Bipolar Anger: Managing Irritability & Outbursts

Bipolar anger can build quickly. Here’s why it happens — and the strategies that can help you manage it before it takes over.

It starts with a routine annoyance — the living room is a mess again, or yet another driver cuts you off. Irritation takes hold, then mushrooms as swiftly as a nuclear explosion. Cheeks redden, the pulse quickens, and … boom. Welcome to bipolar rage.

For Paul A., of Las Vegas, an innocuous comment by his wife during dinner could flip his switch. “I would go off,” the architect says. 

Paul recognized that something wasn’t right with his ever-changing moods, but, for several years, stigma kept him from seeking treatment for his bipolar disorder. So periodically, “for the better part of 20 years, I would get irate over nothing,” he says.

Stress at work would affect his sleep, which would affect his equilibrium. He would keep it together at the office, only to take it out in harsh words at home. His three sons would make themselves scarce, and his wife bore the brunt of his verbal attacks before their marriage ended.

“It was 100 percent the reason for my divorce,” Paul says.

The Link Between Bipolar Disorder and Anger

Irritation and anger can be commonplace — and even healthy — responses to certain provocations. As with many emotions, however, people with bipolar disorder appear to be more vulnerable to extreme reactions.

RELATED: 6 Things About Bipolar Anger You Might Not Know

“Everyone can become frustrated or angry, but loss of control can be part and parcel of bipolar disorder rage,” says Jeffrey Borenstein, MD, president and CEO of the Brain & Behavior Research Foundation.

Irritable mood is among the primary diagnostic criteria for mania and hypomania, and there’s growing understanding that anger and irritability can be hallmarks of depression, as well.

Left unchecked, irritability and its downstream cousins, anger and rage, can have dramatic and devastating effects. Family life and friendships suffer. There can be severe repercussions in the workplace, and, on occasion, seismic encounters with the justice system.

At the least, guilt and regret after an outburst have corrosive emotional consequences.

“For five seconds afterward, there is some relief,” Paul admits. “And then there’s the, ‘Oh my God, what did I just do?’ and the remorse would send me into a depressive state.”

Anxiety, Irritability, and Agitation With Bipolar 1 Disorder

Signs of anxiety, irritability, and agitation (AIA) are common among people experiencing mania in bipolar 1 disorder, especially when depressive symptoms are also present.

In an analysis of two clinical trials, 960 participants were studied — 665 with a manic episode and 295 with a mixed one. Among those with depressive symptoms, anxiety, irritability, and severe AIA (but not agitation alone) were significantly more common. The researchers noted that assessing AIA symptoms may help clinicians identify individuals with more severe depressive features, and this harder-to-treat form of bipolar 1. 

How Anger Can Affect Your Health, With or Without Bipolar 

In addition to negatively impacting relationships, rage may have devastating physiologic effects, explains Redford Williams, MD, professor emeritus, psychiatry and behavioral sciences at Duke University School of Medicine.

“Anger activates our body’s fight-or-flight response, which is the release of stress hormones, such as adrenaline and cortisol,” says Dr. Williams, whose books include Anger Kills: Seventeen Strategies for Controlling the Hostility That Can Harm Your Health.

Over time, elevated levels of stress hormones cause wear and tear on all body systems. And when people who are irritable and easily frustrated by temperament go into anger mode, Williams says, “all components of this anger response occur at higher levels.”

“We know that people with a hostile personality type develop hardening of their coronary arteries at an earlier age than their less hostile counterparts,” Williams says, and that enhanced response may be why.

“Whether or not people who have anger as a component of bipolar disorder show the same exaggerated fight-flight response is not known, but anger is certainly bad for the heart and a potential contributor to the development of heart disease and high blood pressure,” he adds.

Anger may also contribute to heart attack risk, according to a research article published in the Journal of the American Heart Association. This is due to the blood vessels not dilating properly.

The Importance of Recognizing Bipolar Mood Shift Triggers

Bringing bipolar mood shifts under control may lessen the pressure to blow up, but that doesn’t mean the volatile emotions will entirely evaporate. That’s where anger management techniques come in, such as counting to 10, taking deep breaths, and finding a positive outlet instead of letting the steam build.

It’s also important to learn the triggers that typically set you off, as well as the mental and physical signs of an impending eruption. 

Paul says that, over time, he has gotten better at recognizing his warning signs. “I feel my blood pressure start to boil, and have to catch it and calm down,” he explains.

Learning to tease apart appropriate emotional reactions from those associated with a mood shift — in either direction — requires insight(s) developed over time.

The Connection Between Anger and Bipolar Symptoms

“It’s important to know if your anger travels with symptoms of mania, such as not needing to sleep, or with the symptoms of depression, such as losing interest in things,” says Elizabeth Brondolo, PhD, a psychology professor at St. John’s University in New York City and co-author of Break the Bipolar Cycle: A Day-to-Day Guide to Living With Bipolar Disorder.

It’s easy to detect changes when a person who’s usually easygoing starts to get cranky. Yet for those whose temperaments are marked by “hostile personality traits” — impatience, frustration, and rudeness (such as interrupting when others are speaking) — there may be a more subtle crescendo.

One older study found that those with bipolar (either type 1 or 2) are more likely to be argumentative, feel hostile toward others, have hot tempers, and act out than those without the disorder, especially during a mood episode. There’s also a greater likelihood of anger escalating quickly, resulting in sudden and explosive outbursts.

However, there may be underlying differences in disposition between people who feel “snappy” and those who feel “happy” during hypomanic and manic phases. 

A research report found that, on a temperament scale, the “snappy” group scored as more irritable, more self-focused, and less cooperative. They were also more likely to report higher levels of irritability during depression and to have a comorbid anxiety disorder.

Symptoms inherent in bipolar may also feed a propensity to flare up, according to Dr. Brondolo. For example, when your mind starts racing, “you are pushing your thoughts forward and may rush to catastrophic or unjust conclusions that can make you angry,” she says.

How to Manage Bipolar Anger and Irritability 

To better manage bipolar anger, Brondolo has some ideas. She recommends tracking various aspects of your feelings and behaviors on a regular basis — although she notes that such self-awareness isn’t easy once your brain starts misfiring.

Her checklist starts with the basics: Am I upset about something? If so, what and why?

Also consider whether you are feeling anxious, sleeping well, drinking alcohol, experiencing symptoms of mania or depression, and taking medications as prescribed.

“The answers to these questions may motivate you to call your doctor,” she says.

Research points to sleep being one of the most sensitive early markers of a shifting mood — even one night of lost sleep can be a trigger for anger.

RELATED: The Difference Between Anger and ‘Bipolar Anger’

Here are nine specific ways to manage bipolar anger.

1. Take a Break to Interrupt the Anger Response

When emotions start to boil, you can turn down the heat by giving yourself time or space. That’s where classic advice to take three deep breaths, or count to 10, comes in — anything that interrupts the anger response.

Stepping away may be even better for both parties in the situation.

Kitty, an IT consultant in Toronto, knows she needs some time alone when she’s feeling irritated. She recalls one occasion when she was feeling “super annoyed” with everything her partner did and said.

“In my mind, I heard myself saying something horrendous that would have made her feel awful about herself,” Kitty explains. “I immediately turned around and told her to give me some space.”

Kitty used her “alone time” to review some of the usual suspects. “Did I take my meds? Yes. Did I sleep well that night? Yes. Was I depressed? Nope. Did I have a stressful day? Not really. When was my next period due? … bingo!”

She adds, “Once I was able to process all of this, I went to find my partner, gave her a huge hug and a kiss, and began to explain what happened and discuss her feelings.”

2. Help Others Understand Your Anger Symptoms

Open and honest communication, along with education on bipolar for all parties, makes a huge difference. 

Family therapy can be helpful, too, in promoting discussion about the disorder and related issues, exploring family dynamics and communication patterns, and developing a unified response strategy.

“Families can learn about the signs of bipolar anger and work together to devise a plan about what to do to better identify and manage the symptoms when they occur,” Dr. Borenstein says.

That might mean walking away from a loved one when they’re starting to get angry or removing young children from a potentially ugly scene, he says.

Recognizing that someone’s words and actions stem from a bipolar mood shift — and learning not to take it personally — can be hard enough for adult partners, let alone the younger members of the family. It may also be helpful to have an age-appropriate discussion with children about your diagnosis.

“You can acknowledge that this is a medical condition, and instead of having symptoms like a rash or fever, the symptoms of bipolar are behavioral disturbances — like moodiness or exhaustion — that wax and wane,” he says. “Give kids a context so they know that you may be a little more irritable, and so they understand that this is not their fault.”

3. Learn to Recognize Legitimate Anger Versus Extreme Anger

Sometimes the pendulum can swing too far in the other direction: Any signs of anger and irritation get dismissed as “just part of bipolar,” even when they’re justified. That’s why developing the skills to have a calm, frank discussion focused on perceived problems, not personalities, matters so much.

That conversation isn’t likely to happen once symptomatic irritability or anger take hold, however. Years of experience have taught Anna when to try to talk to her husband and when to simply leave the room.

“Sometimes, he can’t be reasoned with,” she says of her husband, Jack, a television executive from Connecticut. (The couple asked that their real names not be used.)

If Jack’s vehemence is out of proportion to the situation, Anna will leave him alone. 

She’s also grown familiar with the situations that tend to set him off. Although he’s much better at recognizing and defusing his anger these days, she says, she still gets tense when they’re in the car together, especially when there’s traffic.

“Bad drivers and rude people can start my clock ticking,” admits Jack, “and then I imagine all sorts of arguments with the ‘offending’ person. I can almost feel my blood pressure rise.”

Now that his bipolar is under control with medication, he usually has enough clarity to hit pause when he’s getting stirred up. That wasn’t always the case.

“I’ve gotten myself into trouble before,” he admits, recalling one encounter with a fellow customer at a gas station that ended with him in police custody.

4. Learn to Control and Redirect Angry Impulses

Jack says that if he were to find himself facing that same inconsiderate person at that same gas station today, he would walk away and talk himself down.

“You have to learn how to control your impulses and know when they are coming,” he says.

It’s a process that involves a lot of trial and error, he points out — and the results aren’t guaranteed to work every time. In fact, he and his wife are considering moving to a less stressful community to avoid some of his triggers.

Other favored strategies when he feels on edge include playing some feel-good music “real loud” and hitting the gym.

“I do cardio and listen to music, and usually feel a lot better when I finish my workout,” he says.

5. Track Your Moods and Bipolar Triggers

Keeping a journal helped Joyce K., of Sioux City, Iowa, figure out her typical triggers.

“I write down how I am feeling so I can look back and reference other entries to look for common themes,” she says.

Journaling helped her identify behaviors to address, such as waiting calmly at traffic lights, being patient with others, and handling comments that irk her, “whether aimed at me or not,” she reports.

After three decades of living with bipolar, she has a handle on the emotional and physical signals that tell her it’s time to redirect her energy. When she feels her temper heat up, she gets down to her favorite music, including disco tunes like Chic’s 1978 hit “Le Freak.”

“My therapist told me to put on my favorite music and dance when I am feeling rage,” she explains. “I had to laugh at the suggestion at first, but it works, and the only one who can see me is my cat.”

6. Release Energy Through Movement

Working out on exercise equipment, getting in the pool, or taking a brisk jog also gives Joyce’s angry feelings a positive outlet.

“Sometimes I have to push myself to do something physical to nip it,” she notes. “Going for a walk or hike, or just changing scenery, also helps me let off steam in a healthy way. If you go out and bash the windows of your apartment, you will end up with more problems than when you started.”

7. Find Preventive Strategies to Help Curb Anger and Rage Episodes 

Preventive stress management helps head off anger and rage. There are many different approaches, and the key is to find one that works for you.

RELATED: Bipolar Anger and Work: How to Remain Professional

Kitty says yoga has really helped her. Through a local foundation, she’s now helping others learn yoga as a way to cope with their moods.

Kitty wishes that she’d had better coping tools earlier in the course of her bipolar.

“I said horrible things to my siblings and parents that hurt them, and they remember them to this day,” she says.

As she worked her way back to wellness, she adds, “we’ve done much healing and growth.” And rather than beat herself up over the past, she chooses to focus on how far she’s come since then.

“No one will make you feel worse than yourself, so forgive yourself for the things you did and said to your friends and family members,” she says. “Now, I just take a few deep breaths and a fraction of a second to collect myself, and remind myself that I am in charge, not the bipolar.”

8. Prepare With Loved Ones for Possible Anger Episodes

The best way for couples and families to weather angry outbursts is to plan ahead, says clinical psychologist Sarah K. Keedy, PhD.

“We all need a tool kit filled with healthy strategies on how to cope with moods and this is best developed in advance,” says Dr. Keedy, who is also the director of the Cognition Emotion Neuroscience Laboratory at the University of Chicago.

Having all parties sign off on an action plan up front is essential. For example, she says, talk through what you think should happen when anger starts to get the best of you.

“Should the family member leave or should they remind you about your coping strategies?” she says. “The key is to agree on what is okay in advance. This may help the situation go more smoothly, as well as mitigate guilt or other hurt feelings later for all parties.”

That conversation should include the best way to handle potentially volatile situations, such as the behaviors and circumstances that “would trigger the need for outside intervention of any kind,” Keedy says — from “calling the person’s medical team” when signs of agitation and anger appear to calling the police.

9. Try The ‘I Am Worth It’ Exercise

Clinical research demonstrates that cognitive behavioral stress management training can help people learn to reduce hostility and anger. 

Here is an exercise from the Williams LifeSkills® (WLS®) program, founded by researcher and physician Redford Williams and educator/historian Virginia Williams. It goes by the mnemonic “I AM WORTH IT.”

• I: Is the situation important to you?
• A: Is your anger appropriate, given the facts of the situation?
• M: Is the situation modifiable?
• WORTH IT: Is taking action worth it?

If you answer “no” to any of those questions, it’s a signal to modify your reaction — for example, by reminding yourself, “Hey, this is not that important!” or by practicing a meditation exercise.

If the answer to each question is “yes,” you can take steps to target the trigger for your emotion in a way that is proactive rather than destructive.

That would include problem-solving to change the situation, or approaching the other people involved to assertively discuss how their behavior is affecting you and what you need to have happen differently.

From recognizing early warning signs to building coping strategies and involving loved ones in planning ahead, there are ways to reduce the fallout of rage and reclaim a sense of control.

Editorial Sources and Fact-Checking

• Williams RB et al. Adaptation and Implementation of an Evidence-Based Behavioral Medicine Program in Diverse Global Settings: The Williams LifeSkills Experience. Translational Behavioral Medicine. March 11, 2011.
• Suppes T et al. Anxiety, Irritability, and Agitation as Indicators of Bipolar Mania With Depressive Symptoms: A Post Hoc Analysis of Two Clinical Trials. International Journal of Bipolar Disorders. November 2017.  
• Shimbo D et al. Translational Research of the Acute Effects of Negative Emotions on Vascular Endothelial Health: Findings From a Randomized Controlled Study. Journal of the American Heart Association. May 1, 2024.
• Ballester J et al. Is Bipolar Disorder Specifically Associated With Aggression? Bipolar Disorders. May 1, 2013.
• Graham RK et al. Clinical Characteristics and Temperament Influences on ‘Happy’ Euphoric and ‘Snappy’ Irritable Bipolar Hypo/manic Mood States. Journal of Affective Disorders. March 15, 2015.

UPDATED: Printed as “Unravel Your Wrath,” Winter 2016