Managing Irritability and Anger

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Feelings of irritability and anger are fundamental symptoms of bipolar disorder that can occur as part of hypomanic, manic, or depressive episodes. When anger and irritability emerge as part of (hypo)mania, they often occur with a sense of internal pressure, including a humming sense of urgency, burden, or sensitivity to comments or actions from others. At times, individuals with bipolar disorder describe these feelings as a need to look for a fight, almost like they are seeking an explanation for the emotional tone in their bodies ("Oh yeah, I knew there was a reason I was feeling angry, it is because he/she is... "). When you experience this type of irritable mood, you focus your attention on potential slights and errors. Once you notice a small infraction, all of the irritable emotion is set into play ("I am so sick of this, I am going to put a stop to this right now") and an unnecessary argument or a self-defeating outburst can result.

Irritability and anger also emerge as part of depressive episodes. For many individuals, depressive irritability is similar to the feeling of having a constant toothache; because of the constant backdrop of pain, there is the sense of not being able to cope with much more. Sounds seem louder and shrill, imperfect behavior from others feels more intolerable, problems seem more catastrophic, and requests from others feel more overwhelming. At times, urges to fight against these annoyances are intensified by an internal sense of agitation, an inability to sit still, where the next annoyance feels like the perfect target to communicate, "stop it, stop it, stop it!" Similar to the feelings in irritable hypomania, the angry outburst feels justified at the moment. But later, when a sense of perspective returns, the thought is frequently, "I can't believe I got so upset and acted that way."

Part of effectively coping with bipolar disorder involves becoming skilled with understanding and reducing the impact of irritability and anger. One strategy for coping with irritability is to consult with your psychiatric provider to see if a medication adjustment may help keep these emotions in check. It is also useful to see how well you

Good anger management skills can break the links between mood disturbances, irritability; and aggressive behavior.

not deny the annoyances or frustrations in life. Instead, efforts to control anger are directed at avoiding the additional mood problems and strained relationships that anger causes.

To achieve your goals of reducing anger and irritation, we suggest rehearsal of four related skills. These skills are aimed at reducing the emergence as well as the escalation of anger. Should these preventive efforts fail, they are also targeted at minimizing aggressive behavior once it is initiated. Together, these four principles are designed to help you reduce the cost of irritability and anger episodes to your mood and to your relationships and work goals:

1. Don't let poor thinking habits goad you into an angry outburst or argument.

2. You don't have to solve an irritation right now;

can develop additional anger management skills to break the links between mood disturbances, irritability, and aggressive behavior. In preparing to consider these skills, it is important to remember that the goal of anger management is to maximize your own wellbeing. Efforts to control anger do

3. Beware of win/lose thinking.

4. Remember to selfishly value your life goals, even when angry.

The remaining sections provide information on putting these principles to use.

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