"Anger" Issue in BP II
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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.

Thank you

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 II.  

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.  

Dr. Phelps

Published December, 2002 


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