Hurtful or violent acts
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Hurtful or violent acts

Q: My 36 yr old daughter has recently told me that she planned and attempted suicide on her 31 yr old brother's birthday. She suggested she chose that day to hurt me. My question: Does the choice of that day represent an "act of violence" against her brother. She is not in a treatment program and verbally expresses extraordinary anger/hostility to her immediate family. Is violence characteristic of the disorder?

Dear Ms. H'--
Your direct question there at the end is easier to address than the situation as a whole.  Hurtful acts I believe can come from desperate and very harsh internal experience such as bipolar disorder can cause, so I would hold out some hope (but not certainty) that this behavior would not persist if symptoms were well controlled.

Violence has been associated with bipolar disorder, particularly the hostile manic phases. In my opinion, based on my experience with patients, there is also an association between serotonergic antidepressants and violent thoughts, even violent actions: my patients have described "weird" violent thoughts when placed on antidepressants, that stop when they stop these medications.  There was report a long time ago about Prozac and violent suicidal/homicidal acts.  I believe there really is a connection there, although there is little else in the research literature to support this.  So my personal response would be to look to see if this young woman was taking an antidepressant at the time of the thinking you report.  In any case, "extraordinary anger/hostility to her immediate family" is highly characteristic of bipolar hypomania and is a very treatable symptom, one of the first to respond to mood stabilizers.

Dr. Phelps

Published November, 2000

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