Understanding Bipolar Disorder in a Society Where Mood Reactivity is Over-Pathologized

In the complex realm of mental health, understanding various mental health conditions is important for both individuals and their loved ones. With the influence social media has on people’s understanding of themselves, especially regarding mood reactivity or “big feelings,” it seems like everyone has Bipolar Disorder. Well, I’m here to thankfully tell you this is most likely false (though if you do think you might have a mental health condition, please seek professional support with a licensed mental health clinician). In this blog post, I aim to shed light on the distinctive features of Bipolar Disorder and non-pathological dysregulated mood or anger, helping you navigate these emotional landscapes with clarity and empathy. 

I’m sure all of us have done this at some point in our life: someone gets really angry with us, maybe what we perceive as out of nowhere, and we roll our eyes thinking, making a (now socially inappropriate) comment like, “You are Bipolar!” There’s lots to unpack here… but there is a big difference between someone who is very angry, maybe experiences unhelpful or dangerous rage, or perhaps is demonstrating abusive behaviors and someone who has bipolar disorder. 

According to the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition – Text Revision (DSM-5-TR), bipolar disorder is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting a minimum of four days and upward of over one week. These symptoms are present most of the day, nearly every day, and in some cases, result in hospitalization. Several additional symptoms that are noticeably different from baseline behaviors must also be present, including inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, unusual distractibility, unusual increase in goal-directed activity or psychomotor agitation (i.e., purposeless non-goal-directed activity), and excessive involvement in activities that have a high potential for painful consequences.

What does this mumbo jumbo mean? Let’s break this down:

Part 1: … abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy… This means that someone’s baseline mood experienced is abnormally and persistently different from their mood typically. There are a couple of keywords here: abnormal and persistent. Someone’s anger or mood reactivity must be drastically different than their typical mood. If someone is regularly irritable, grumpy, or persistently hyper and energized, this wouldn’t be considered a change from their baseline. 

Part 2: … by a distinct period… lasting a minimum of four days and upward of over one week… This means the abnormal change lasts consistently for a minimum of four days. The keywords here are distinct period and consistent. The mood fluctuations are highly unlikely to change several times throughout the day if it is bipolar disorder (there is a different condition for that, which can be discussed another day). The graph below does a much better job of explaining it. See how the “high” looks like a plateau? That’s because this person’s mood demonstrated a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy that lasted a minimum of four days and upward of over one week. Do you see how this is different from someone being quickly angered? Side note: the difference in duration helps mental health professionals determine which type of bipolar someone might have. 

Part 3: …present most of the day, nearly every day, and in some cases, result in hospitalization…. This part is also essential and differentiates non-pathological anger from bipolar disorder. Similar to the plateau above, that mood is present for most of that time. This means it can’t be present for 30 minutes to an hour or two, then go away for the afternoon and come back at bedtime, or be present for a full day, then gone the next, and back again the following day. These abnormal mood changes are persistent, as indicated in Part 1. 

When mental health professionals gather evidence that fits these symptoms, we start considering if a person has had a manic or hypomanic episode. Now, in addition to everything already discussed, there are other specific things that clinicians look for in someone who might have had a manic or hypomanic episode. Which brings me to….

Part 4: There are lots, so let’s break this down further. This part gets tricky because not everyone is the same here, and it can look different from person to person. So please rely on the expertise of a mental health professional to differentiate these symptoms and know that these are examples only.

• Inflated self-esteem or grandiosity: This is more than just feeling confident because you did your hair or put on a complimentary outfit. This feeling on top of the world, like you can outperform the best of the best when this isn’t plausible.
• Decreasing need for sleep: This is different from saying, “I can’t sleep,” or “I don’t sleep a lot, and I’m always tired and grumpy after.” This is, only need minimal sleep (30 minutes, an hour, maybe not at all) and feel energized entirely or still have unusual energy different from baseline. 
• More talkative than usual or pressure to keep talking: This is more than being more social. This type of socialization is unusual and uncomfortable. It makes people around them really feel concerned for a person’s well-being. 
• Flight of ideas or subjective experience that thoughts are racing: This is similar to pressure to keep talking, but this can look bizarre sometimes, where a person runs out of breath or transitions to extremely unrelated thoughts that are not typical. 
• Unusual distractibility: This is more than just zoning out or losing focus. This is being unusually distracted by unusual things that someone is not typically distracted by.
• unusual increase in goal-directed activity or psychomotor agitation (i.e., purposeless non-goal-directed activity): This isn’t just, “Oh wow, I can actually complete my daily living tasks today.” This is, I’m not able to stop moving, and maybe I’m not aware that I’ve got myself into a dangerous or risky situation.
• Excessive involvement in activities with a high potential for painful consequences: This is very unusual. Like knowing you are saving for a down payment on a house, but instead, taking that money and buying everyone in your workplace a new pair of shoes. Or joining an intense nursing program when you have no experience in this field. 

But wait! There’s more! There’s a certain number of these extra symptoms that need to happen at the same time as this heightened mood period for mental health professionals to determine if a manic or hypomanic episode was experienced. And, as with all mental health disorders, these symptoms must be causing significant functional impairment. Functional impairment means someone has difficulty doing everyday things that most people can do easily (and safely), like getting dressed, going to school or work, making friends, taking care of themselves, making safe decisions, etc. Oh, one last thing: these symptoms and experiences cannot be explained by another mental health or medical condition! 

See how telling if someone or yourself might have bipolar disorder can get really tricky? Or how social media might provide inaccurate information about a severe condition? Or how calling someone bipolar could be hurtful and invalidating? Hopefully this clears the air. And please, if you or someone else believes they may have bipolar disorder or any other mental health challenge, please reach out to a mental health professional (or call 911 if immediate care is needed).