Q: "Anger" Issue in Bipolar II
I have been diagnosed with BP II, which I don't question the diagnosis. The
original depression diagnosis seemed to be missing something right from the
start, it always seemed to only address one issue I was having. I have
concerns, however, about the anger you explained. I do get angry, I have a
very short fuse and am wondering if that can become abusive? Are
people with BP II known for being abusive? Please expand a bit on the
anger side of BP II.
Dear Liza --
On this "anger" issue in bipolar II, I've seen everything along a
spectrum from people who can see what's happening to them and control their
behavior completely (milder versions) to people who completely "lose
control" of their behavior and become at least very verbally abusive.
Since generally becoming physically abusive is kind of a guy thing to do, and
since that can happen without bipolar II to explain it, you can see that it
becomes a bit tricky to say whether a guy who has become physically abusive did
that "because" of his bipolar II, or just because he's a guy and guys
can do this from time to time -- not that this is okay, mind you; our society
seems to be making pretty good progress overall at getting it societally clear
that such behavior is completely unacceptable.
I hear of women throwing things across the room pretty
often: plates, phones. But I don't hear about them just starting to slug
people. How about beating up their kids? Ah, same problem as the guy
thing above, in my view: that happens too, unfortunately, without bipolar
Now, in really severe bipolar I, where we have people
coming into the hospital really manic, we often see a hostile mania as the
dominant feature: angry, agitated, interpreting every remark as a threat
somehow. People in this state are clearly at high risk of being physically
assaultive, and we approach them so (it's one of the hardest parts of this
job). In this context we do generally draw a pretty close association
between the bipolar disorder and the assaultive risk, because when these folks
get better (i.e. less manic) their hostility/rage stuff generally gets much
better too, like once they've finally slept some.
So: are people with BP II "known" for being
abusive? (I'll bet there's quite a story behind that question). On
the whole, I'd say no, certainly not compared to bipolar I, but this distinction
is not all that solid. I'd say it has more to do with the person
and his/her behavioral control generally than with the bipolar II, as to whether
when they're in the hypomanic phase and angry they act it out really severely,
or more subtly.
Published December, 2002