It’s tempting after a vitriolic argument with your partner to half-heartedly joke that they must be “bipolar.” How many women have heard that line tossed flippantly at them during that time of the month? Or if someone is angry or emotional, how easy is it to try to assign them such a readily available diagnosis? Mood swings = Bipolar, right? We feel better naming these behaviors, because then it feels more hopeful that they can be stopped. OR at least we know the problem lies with the other person and not us.
While all of the above scenarios are concerning, uncomfortable, and certainly can present in the case of a true bipolar disorder, the flagship BIPOLAR ILLLNESS SPECTRUM DISORDER is identified by more than angry outbursts and poor emotional regulation. It can be a debilitating set of symptoms that if not properly treated and placed into context, can disturb a person’s work, relationships, safety, and health.
Shades of Moodiness: When It’s NOT Bipolar Disorder
Depression—Irritability can be a core symptom of “unipolar” depression. A person’s mood can go too low, along with the other main signs of depression (sad mood, anhedonia, low energy, poor concentration, ruminations, appetite changes, sleep disturbance,) without ever displaying the classic “highs” related to Bipolar Disorder. (More on this later.)
Anxiety—There are 7-ish main Anxiety Disorders. We can revisit them on a later day. But in general, anxiety, panic, worry, and the like can also produce a short temper, irritability, and verbal outbursts if left untreated.
Stress aka Adjustment Disorders—This is a bucket term for anything in our life that takes us out of homeostasis, “any self-regulating process by which biological systems tend to maintain stability.” Succinctly, anything that knocks us out of our comfort zone, causes pain, illness, or discomfort, is “stress” and disturbs homeostasis causing grumpiness, snappishness, short temper.
Sleep disturbance—Who isn’t grumpy if they can’t fall asleep, stay asleep, or don’t feel refreshed when they wake up? Have you seen my 3 year old at 1 pm before nap time???
Diet—I could go on about this and will in another post. Eating the wrong foods, not enough of the right foods, or too much or too little can throw our brain hormones off in a big way, leading to mood swings.
Lack of exercise—Exercise is Medicine, bottom line. In some studies it stands up to antidepressants in terms of assisting with mood and regulation. Another topic for another day.
Hormonal--Fluctuations in testosterone, estrogen and progesterone actually do impact brain health and function and should be incorporated into evaluations for “moodiness.” And hey, let’s stop singling women out on this issue ok? Men have hormonal mood swings too!
Bad Day, plain and simple. Cue Daniel Powter circa 2005 😊
So when is a mood swing more than just a mood swing? When we start to experience either too many really bad days and conversely, too many REALLY GOOD days, uh-oh. It’s time to look deeper.
Bipolar and Related Disorders
To diagnose Bipolar Disorder, the most important criteria to meet is the manic or hypomanic episode. Without clear indications of mania, a person cannot be diagnosed with a Bipolar spectrum illness. So even if it’s anger, rage, yelling, cursing, hating the world, etc, if it’s not in the context of at least one lifetime experience of mania or hypomania, it’s not Bipolar Disorder.
The flip side of this is that once a person has even one clear manifestation of mania, they will always need to be considered on the “Bipolar Spectrum.”
To diagnose Bipolar 1 (the most severe,) one must exhibit either irritable or euphoric/energetic mood + 3 or 4 of the following for at least a week OR for any length of time if a hospitalization becomes necessary, and must significantly impair functioning:
7 Signs of Mania or Hypomania
Inflated self-esteem or grandiosity—My patients in mania will often say they believe they are in their most “creative phase ever” and they are feeling far smarter or stronger or more attractive than others. Think confidence on steroids with absolutely no self-doubt on board whatsoever.
Decreased need for sleep—Confused with insomnia, but not insomnia. Insomniacs wish they could sleep and feel tired when they don’t. People going through mania don’t feel tired even after getting very little sleep for days to weeks on end.
More talkative than usual—A term I have affectionately named “diarrhea of the mouth.” Manic patients often say that they feel like they cannot keep up with the volume of thoughts in their heads and simply cannot stop talking.
Flight of ideas or racing thoughts—What’s going on in the mind before all the talking starts.
Distractibility—Everything is interesting!
Increased goal-directed activity--One of my favorite patients would describe these as “missions.” They would be SO productive cleaning, planning, decorating, purchasing things, and NOTHING was going to get in their way!
Risk taking behaviors—Cue the uncharacteristic sexual indiscretions, purchasing of motorcycles, new tattoos, and grand business plans. Risk goes out of the window. The sky is the limit!
(Psychotic Symptoms)—Hearing voices or believing truly bizarre, untrue things. Some people have told me that they are God, or can fly.
OK, we’ve defined Bipolar 1 and Manic symptoms. But there’s more.
4 Other Bipolar Related Disorders
Bipolar 2—Like Bipolar 1, but one also has to have had a Major Depressive Episode (described above,) BUT hypomania only needs to have lasted for 4 days, and doesn’t cause (as) severe impairments.
Cyclothymia—Think low grade depression alternating with hypomania for 2 years or more, never fully resolving for more than 2 months but also never becoming severe. Still unpleasant.
Substance Induced—Any of the above symptoms can present, but experienced directly related to a substance intoxication or withdrawal. For example, a person with asthma is placed on a course of steroids and stops sleeping, becomes overly talkative, and appears excitable and energetic. Or the person who only exhibits mania when intoxicated with alcohol.
Due to General Medical Condition—For example, brain tumors, hyperactive thyroid, autoimmune disease, and dementia can all present with manic like symptoms.
What now? If you’re reading this post, I assume you’re curious about Bipolar Disorder either for yourself or a loved one. Here are some steps you can take get the help you are needing with this complex, confusing disorder, and hopefully this was enlightening.
8 Steps to Take If You’re Worried About Mood Swings
Call 911, call/text the Suicide Prevention Hotline at 988, or go to your nearest emergency room immediately if you aren’t feeling safe.
Avoid any substance use including illicit drugs, prescription drug misuse, alcohol, cannabis products, and caffeine.
Do your best to sleep on a regular schedule and seek help if you can’t.
Take a breath—Stress management is key. If you already know some techniques (breathing, counting, recreation, mindfulness/meditation, exercise,) use them and if you don’t, see steps 6-8.
Eat well—Consuming fatty fish, berries, green leafy vegetables, and whole grains, (barring allergies,) can be a great source of fuel for brain health.
Talk to trusted family and friends about your fears.
Start a conversation with your Primary Care Physician or established Mental Health Professional.
Fill out the inquiry form here on drbritany.com or text (951) 339-6714 to set up a free 15 min discovery call with me, Dr. Britany at Another Chance Integrative Mental Health.
Warmly,
Dr. Britany
Dr. Britany Alexander is a Board Certified Integrative Psychiatrist
