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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience:  Dr. Mark is a PhD in psychology in private practice
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I tend to have outbursts that I later regret. Do you think

Customer Question

I tend to have outbursts that I later regret. Do you think its bipolar or emotional dysregulation. It is affecting my marriage and i want to get a handle on it. What should i do, where should i go for help?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.

Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.


What made you go straight to Bipolar Disorder (BD)? That's very extreme. Are you already diagnosed with this disorder?

What type of outbursts do you have? Are these outbursts of anger? Can you share what happens?

How long do they last? How often do they occur? What does your spouse do?

What seems to trigger your outbursts?

Now for general information:

Was there trauma or abuse in your childhood? What about alcohol or dysfunction in your family when you were growing up?

Are you interested in medications to help? Or self help techniques? Or psychotherapy?

Are you getting any treatment right now? If so, what type? How is it going?

If not, when was the last treatment? What type of treatment was it? Was it helpful?

Any extra information that will help, feel free to share.


Dr. Mark

Customer: replied 2 years ago.

I thought i would put it out there because my spouse tells me she thinks thats what i have because she works with some one whos spouse has it.I tend to yell and get angry. Its worse when they don't listen or when they try and compare it to other things.They happen off and on. sometimes they happen 2 out of 3 days or i can go a week or so at a time with nothing. Could it be i hold things in to long before i talk about them and it all blows up at once?when people don't listen or when i get bossed around all the time.there was no trauma or abuse when i was younger but i can remember my dad raising his voice to us as we were growing up.I'm interested in what ever is the best possible solution to my problem. if medication works i'm for it.

Expert:  Dr. Mark replied 2 years ago.
I want to make sure I understand clearly before I answer so that my answer is on target, okay?


So you have outbursts of anger at your wife and kids. Is it only at them or do you get angry in other situations, like driving at other drivers, or in restaurants, or work?


Bipolar Disorder is based on to extremes of moods: one extreme can be irritation and anger with a lot of anxiety, which then gives way to a depressed mood, a low depression that can last a while, then lift and after a while it goes back up to that angry anxiety state. These moods swing back and forth. Is this what you're experiencing?


Dr. Mark
Customer: replied 2 years ago.

It really only happens at home, and yes i have those kind of swings. Sometimes the swing is faster then others.


 

Expert:  Dr. Mark replied 2 years ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.


Okay, so we've gotten to the long term exploration you're going to need to do because you believe your behavior to be consistent with Bipolar Disorder (BD). So I'll give you information about BD to help you on that journey in clarifying if you really think BD is involved. And before that, I'll focus on an immediate framework for working on dealing with your anger outbursts. I also want to say that I will paste for you a technique for getting some quick relief when you are feeling anxiety or overwhelm and anger. The technique is not a cure, but it will help you in moments of difficulties, depression and anxiety, and you can use it over and over again. Because your moods when they swing from one pole to the other will produce a lot of anxiety. And it will help with anger as well.


That you recognize that this is not a good situation and that you need to do something about it is so very encouraging. Good for you. Use this recognition within yourself that you need to change the situation to motivate you to keep going in this direction.

The source of anger is the need to be in control. Anger is when things occur counter to how you want them to have occurred. They did not go as you wanted them to go, thought they should go, needed them to go, or demanded they go. They turned out some other way and you couldn't control things.

A classic example is road rage: someone pulls right in front of you in traffic and you have to put on the brakes suddenly. That jerk! How dare he! I've had patients in my office who have followed the person who did this to them all the way to that person's destination and gotten into a fight with him and wound up spending the night in jail. Seriously. What was the problem?

On the surface it looks like disrespect: they became angry because that person showed them no respect. But disrespect is just the result. It is a lack of control. Another example will show this:

Her kid spills the milk on the floor. She's upset. Why does he always do this when she's late! What's wrong with him? Why can't he be careful?

What's the same in both these examples? They are events you can't control. You can't control what someone else does. You can't control the guy in the car pulling ahead of you and you can't control a kid's clumsiness.

So the angry person says, he did that to me so I got mad. As if it was automatic. But it's not automatic. You CAN control how you react. Here's what I mean.

When you're cut off in traffic, when your kid spills the milk, the first reaction is to have heightened anxiety, to get startled and to be angry. Everyone feels this. But the reaction to that initial feeling of anger and anxiety is under our control. It's not automatic. There's no reflex that makes us scream at our kid. There's no reflex that makes us scream at the guy who cut us off. That's under our control.

Therefore, the goal of all anger management is to learn to make a pause between that initial feeling of anger at the event and the acting out of anger. The pause between the feeling and the reaction. That's the key. Again, with controlling your anger, the principles above are the principles of all anger management: make peace with not being in control of what happens in the world. And second, pause between the feeling and the reaction to CHOOSE your behavior. This is the basis of all anger management classes.

You might consider going to anger management classes. You can Google them in your area. Remember that most classes are going to be filled with people who are court mandated to be there for doing something angry that got them in trouble. So they may not want to be there. Don't be influenced by them. But you may choose instead to focus on your anger as part of the BD and to seek professional help for the BD.


For a real diagnosis, you need to get a proper psychiatric evaluation for BD. Let's look at the Diagnostic Criteria for BD. Then I'll continue.


Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes

  • A long period of feeling "high," or an overly happy or outgoing mood
  • Extremely irritable mood, agitation, feeling "jumpy" or "wired."

Behavioral Changes

  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing goal-directed activities, such as taking on new projects
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and taking part in a lot of pleasurable,
    high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Mood Changes

  • A long period of feeling worried or empty
  • Loss of interest in activities once enjoyed, including sex.

Behavioral Changes

  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

What do you think? Does this sound like it describes your situation? The idea is that the mood swings back and forth unpredictably, with some quicker than others. Here's a quote from the DSM-IV: "Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed."

Let me end off with this because it may be of use to you:


In my practice, I use the resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep up with. The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.


The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr

Now here's a YouTube search I've put together on the WRAP program. I want you to look at the videos and see what you think:

http://www.youtube.com/results?search_query=copeland+wrap&aq=f

The video with Mary Ellen is a bit strong but worthwhile. Okay, so you see I hope my point here:

I believe from my experience that if you are diagnosed with BD, it is SO important for you to not just take the meds and expect them to do everything. YOU have to take charge of managing your BD. And having a strategy like the WRAP program is a coherent way to do this. So that you can regulate your moods as they cycle. Here's what I mean:

Most people are like cars with automatic transmission. They tool around the day going from a little sad and then they feel a little glad and if they get to too high a gear, the emotional transmission just automatically sends them back to a lower gear and if the low gets too low, the transmission clicks into a higher gear. Rarely are they thinking about it. They are usually within their normal range.

You with BD are like a car with a manual transmission. You start having a racing mood and unless you downshift manually, you're going to be out of control soon until you can't maintain that and you cycle down and then get too far down, etc. So you have to continually use the clutch and manually adjust the emotional gear.

That's what a program like the WRAP plan is about. It gives you the tools to notice what's going on and to make adjustments. So that is why I'm stressing it for you. So along with medications (psychiatrist) you need to find a therapist to work on a mood management program.

If you don’t have a good referral source, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (because they seem smart and not so easily manipulatable!) look at the listing and see if they list BD as one of the disorders they work with.

http://therapists.psychologytoday.com/rms/

Good Therapy is a non profit directory. Same idea as the one above:

http://www.goodtherapy.org/advanced-search.html

I wish you the very best and be hopeful and confident for the future!

Now, I want to give you a tool to use for when the irritation is overwhelming or there is anxiety. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety (the poles of BD), when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks and for feeling as though you are in a dark hole of depression as well.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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