What Is Pressured Speech in Bipolar Disorder?

Signs and Symptoms of Pressured Speech in Bipolar Disorder

Pressured Speech
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Pressured speech is a hallmark symptom of mania or hypomania in bipolar disorder. The presence of pressured speech (also called "pressure of speech" and "cluttered speech") in combination with several other symptoms can confirm a diagnosis of bipolar disorder. Pressured speech may occur in other psychiatric conditions.

How Pressured Speech Is Described

Someone with pressured speech speaks quickly and loudly.

Pressured speech can be difficult to understand, in part because it's so fast and in part because it may jumps around to many different topics. In a person who is also experiencing flight of ideas, the pressured speech may also be disjointed and incoherent.

Jacob L. Driesen, MD, a specialist in behavioral neuroscience and behavioral medicine, defines pressured speech as "rapid, virtually nonstop, often loud and emphatic, seemingly driven, and usually hard to interrupt. It typically occurs in mania [and hypomania] and in some drug-induced states and in severe anxiety states." More simply, in her book Bipolar Disorders, Mitzi Waltz uses the phrase "motormouth" to describe pressured speech.

Prevalence and Diagnosis of Pressured Speech

Pressured speech occurs in bipolar children as well as adults. It's one of the most common symptoms of bipolar disorder as nearly one-third of bipolar patients will have pressured speech at some point during their diagnosis.

Controlling a Manic Episode

If pressured speech is due to a manic episode, the first thing you have to do is seek help. Work with whomever you'd previously designated to help you — that person can walk you through slowing your thoughts down.

If the episode is not violent and your loved one or friend is well-versed in talking to you during a manic episode, communicate with that person.

If you come up with a plan to handle episodes when you are stable, it will be easier to work through a particular episode until a doctor's appointment can be scheduled.

If a trigger is present that causes or intensifies mania, remove yourself from that environment or subject matter. Getting away from an overly stimulating place is best. Going out in nature, taking a walk, or listening to calming sounds such as ocean waves or other soothing distractions may help alleviate the severity of the episode.

Treating the Symptom by Treating the Condition

Because pressured speech is a symptom, not a condition, the cause of the mania (the condition) must first be addressed in order to treat the symptom.

Sometimes, a mixed mania event occurs and a person has pressured speech along with impulsive behavior and aggression.

In the case of mania, the pressured speech may go away on its own, or psychoactive drugs may be prescribed. There may also be tests taken to rule out a brain injury or other medical condition. Counseling may also help for those who are experiencing an episode due to extreme stress or anxiety.

First-Hand Experiences of Pressured Speech

These statements from people who have bipolar disorder explain what pressured speech feels like from their perspective:

  • "'Pressured Speech' is just a fancy psychiatrist's term for a manicky person's tendency to talk really really fast. I've been told that I just have so many thoughts going through my head so fast and I am trying to fit them all into the words that I am saying at the same time that it doesn't work and that is why my speech comes out at a speed that is unintelligible to most people."
  • "Inside view: the ideas and associations are arriving thick and fast and if you're expressing them by talking to someone, the speech tends to be faster than usual, the idea content more dense, the apparent digressions more abundant and noticeable."

    Further Reading About Manic and Hypomanic Episode Symptoms

    Further Reading About Mania and Hypomania


    Droogendijk, Daniel, RPN. Pressure of Speech. Bipolar Disorder Symptoms. 30 Jan 2009. Accessed 7 Jan 2010.

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