Bipolar & Irritability: Touchy Tempers Signal Mood Shift
When you’re crankier than usual and coping with irritability, it’s time for short-term coping tools—and strategies to prevent a mood shift.
Terry’s commute to work usually takes 40 minutes. She uses that drive to gauge her irritability levels.
“I can usually tell by how many times I yell at people on the way in,” says Terry, who lives outside Vancouver. “They are all stupid. I don’t know how they got their licenses. That is usually the first sign to me.”
Sure, rush-hour stress can take a toll on anyone’s spirits. For Terry, though, it’s crucial to recognize when normal annoyance shades into overreaction. She knows that an overall prickly, ready-to-detonate feeling may signal she’s tilting off-balance.
For many people with bipolar, increased irritability can precede a mood shift to hypomania, mania, or depression. Learning countermeasures is important not only for the sake of overall wellness, but also for better harmony in relationships, the workplace, and other aspects of everyday life.
A 2003 study published in the Journal of Affective Disorders found irritability, racing thoughts, and increased energy in more than half of people with hypomania. The researchers concluded that tracking those three symptoms was more effective in preventing hypomania than tracking feelings of euphoria.
“Irritability goes hand in hand with mania,” says Lewis Judd, MD, a psychiatry professor at University of California–San Diego. Judd’s research also highlights the prevalence of irritability and anger in depression.
Although every individual with bipolar “goes into mania differently,” Judd notes, he has patients who’ve come to understand that it’s a red flag when things that don’t usually bother them begin to bug them a lot.
A little self-reflection can help identify if irritability is part of your symptomatic package, Judd says.
“After the fact, look back and see what was the first thing you noticed when you were becoming manic,” he suggests.
Once you are alert to such “breakthrough symptoms”—a term describing subtle symptoms that tend to bubble up, usually in clusters, before a mood episode—you can take preemptive action, Judd points out.
Irritability and anxiety go together for Richard. When his mood is veering off track, he starts to worry obsessively, has panic attacks, and wakes up from haunting dreams with his heart racing. And during daily interactions, he notes, “I get irritated at people, even in the supermarket.”
Testiness in the checkout line is one thing. Richard, who lives in Southern California, recalls one incident of road rage that had him fearing for his personal safety. When a car cut him off, Richard zoomed alongside to yell at the driver. The driver then followed him for several miles through an isolated area until Richard was able to lose him.
Now when he begins to feel fearful and cranky, he listens to a 20-minute meditation tape to restore some calm.
Laura Gray of Toronto notices that insensitivity and talkativeness come along with her irritability. Although she’s normally assertive anyway, she says, “There is a tipping point where it goes from assertive to pushing my ideas on people and not listening to them.”
Laura credits her partner with helping her sort out her true personality, her baseline, from the overdrive that kicks in when her mood isn’t stable.
“One of the first things I notice is that I snap really fast. My reactions seem to be a little more intense…. There is yelling involved,” she explains.
“When it is in depression it is really hard to deal with,” adds Laura, who says she tends to “the lower end” of mood issues.
Like Richard, Laura benefits from a meditative practice. Techniques she learned in a mindfulness meditation course come in handy when irritability and other feelings start to swell.
“As I learned to quiet my mind, it does help me with my stronger emotions,” she notes.
To address hyper-touchiness in the short term, Laura finds taking a 15-minute nap in a darkened space helps her “cool down.” Yet she also finds it helpful to get out and get active, especially taking a long walk.
“Sometimes walking will take the steam out of anger and irritability…. That will be enough to take away my mood and help me sleep better,” she says.
In the aftermath
Letting that angry vibe run unchecked can lead to unpleasant consequences. At worst, as Richard found out, there’s the risk of bodily harm from acting out in the wrong place at the wrong time. More commonly, outbursts of nastiness strain friendships and other social relationships or boomerang at work.
“An irritable mood leads to problems with communication with others,” points out Kemal Sagduyu, MD, a psychiatry professor at the University of Missouri who studies various aspects of bipolar disorder.
That can trigger a downward cycle, he says: “Not getting along with others, not maintaining good communication, leads to an even more irritable mood.”
Furthermore, he notes, in the wake of conflicts and also “because feeling irritable is unpleasant, many times an irritable mood can trigger drinking and other forms of self-medication, which are risky for someone with bipolar.”
Doug, a business executive from Indiana, says a hair-trigger temper and simmering wrath were “pretty much my personality” before he was diagnosed and started treatment nine years ago. Whenever his angry outbursts targeted his wife, he would get bogged down in negative emotions afterward.
He remembers one vacation when his wife was in charge of navigating their route. They got lost and ended up a half-hour out of their way. “I felt myself boiling and boiling…I pulled over to the side of the highway and told her to get out of the car,” he admits.
Doug expresses admiration for his wife’s patience and her ability to step away and let him get through his temper tantrums. Even so, “the byproduct of that is that I felt extremely remorseful. That would create a vicious cycle.”
He felt less concern about his behavior in the workplace, where he considered his irritability to be an expression of his passion. In fact, Doug reports, his aggressive persona aided his climb up the corporate ladder because his superiors would channel difficult tasks and employees his way.
Other colleagues, however, felt intimidated. One co-worker revealed she didn’t want to be in meetings with him because his in-your-face attitude made her so uncomfortable.
His former persona unnerves him now, too, and he stays “ever vigilant” to signs that his temper is stirring—not only to get early warning of a manic shift, but also because he doesn’t want to be that overbearing guy anymore.
As part of his post-diagnosis reinvention, he has developed a more effective communication style.
“I listen,” he explains. “Rather than take control of the situation, I try to digest and process as much information as I possibly can, before I speak.”
When irritability gets the better of Terry at work, she’s been known to speak harshly to the people she deals with.
“I tend towards perfectionism to start with. When people make mistakes it really irritates me,” she says. “Sometimes I will just be very abrupt.”
She can’t take it back, but she makes it a point to apologize. Sometimes, though, she’s not clued in to how she comes across. Terry recalls her boss pulling her aside to counsel her after she’d been rude and defensive in responding to a question he’d asked.
“I wasn’t even aware that I had done that … He was very nice about it. Now that he’s told me, that is one more thing I have to be aware of,” she says.
Any habits that promote self-awareness can help in recognizing early symptoms such as irritability. For overall monitoring, numerous studies, experts and individuals cite the benefits of charting moods.
“When I started charting, things started to get really good for me,” Laura says, adding: “When you know yourself better, it creates an inner security that you’re not at the mercy of your moods. You can actually move forward and live life.
Terry uses an iPhone app that translates data such as sleep, exercise, medication, triggers and symptoms into charts and reports that she can share with her psychiatrist. That kind of information can be extremely helpful to mark when hypomanic or depressive symptoms are edging forward.
“It’s really about assessing the situation and trying to determine why the person is experiencing these breakthrough symptoms,” says Anne Duffy, MD, a psychiatry professor at the University of Calgary.
Then comes figuring out whether more sleep, less stimulation, tweaking medication, or other changes are necessary to keep early symptoms from escalating to a full-blown episode.
Sagduyu stress the link between disrupted sleep and irritability. In fact, he says irritability “is one of the number one effects of lack of sleep.”
Awareness of an irritability attack in progress is also key. Before his diagnosis, Doug says, he didn’t have the insight to prevent irritability from escalating to a rage storm. Now he stays mindful of his body’s signals.
When anxiety and irritability are setting in, his heart races, his breathing becomes rapid, and he experiences a “shakiness” that feels very different from his normal self.
When that happens, Doug says, “The biggest thing is making sure that I’m relaxed. I sit down if I can. I just make sure that I’m inflating as I inhale, deflating as I exhale, and that my breathing is rhythmic.”
Another key strategy when irritability threatens to take over: thought correction.
“I focus away from what it is that seems to have me irritated,” Doug says. “I look at the bigger picture.”
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Terry needs an arsenal of coping strategies when symptoms of irritability roar into her life. “Irritability happens to me all the time. I can go up and down in the space of a few minutes. In the space of a day,” says Terry, whose heightened aggravation can persist for “days on end.” Some things that help her:
Breathe deeply: “Once I notice that I’m overreacting, the first thing I do is force myself to stop, take a deep breath, and blow it out slowly. I’ll do this several times until I can feel my anger or irritability start to dissipate,” Terry says.
Smile: “One of my therapists told me to smile, that it is really hard to be angry when you are smiling. ‘When you go for a walk, smile,’” Terry reports. “I thought this was really stupid. But I did it and I felt better. It sounds like such a simple thing, but it actually makes a difference.”
Filter what you take in: When Terry turns on the TV, she avoids police dramas or anything else disturbing. “I have enough negative stuff in my head,” she explains.
Keep a crisis letter: When anxiety and irritability drive her to tears, Terry pulls out a letter she wrote to herself. She quotes the opening lines: “If you are reading this you must be in a really bad way. Just remember that you are a good person. This won’t last forever.” After reading the letter, she usually comforts herself with a cup of tea.
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Printed as “All The Rage”, Summer 2014