Bipolar Disorder: Struggling with Aggression


Bipolar disorder is a serious mood disorder that can make a person feel like they are on an emotional roller-coaster ride. The illness is treatable with a combination of medication, disciplined lifestyle and regular counseling. People with all forms of bipolar disorder have trouble with extreme emotions. A recent study reveals that extreme aggression is just one of the disorder’s challenges.

There are actually two types of bipolar disorder, type I and type II. Type II is a less evident and less disruptive form of the illness. In both cases, the bipolar person experiences wide swings of emotion. During one phase, or episode, the person may feel extremely low. As with unipolar depression, the person may feel unable to escape their sadness and lack of motivation. At times the depression can become paralyzing until even bathing and changing clothes requires monumental effort.

On the other extreme, they may experience periods of unfounded euphoria. This is where the two types of the disorder diverge. For the person with type II, the “up” emotions, known as mania, are less extreme. For them, this mood swing is called hypomania. For persons with type I bipolar disorder, manic episodes are frenetic in terms of thoughts, speech and activity. The person feels optimistic, energetic (even to the point of sleeplessness) and grandiose. Their thoughts seem to race and they can’t speak fast enough.

A longitudinal study of bipolar disorder was conducted through Western Psychiatric Institute and Clinic in Pennsylvania and was headed up by Javier Ballester, M.D. Ballester and his colleagues used the Aggression Questionnaire to assess differences between bipolar patients, patients with another form of mental illness and mentally healthy subjects.

After controlling for several factors the researchers found that people with bipolar showed greater evidence of anger, hostility and physical or verbal aggression compared to other study participants. The link between bipolar disorder and increased aggression was present whether the person had type I or type II bipolar. The association was also found regardless of other factors like comorbidity, medication being taken, psychosis or intensity of mood episodes.

Of the bipolar subjects 87.1 percent reported notably higher aggression scores than the 64.1 non-bipolar mental health patients or 53.8 percent with good mental health.

When the aggression questionnaire was given two years later, the scores showed similar disparities. Subjects with bipolar scored 78.6 compared to non-bipolar patients who scored 63.3 and healthy subjects who scored 50.7.

Four years hence those with bipolar continued to outscore everyone else. Subjects with bipolar reported scoring 77.5 compared to non-bipolar scores of 59.8 and health scores of 49.6.

Those with bipolar reported higher total scores and they scored higher on every subscale as well: verbal aggression, physical aggression, hostility, anger and indirect aggression. The highest scores of all were noted by bipolar subjects who were in the midst of an acute episode. Interestingly, the aggression scores were not so divergent between non-bipolar patients and mentally healthy subjects.

An increased problem with aggression does not equal increased danger. People with bipolar disorder are not more likely to commit violent crimes such as rape or murder, say the researchers. But the study does underline the importance of managing mood episodes through regular counseling and appropriate medication.

Heightened aggression puts an obvious strain on family relationships and increases workplace conflicts. Ballester’s research shows the importance of steady symptom management to help reduce aggression’s impact. It is the natural tendency of the illness to set a person at odds with everyone around them. Only steady treatment and careful lifestyle (regular sleep, exercise and positive socialization) can minimize the risk.

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