

Coping With Bipolar Rage

Bipolar rage is not a typical symptom of a bipolar diagnosis. The warning signs can help people prepare and use coping skills. Coupled with bipolar disorder treatment, strategies for anger management and methods to control anger can help minimize the risk of bipolar anger episodes.

Here are six tips for coping with bipolar rage:

1. Be Mindful of the Warning Signs

When warning signs occur, take a step back and consider what is happening.

Some helpful questions:

• “What emotional, physical, and cognitive sensations am I experiencing?”
• “What is making me angry?”
• “Does it make sense that I am feeling this way?”
• “How can I work through this?”

2. Identify Triggers

Identify potential triggers. Write down known stressors for future reference.  As new triggers appear, add them to the list. This self-awareness can help you notice potential issues before they’re a big problem.

3. Take a Time Out

After noticing the warning signs, take a time out. If anger is imminent, remove yourself from the situation. In some cases, this may not be possible. Having coping skills that you can use in public and in private can be helpful. During the time out, engage in adaptive coping skills.

4. Enact Adaptive Coping Skills

Pleasurable, meaningful, and relaxing coping skills will be different for everybody.

Adaptive coping skills may include:

• Breathwork (e.g., structured deep breathing)
• Mindfulness (e.g., Mindfulness-Based Stress Reduction (MBSR))
• Meditation
• Light exercise (e.g., walking meditation, or stretching)
• Listening to music
• Speaking to a trusted other
• Journaling
• Visualizations
• Mantras

5. Stick to a Medication Regimen

Given that bipolar disorder is an organic brain condition in which brain structure and chemistry are compromised, medication is a necessary component of treatment.

Common medications for bipolar disorder include:

• Lithium (Lithobid)
• Valproic acid (Depakene)
• Divalproex sodium (Depakote)
• Carbamazepine (Tegretol, Equetro)
• Lamotrigine (Lamictal)
• Quetiapine (Seroquel)

Not taking medication as scheduled may aggravate bipolar cycles. Discontinuing medication when symptoms go away is a common mistake. Bipolar disorder is treatable, but there is no cure. Alleviation of symptoms is a sign the medication is working., but not a cure.  Medication must be prescribed by a psychiatrist., either in person or online.

Most individuals with bipolar disorder diagnoses take medication throughout their lives. The type and dosage may fluctuate over time. Prescribed treatment should be combined with talk therapy (such as cognitive behavioral therapy for bipolar disorder) to maximize effectiveness.

6. Live a Healthy Lifestyle

A healthy, balanced lifestyle can reduce the likelihood of becoming overwhelmed.

Some considerations for maintaining a healthy life include:

• Sleeping 6-9 hours per day
• Eating three balanced, nutritional meals with healthy snacks
• Regular exercise
• Attaining balance between work and enjoyable activities
• Avoiding toxic relationships and environments
• Abstaining from drugs, alcohol, and other substances of abuse
• Avoiding addictive behaviors that may lead to processing disorders and other complex conditions

How to Deal with Someone Who Is Exhibiting Bipolar Rage

Dealing with someone who is exhibiting bipolar rage is difficult. Keep in mind, the behavior is a product of the condition.

Here are five tips for effectively dealing with someone exhibiting bipolar rage:

1. Remain Calm

When people become angry, reacting with anger may only worsen the situation. Take deep breaths or engage in coping skills. Arguing with irrational thoughts, going on the attack, or using defense mechanisms are not helpful.

2. Provide Some Space

When someone is experiencing bipolar rage, give them space. Crowding the individual, pressing on the issue, and otherwise suffocating or minimizing the opportunity for the other to step away prevents them from enacting their adaptive coping skills. Giving space provides the opportunity for you to do the same. Remember, those experiencing anger are encouraged to make their own space and enact adaptive skills. If you do not afford them this opportunity, it minimizes their ability to cope as well as yours. You are now the one invading their space.

When people are experiencing bipolar rage, give them space. Crowding the individual, pressing on the issue, and minimizing the opportunity to step away  prevent the person from using their coping skills. Space can be a helpful coping strategy, also,  for those around the person with bipolar rage.

3. Set Boundaries

Setting boundaries is appropriate. During a calm moment, explore ways in which you may effectively work through rage. These should be clearly defined and collaborative. Once set, ensure you are consistent with their maintenance. It may help to write these down and revisit them when necessary.

4. Become Educated on Bipolar Disorder

Understanding the condition can help you make informed decisions. Having robust knowledge of the disorder can facilitate healthy communication without judgment and without minimizing feelings or behaviors.

5. Seek Support & Therapy

If dealing with bipolar rage becomes overwhelming, it is appropriate to seek support. Especially when the individual is a loved one, lives with you, or lives in close proximity.  Seeing a counselor in an outpatient setting (in the office or online) may provide a safe space to discuss your experience and devise adaptive coping skills.

In-person or online support groups are also helpful. Here, you can meet with others in similar situations to find common ground, provide support, and share adaptive coping skills and resources.

To find a therapist who specializes in anger management and bipolar disorders, you can ask your primary care provider for a referral or check in an online therapist directory.

Final Thoughts on Bipolar Rage

Talking to a therapist or reaching out to a trusted friend or family member can help you deal with anger and bipolar rage. Coping strategies for each person will be different. Mastering coping skills can take time. Living a fulfilling life with meaningful relationships is possible if you put in the effort.