In a recent post on my blog: A Gunmen Storms a School in Georgia: is Bipolar Disorder the cause?

I neglected to check which version of the story I was uploading. What ended up on the post was my rough draft. This caused some readers to send me very angry comments which I can completely understand. Also missing were my research sources. (I have included some links below)

 

This is a very controversial topic, but having loss one of my dearest friends recently, (she spent her life battling mental illness), my desire is to shed some light on a few of these issues.  Most people who are not directly affected by mental illness would rather not talk about it. The statement, “they’re just crazy”, is the way a lot of people dismiss the subject and the human beings who, on a day to day basis, are dealing with these issues.

 

It is only when something tragic happens, and the media focuses on the people involved, that we have a chance to make people more aware of the mental health challenges we face as a nation. All of us are, or will be, affected if we do not pay greater attention to the growing evidence that we seem to be failing to identify those people who are at risk of hurting themselves or others. The Sandy Hook school shooting, the Colorado Movie Shootings, Virginia Tech Shooting and Fort Hood Shooting, are a few examples that, even if you think this issue does not affect you, prove you could be tragically wrong.

 

It is true that most people suffering from mental illness are not dangerous in any way.

Most suffer in silence and you would never know they are not like everyone else.  I do not wish to stigmatize people who suffer from mental illness.  I wish to share my experiences with some of the most wonderful, kind, talented and loving souls that I have ever known, in or out of my professional life.

 

I have known people from the time I was 10 years old, who were suffering from bipolar disorder, these dear friends have helped me to understand some of the challenges that they face, and how we can all be more aware and understanding. But beyond that, we can make a difference by asking that our health care providers, prison rehabilitation programs, and community health clinics make more mental health resources available.

Here are two articles that may shed more light on this subject;

Violence in Bipolar Disorder

November 17, 2010 | Bipolar DisorderTrauma And Violence

By Allison M. R. Lee, MD and Igor I. Galynker, MD, PhD

Linked Articles

Working With Traumatized Patients

Biological Consequences and Transgenerational Impact of Violence and Abuse

Secondary Trauma Issues for Psychiatrists

Disaster Psychiatry: What Psychiatrists Need to Know

Violence in Bipolar Disorder

The relationship between mental illness and violence is controversial. On the one hand, there is considerable unfounded stigma and discrimination toward the mentally ill based on the popular notion that psychiatric patients are dangerous people. On the other hand, there is a legitimate need for psychiatrists to identify and manage what risk of violence does exist in their patients. Research that examines how and why violence occurs in the mentally ill is necessary for psychiatrists to determine as accurately as possible which patients are prone to violence and to manage their care accordingly.

Traumatic experiences in childhood have been linked to the potential for violence in adults and to vulnerability to adult psychiatric disorders.1-5 Bipolar disorder has been linked to both traumatic childhood experience and to the potential for violence. This review aims to explain the association between bipolar disorder, trauma, and violence, and to provide guidance for assessing violence potential in bipolar patients.

Childhood trauma in bipolar disorder

Trauma is defined by DSM-IV-TR as:

• Experiencing, witnessing, or confronting an event that involves “actual or threatened death or serious injury, or a threat to the bodily integrity of the self or others”

• An emotional response to the event that involves “intense fear, helplessness, or horror”

A history of childhood traumatic experience has been associated with increased vulnerability to multiple mental disorders, including mood disorders and personality disorders.3-5 Studies have found that a high proportion (around 50%) of patients with bipolar disorder endorse histories of childhood trauma, with a high incidence of emotional abuse.6-9

In a group of 100 individuals with bipolar disorder, Garno and colleagues8 found that 37% had been emotionally abused, 24% had been physically abused, 21% had been sexually abused, 24% had been victims of emotional neglect, and 12% had been victims of physical neglect. A third of these patients had experienced 2 or more forms of trauma. A history of 2 or more types of trauma has been associated with a 3-fold increase in the risk for bipolar disorder.9 A history of trauma in bipolar disorder has also been associated with a worse clinical course—including earlier onset of bipolar disorder, faster cycling, and increased rates of suicide. Trauma history has further been associated with more comorbidity in bipolar disorder, including anxiety disorders, personality disorders, and substance use disorders.6-8

There are several pathways by which childhood trauma could lead to the development of bipolar disorder9:

• Affective disturbances in relationships between parents and their children directly predispose the children to affective disturbances in adulthood

• Children in whom bipolar disorder later develops are prone to more behavioral disturbances in childhood (a prodrome or early onset of bipolar disorder), which could disrupt relationships with parents and lead to dysfunctional parenting

• Children of affectively ill parents could be affected by genetic transmission of affective illness predisposition as well as by parental psychopathology, which increases the likelihood of childhood trauma

Any one or a combination of these pathways could be operational in the development of bipolar disorder in individuals who have experienced childhood trauma. Thus, either the trauma itself or the factors that lead to trauma—or both—could affect the development and course of bipolar disorder.

The link between trauma and violence in bipolar disorder

Childhood trauma history has been found to correlate with increased aggression in adults with and without affective disorders.1,2,10 In addition, there is an overlap between the neurochemical changes found in adults with histories of traumatic stress and those in adults with increased impulsive aggression, in particular, increased functioning of both the catecholamine system and the hypo-thalamic-pituitary-adrenal axis.11

– See more at: http://www.psychiatrictimes.com/bipolar-disorder/violence-bipolar-disorder#sthash.nCUjUhW4.dpuf

 

 

 

Is violent behavior a symptom of bipolar disorder?

Julie A. FastPsychology, answered

Sometimes.

Violence and rage are unfortunate symptoms of bipolar disorder. Many people who commit violent and rage filled acts are often punished or incarcerated without getting a much needed bipolar diagnosis. The behavior is often seen as an anger management problem and proper treatment is not initiated.

During a mood swing, a person can think, say and do things they would never even contemplate when not ill. And though it’s easy to assume that violent and rage symptoms only happen to men, this is simply not true. Women experience these symptoms as well. I have had mood swings where I have chased down a car when a driver flipped me off and almost had a fight with a woman on a bicycle who went through a red light in front of me. I held myself back because I realized that bipolar was thinking for me. But I really wanted to make someone hurt.

Violence and Rage Symptoms

  • Want to hurt someone- fighting in public
  • Screaming
  • Have violent thoughts that are scary and not the norm
  • Road rage (so common!)
  • Kick and punch things really hard to the point of breaking a bone
  • Yell and hit loved ones
  • Unable to control feelings or behavior
  • Out of proportion reactions to normal events
  • Unable to see consequences of actions
  • Lose contact with reality

Please, please remember: The above actions happen when the person is in a mood swing- it’s usually a dysphoric (agitated, upset and negative ) manic episode- often with psychosis. These are not in any way their normal behaviors, nor are they a part of a person’s personality.

When the mood swing ends, the person is often mortified, ashamed and truly repentant regarding what happened. I’ve heard so many stories where gentle and kind people do something violent while manic and have no idea what happened. A friend of mine beat up a man on a train platform in Japan. He just did it out of nowhere. The mania was that strong.

People who do something violent and very out of character when ill need a lot of compassion.

How Can this be Prevented?

Violent mania often starts with irritation- if a person knows their irritation signs and immediately gets help with medications and a management plan, these destructive mood swings can be prevented. This is good news! Even if someone is refusing treatment now, I’ve seen plenty of people change and accept help eventually. 

No one wants to be in constant fights. Ultimately, managing bipolar is better than waking up in jail.

More Answers from Julie A. Fast 

Loving someone with Bipolar Disorder by Julie A. Fast, John D. Preston Ph.D

http://www.sharecare.com/user/julie-a-fast/answers

 

http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_no1/dnb_vol25_no1_24.pdf

http://archpsyc.jamanetwork.com/article.aspx?articleid=210872

 

 

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