For the Anger, Rage and Emotional Volatility of Bipolar Disorder, Type II Patients & Their Families

  • About
  • Evaluation Scale
  • Symptoms
  • Treatments
  • Medications

About

In the winter of 2004, an article from a medical journal on bipolar depression or Bipolar Disorder, Type II came across my desk. Like most other clinicians, I was trained to identify Bipolar Disorder, Type I or manic-depression. However, the Type II classification was basically omitted from my training. I had never encountered such a clear and concise description of this common mood disorder, which has escaped awareness by most medical and psychological practitioners.I had over 24 years of experience at that time treating mood disorders and anxiety, but never understood that bipolar depression was an actual clinical entity. As I read this journal article, it became clear I was in the dark when it came to diagnosing and treating this condition. I obtained only brief and superficial exposure to Bipolar Disorder, Type II, while studying the Diagnostic and Statistical Manual and never really associated it with the depression I was seeing in the office. However, I was very aware of the fact that many depressed patients did not seem to get well, despite receiving good psychotherapy and the best medications available for depression and anxiety.

The article went on to explain that patients with bipolar depression are generally misdiagnosed with unipolar depression and anxiety. Their condition may worsen over time and many end up taking their own lives and the lives of others through murder and suicide. The fact is that any bipolar mood disorder will not improve without utilizing a class of medications referred to as mood stabilizers. Most of those with Bipolar, Type II illness have never been treated with a mood stabilizer and the focus has been on reducing anxiety with Benzodiazepines such as Xanax and treatment of the depression with SSRI’s such as Prozac, Effexor or Zoloft. These medicines offer minimal help and the agitation, irritability, anger and rage associated with Bipolar Disorder, Type II will progressively worsen over time.

I began paying closer attention to my patients who had a chronic depressive history, despite being treated for years by many clinicians with these medications and psychotherapies. They all seemed to have similar and unresolved symptoms including; mood swings, irritability, agitation, racing thoughts, depression and rage episodes. I came to the conclusion that these patients were misdiagnosed with depression and anxiety and they were, in fact, the type of patients discussed in the journal article. The absence of full-blown manic episodes was a major reason for the misdiagnoses. Further research, which was sparse and difficult to find confirmed what was reported.

Misdiagnosis of bipolar depression has been partly responsible for the epidemic of domestic violence, substance abuse and more importantly, destruction of the family unit. Families of an individual with bipolar depression are highly susceptible to frequent episodes of verbal and physical abuse. The psychological damage to these family members can be severe because of the highlevels of fear, depression and co-dependency it causes.The judicial system has been dealing with the cycle of domestic violence and substance abuse associated with bipolar depression for many decades through referral to anger management and mental health recovery programs. Ironically, most of these programs fail to correctly identify the root problem, which is bipolar depression.

“The Ticking Time Bomb,” is a title created specifically to exemplify the emotional condition of each individual with Bipolar Disorder, Type II. The explosive anger, rage and abuse are characteristic of a “time bomb” ready to detonate with dangerous and serious consequences, not only for the individual, but also, for those within the immediate environment. The explosiveness of most individuals with bipolar depression can be diffused and can improve, provided it is correctly diagnosed. Bipolar Disorder, Type II is hereditary and a medical condition which can be triggered by minimal levels of stress. Changes in brain chemistry occur following exposure to stress, which causes racing thoughts, mood swings, anger, rage and depression. This is not an ordinary type of depression, anxiety or a personality disorder, which it is so often confused with by healthcare professionals. This is a bipolar mood disorder, which needs to be correctly identified and treated. People with this disorder can improve and live a more healthy and productive life with proper diagnosis and treatment.

HereisHelp.net has been established, in part to help generate greater public awareness of bipolar depression. We have been successfully treating this condition since 2004 and hope to reach greater numbers through our web based information and services. Many more articles, webinars, podcasts, DVD’s and this book on Bipolar Disorder, Type II are becoming available to help reduce the epidemic of rage and violence facing our world.

Michael J. Woulas, Ph.D.

Evaluation Scale

The WBPDII is a self administered rating scale to help identify the primary symptoms of Bipolar Disorder, Type II. This is not intended to replace a full diagnostic assessment, which is typically conducted by health care professionals.

Our evaluation scale is currently available in PDF format. Click here to download the file.

Contact a health care provider for further advice.

Symptoms

Here are the basic symptoms to keep in mind when considering bipolar depression in the family.

  1. Mood swings: Mood changes can occur very rapidly with little warning. These changes are unpredictable and erratic. Often times, trivial events can trigger a dramatic change in mood. Family members may become overly cautious and feel as though they are “walking on egg shells”.
  2. Hypomania: (hypo means low and hyper means high)In this case hypomania refers to a low-grade manic episode. Moods occasionally become elevated and the individual may become more talkative than usual, with increased energy and diminished need for sleep.
  3. Depression: Depression is commonly observed in Bipolar Disorder Type II. Sadness and depression manifest as a decrease in energy and loss of motivation. There is a tendency to cry easily, avoid social contact and to isolate for extended periods of time. Attempts at suicide are made during this deeply depressed emotion state.
  4. Racing thoughts: A very common symptom of Bipolar Disorder Type II is racing thoughts, which refers to a steady flow of ideas. The mind is seldom at rest. It is this failure of the mind to rest which causes the sleep disturbances of Bipolar Disorder, Type II and contributes to anxiety.
  5. Irritability: Irritable mood is a common symptom of Bipolar Disorder Type II. The patient is often described as grouchy and miserable to live with. They are unsettled and they have difficulty relaxing. A lack of cooperation with others is commonly reported in people with bipolar depression.
  6. Agitation: Agitation is also common in Bipolar Disorder Type II. Often times, agitation leads to episodes of rage and violence, when the patient is under stress. This symptom should be taken seriously because most abusive and violent acts are preceded by periods of agitation.
  7. Rage: Raging is a common occurrence by people with Bipolar Disorder, Type II. This is the most serious symptom because both domestic and social violence often occurs as a result of bipolar rage. Tirade is another word, which is synonymous with rage. The tirades can become uncontrollable. Verbal and physical abuse often ensues and most violent crimes against society, family and self originate out of this rage.

Treatments


A combination of medications and counseling / psychotherapies is most effective for the management of symptoms related to Bipolar Disorder, Type II. Psychological & counseling treatments include but are not limited to:

  1. Cognitive-behavioral therapy
  2. Insight oriented therapy
  3. Family therapy
  4. Chemical dependency/substance abuse counseling
  5. Twelve-step recovery programs

Medications


Three classes of prescription medications are available to effectively treat Bipolar Disorder, Type II:

  1. Mood Stabilizers (i.e. Lamictal, Depakote, Trileptal, and Lithium)
  2. Antidepressants (i.e. Lexapro, Prozac, Zoloft and Wellbutrin XL)
  3. Atypical Antipsychotics (i.e. Seraquel XR, Abilify, Risperdal and Zyprexa)

Refer to The Ticking Time Bomb (Book) for more detailed descriptions of the topics above.