Understanding Dysphoric Mania

Co-Existing, Contradictory Symptoms of Bipolar Disorder

Dysphoria
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Dysphoria is a word that turns up often in the literature describing bipolar disorder. It can be applied and interpreted in different ways depending on whether you are a medical professional or a person on the street.

By definition, dysphoria is a profound state of unease or a general dissatisfaction with life. For you and me, that can apply to any number of people we know. But does that, in and of itself, suggest a person who is inherently unhappy or anxious has bipolar disorder?

Usually not. From a clinical standpoint, the word "dysphoria" suggests a serious depressive episode accompanied by a manic psychosis (the loss of external reality). As such, it is not considered a reasonable response to an event of stimulus but rather a feature of an ever-changing cycle in moods that can lead, often inexplicably, to profound episodes of emotional dysfunction.

Simply put, it is a disconnect in emotion that has little or no bearing to what is actually going on.

Dysphoria is not only associated with bipolar disorder but other psychiatric and nonpsychiatric conditions. These can include schizophrenia, gender identity disorder (GID), illicit drug use, and even premenstrual cycles (premenstrual dysphoric disorder).

Diagnosing Dysphoric Mania

Dysphoric mania is not a term we use often these days but one that can help clarify how dysphoria applies to a bipolar disorder. In this instance, a bipolar person might concurrently exhibit signs of mania along with signs of depression.

Today, we tend to describe this as a mixed feature of bipolar disorder.

People with dysphoric mania will experience at least two symptoms of mania with at least one symptom of depression. The symptoms can be wide-ranging but are ultimately characterized by a contradiction in action and state (such as a person who is frenetic and loud even if he or she is emotionally drained and depressed).

Symptoms of mania can include:

  • Grandiosity and exaggerated feelings self-importance
  • Hallucinations or delusions
  • Racing thoughts
  • Rapid, frenzied speech (pressured speech)
  • Recklessness and risk-taking behavior
  • Aggressiveness or irritability
  • Needing less sleep or not feeling tired
  • Purposeless, often relentless activity (psychomotor agitation)

Symptoms of depression, by contrast, can include:

  • Inexplicable crying or long periods of sadness
  • Curtailed sleep or appetite
  • Thoughts of suicide (suicidal ideation)
  • Feelings of worthlessness or guilt
  • Lethargy
  • Social isolation
  • Indecisiveness or confusion

When these ranges of symptoms co-occur, the state can then be broadly described as being dysphoric.

Treating Dysphoric Mania

It is important to remember, first and foremost, that dysphoria is not a condition. It is a symptom in the same way that euphoria (intense feelings of happiness or well-being) is a symptom. As such, you do not "treat" dysphoria per se but the underlying condition.

With that being said, dysphoric episodes are often difficult to treat because the majority of drugs used to treat bipolar disorder address either depression or mania, not both. Mood stabilizers and antipsychotic drugs may be effective, but the process of finding the right combination of can take time.

Oftentimes, treatment is a process of trial-and-error.

When dysphoria occurs in relation to a mixed episode, the risk of suicide is considered high. In people having suicidal thoughts or those whose behavior is erratic and intensifying, hospitalization may be needed.

Dysphoric mania is a serious disorder that needs immediate and ongoing treatment and support. If you or a loved one are experiencing symptoms of a mixed bipolar episode, seek help as soon as possible. Early intervention is often key to treatment success.

Source:

Hu, J.; Mansur, R.; and McIntyre, R. “Mixed Specifier for Bipolar Mania and Depression: Highlights of DSM-5 Changes and Implications for Diagnosis and Treatment in Primary Care.” Prim Care Companion CNS Disord. 2014; 16(2):PCC.13r01599.

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