When intense irritability and “anger attacks” disrupt your life and damage your relationships it’s time to look at your mood swings, triggers and stress levels.
If Terry had to give herself a diagnosis, it would be “what I call POPD—pissed-off personality disorder,” she says.
Even though the she has learned numerous coping skills to help manage her bipolar II, she is still vulnerable to bouts of disproportionate anger.
“I can take a pimple and turn it into Pikes Peak,” Terry says.
Irritability and its souped-up cousin, anger, are common emotions—part of the universal human experience. With bipolar disorder, their intensity can jump to a different level.
“It’s like turning up the volume, making it a lot louder and harder to ignore,” says Brock Schludecker, PsyD, of Columbus, Ohio.
A 2012 study published in the journal Bipolar Disorders suggests that people with bipolar I or bipolar II have greater rates of anger and aggressive behaviors than the general population. An earlier study from the Journal of Affective Disorders found that at least one-third of patients with bipolar described angry outbursts called “anger attacks.”
Dysphoric mania or hypomania—as opposed to the “high on life” euphoric versions—may be marked by abrupt, aggressive reactions despite little or no provocation. For some, depressive moods also amplify irritability and anger.
(Interestingly, researchers who compared the prevalence of anger attacks in people diagnosed with either major depressive disorder or bipolar disorder found the rates were twice as high for bipolar depressions.)
When your normal tolerance for petty annoyances evaporates, that may be a red flag for an oncoming mood shift in either direction. Paying attention to your “irritability index” lets you deploy preventive measures, giving you back some conscious control over your temper.
Armed with awareness, you’ll be better able to moderate the kind of explosions that wind up sabotaging relationships, jobs, plans, and other things you care about.
Cortisol’s Connection to Anger, Aggression, & Anxiety
Primal emotions—anger, aggression, anxiety, fear—operate in the physiological context of the body’s threat response. Your mind reacts to something that somehow pings that instinctual drive, kicking a small structure in the brain called the amygdala into action.
The amygdala pours the stress hormones cortisol and adrenaline into your system (lending truth to the idiom about making someone’s blood boil). That sets off a complex series of physiological changes gearing the body up for “fight or flight.”
Blood pressure rises, the heart races, the breath speeds up. The reasoning part of the brain takes a step back as focus narrows to the target that triggered the emotion in the first place.
Under the influence of a mood episode, those reactions leapfrog into fast-forward.
“It’s like a hot whirlwind inside my chest and it’s really hard to stop and not get caught up in it,” Shaley Hoogendoorn, 42, says of the anger that can arise during her hypomanic episodes.
“Everything feels so urgent. A part of me is going, ‘OK, you know you’re overreacting,’ but it’s like I can’t not overreact. It’s like it’s painful until I get it out.”
Hoogendoorn, who co-hosts a vlog/podcast called “This is Bipolar” from her home in Port Coquitlam, British Columbia, recalls how prickly she would get before her bipolar was diagnosed and treated. When her temper was on an especially short fuse, she would ruefully ask her husband, “Can I just put a blanket apology over the day?”
Now that her anger doesn’t have the same intensity, she is able to word her request differently: “I can say, ‘I’m feeling really anxious and snappy today, so please have extra grace with me.’”
In other situations, Hoogendoorn tends to frame her snappish phases in medical terms. When she explains that she is experiencing a build-up of cortisol, people tend to understand more easily and see her mood symptoms as separate from her personality.
According to psychiatrist Ben Christenson, MD, sometimes people resist acknowledging they’re having a hard time regulating their temper because they feel guilty for the way their behavior affects those close to them.
Remembering there are positive aspects to the relationship may make it easier to initiate an honest discussion.
“It would be dishonest to say that living with somebody dealing with irritability and anger isn’t hard, but the situation is tempered by other things,” points out Christenson, who is department chairman for Behavioral Health at Park Nicollet, a health care group in Saint Louis Park, Minnesota.
“There is still a relationship. Presumably they love you and you love them. There are some other dynamics going on.”
Turning to Music instead of Meditation for Emotional Release
The physiological component driving primal emotions can be turned around to moderate them instead.
Many standard suggestions for managing anger, such as taking a few deep breaths or going for a brisk walk, interrupt or discharge the stress response and give your rational mind a chance to come back online.
Hoogendoorn used to berate herself for not having a meditation practice or turning to some other quiet activity to ease herself down when she’s wound up. Now she understands that what works for her is some time on the open road.
“I go for drives and listen to heavy metal or some other really, really loud music because then the outside matches my inside,” she says. “That would probably rile up the average person, but it almost jolts my body and I feel calmer afterward.”
Using music to influence or channel emotions has a well-established track record not only in everyday life—the expression “’music has charms to sooth a savage breast” dates back to 1697—but also as a therapeutic intervention.
Results from one well-known study showed that after going through a music therapy program, participants reported improved anger management skills, stronger positive coping skills, and diminished avoidance behaviors.
Meegan Hussain, a music therapist in Philadelphia, says music therapy has benefits regardless of whether you have a background in—or aptitude for—music. For example, something as simple as drumming on the table can be highly cathartic.
Hussain also guides individuals to use rock or hip-hop songs as a medium to vent for their own feelings of anger, sadness, or disaffection. She’ll encourage people to sing or shout along, even get physical if the spirit moves.
Another technique involves rewriting a familiar song’s lyrics in a way that either recasts their experiences in a more positive light or references new coping skills they’ve learned.
“Then they have that with them as a tangible tool when they’re anxious or irritated or have a trigger that comes back up again. They have a new narrative,” she says.
Finding Calm After the Storm of Bipolar Rage
Marek, 31, of Burlington, Vermont, describes his default state as “pretty laid back,” kind, thoughtful, a good listener, reserved, and introverted. When he’s battling mania, though, delusions provoke an anger that stands in stark contrast to his usual temperament.
For example, Marek once saw a news segment on TV about the Czech Republic’s efforts to become known as Czechia. Because his father is from the former Czechoslovakia and his mother from the former Slovakia, he imagined a personal connection.
“I thought the media was tracking my movements and mocking me,” he remembers.
In furious reaction, Marek busted up his house and ended up in a psychiatric ward.
Now when he’s dealing with irritability and fears it might graduate to rage, he recites a mantra he learned at a weeklong meditation retreat:
May I be well May I be happy May I be safe and protected May I be peaceful
Marek also recites the mantra as part of a regular mindfulness meditation practice that makes him feel calmer and helps to slow down his thoughts. He finds that his imagination drops out of overdrive for a while after a meditation session.
“When my symptoms are under control and I am doing well,” he says, “I’m very grateful for that.”
There’s certainly enough in the news lately, from racial tensions to the pandemic, to push anyone’s buttons. When your stress-response system is already on edge, you’re that much closer to a rage eruption.
“It’s hard to argue that people’s lives aren’t hard right now, and if you have more [stressors] on top of that, that needs to be acknowledged,” says Christenson.
Digging Deep—Anger as a Secondary Emotion
At times, anger can be a way we mask or protect ourselves from other feelings. Rather than focusing on the immediate cause of a particular incident, it may be more useful to understand anger as a secondary emotion and tunnel down to what’s underneath.
“I think of anger as being like an iceberg,” says Schludecker. “Anger is what we see sticking out of the water, but the much bigger body of what’s going on is below the surface. And oftentimes that’s other feelings such as guilt or shame or feeling disrespected or feeling unloved.
“Addressing some of those issues is a constant task, but it is where real, useful change can happen.”
Despite her self-described “pissed-off personality,” Terry says she has definitely changed for the better.
When her two sons were young, she would blow up in response to minor—and typical—transgressions, such as failing to empty the dryer lint trap or forgetting to put food back in the refrigerator. After one especially heated argument with her younger sister, the two didn’t speak for seven years.
Terry, who is 74, says that with age she’s become more astute about how to cope with situations that provoke her.
“The great thing about getting older is you get to know yourself better and understand how you relate to the world better,” she says. “I always feel like I’m a work-in-progress.”
Her current strategies for handling her ire include playing solitaire, walking her dog, and imagining handing her anger over to a higher power. The latter is a guiding principle in her 12-step program—as is the practice of making amends, something she does after her anger reaches an explosive level.
“I make amends right away because I am wrong no matter the cause,” she says. “Getting that angry hurts me. I don’t like the person I become. [As Buddha said], it’s like drinking poison and hoping the other person dies.”
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Set boundaries. This is a nuanced skill, according to Brock Schludecker, PsyD, but important for “protecting one’s time and space and autonomy in a way that doesn’t set oneself up to feel taken advantage of, exploited or used”—feelings that can trigger anger. He suggests tackling this with your therapist.
Schedule ways to de-stress. “Few of us have to do everything we think we have to do,” notes Ben Christenson, MD. He advises placing a higher priority on restorative activities like reading a book, going for a walk or watching a movie while balancing non-negotiable responsibilities.
Find a relaxation guide. Look for guided imagery programs on Spotify or YouTube that will help lower your heart rate and regulate breathing when feeling in a heightened state. “There are scripts you can follow that will say, ‘Tense this muscle first,’ or they’ll walk you through visualizing a forest or beach scene,’” says music therapist Meegan Hussain. “They help change that narrative in the mind from rumination and agitation—that negative space—into something positive.”
Put your feet down. Shaley Hoogendoorn tries to release her rage in a healthy way by taking off her shoes and socks—preferably outside—and focusing on the ground beneath her. “Sometimes I close my eyes and tell myself, ‘You’re safe. You’re grounded. There’s an emotion behind this, and it’s not going to last forever.’”
Tracing Your Triggers
What kinds of interactions consistently leave you angry? Taking the time to write down potential interpersonal triggers—such as a high sensitivity to feeling rejected, criticized, or abandoned—can help reduce future regrets.
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