Mood Swings

MOOD SWINGS – Reinette Steyn [Clinical Psychologist]

Assessing the stability of one’s emotional experiences and behaviours is a key diagnostic element.

Many people talk about having mood swings – and, really, it is NOT just due to pregnancy or PMS!

Mood swings can vary from serious depth of depression/ aggression/ helplessness/ jealousy/anxiety/ ecstatic, to light variations of feeling more less ‘up-beat’ or ‘down’.   We all experience mood swings, which can be related to normal chemical changes in our bodies, for instance, due to diet, sleep or lack of it, vigorous exercise, tiredness, excitement, etc.  Or they can be caused by events in our life that we might interpret negatively or positively, or due to inherent neurological, hormonal or chemical problems.

Psychiatric classification:

People who have suffered from some kind of trauma usually experience relative severe mood changes and may display emotional behaviours that are completely foreign to their character.  Thus, it is important first to check for the presence of acute traumatic stress or posttraumatic stress as a possible cause of dysfunctional levels of emotions (or ‘affect’).  The valid treatment would be to debrief the trauma, after which emotional experience and behaviours should normalise.

Regular patterns of severe swings in mood could also indicate either a Personality Disorder or a serious Mood Disorder, such as Bipolar Disorder.  Unfortunately, there may be quite a bit of confusion between various of these categories, resulting sometimes in years of inappropriate treatment.  Such diagnoses should thus preferably be made by experienced clinical diagnosticians such as psychiatrists or clinical psychologists.  The information that follows is really very simplified and not to be substituted for clinical consultation.

The most common type of Bipolar Disorder, Bipolar I Disorder (BID), is generally thought to be genetic in origin and may require life-long management, including daily medication, psychotherapy to improve life skills or hospitalisations to manage severe levels of depression or mania (mania is extreme high mood, usually with disregard of any danger or negative consequences).  Bipolar II Disorder (BIID) may have the same severe levels of depression, but without the extreme mania: instead, the person may feel ‘hypomania’, i.e. ‘bubbly’, hyper-optimistic, excitable, and be very chatty. 

In a Bipolar Disorder the mood swings are from, literally, the ‘poles’ of extremely high ‘over-happiness’ to extremely low ‘depression’.  Usually such periods of depression or mania would last up to several months, but sometimes people have ‘rapid cycling’ severe mood swings instead.  The depression or mania experienced is really extreme, and may be associated with psychotic features such as hallucinations (e.g. hearing voices that tell you that you are terrible and you must kill yourself) or delusions – in mania, for instance, there are frequently delusions of grandeur or of omnipotence (so that people think they can fly or walk on water); in depression such a delusion may be that one is completely corrupt and should thus not be tolerated on earth. 

There is often also substance abuse and addiction associated with Bipolar Disorders – maybe to try to stabilise the negative moods, and people suffering from Bipolar Disorder may also have other kind of psychiatric disorders, such as Narcissistic Personality Disorder (see the articles ‘Difficult People’ and ‘Toxic People’ on the Selfgrow web site).  All of these so-called ‘comorbid’ disorders could further complicate the emotional experience as well as the management of the sufferer, for instance, when alcohol abuse interferes with the medicine, or when personality disorder traits make the sufferer non-compliant with medicine or psychotherapeutic treatment.  The treatment of such severe levels of emotional dysregulation is thus generally long-term and includes very regular psychotherapy sessions. 

The personality disorders are generally caused by childhood experiences.  These can include lack of competent parenting or, often, severe or repeated trauma of some kind.  Frequent mood swings are typical of Borderline Personality Disorder (BPD) and should not be confused with those of BID or BIID.  Although some of the disruption of BPD may need to be managed with antidepressants or very low level anti-psychotic medication, intensive and long term psychotherapy is necessary.  Such therapy should include de-briefing of traumatic incidents that created the feelings of uncontained terror / anxiety / helplessness etc, that resulted in the formation of the personality disorder traits, as well as continual reality-connecting and life skill like conflict management.  BPD is often, but not always, associated with sexual in childhood, and frequently, but not always, includes eating disorders like Bulimia Nervosa. 

It is useful to know the common symptoms (and diagnostic criteria) for Traumatic Stress Disorder or Posttraumatic Stress Disorder (TSD or PTSD).  Healthexpress web site and Selfgrow web site). 

People suffering from TSD or PTSD will generally report most or all of the following symptoms:

-          Avoidance of the triggers, such as the places, smells, sounds, people, activities etc, that remind one of the traumatic incident/s; may include loss of memory (amnesia) of the event or elements associated with it, detachment from other people of events, inability to experience positive feelings like love, and foreboding (feeling that one would not be able to have a positive future)

AND/OR

-          Flashbacks to moments or the whole of the incident/s – these may be smells, tastes, physical sensations, sounds and/or sights that were experienced during the traumatic incident/s, that are felt in the present as if the person were back in the past; may also be in the form of recurrent and distressing dreams.

PLUS THREE OR MORE OF THE FOLLOWING

-          Hyperreactivity – having reactions far greater than the present stimuli would warrant; may include panic attacks

-          Hypersensitivity – reacting very quickly as if one has been traumatised or hurt again; may include intense fear, helplessness, or horror not appropriate to present stimuli, inability to sleep, exaggerated responses to startling incidents, or tearfulness / mood swings

-          Hypervigilance – always having to be very alert and on the look-out for a next ‘attack’ from somewhere or someone unrelated to the original trauma

-          Irritability – which can vary from mild to moderate and chronic to sudden rage attacks

Apart from the above psychiatric causes of various kinds or levels of mood swings, there are also several possible organic causes, of which I’ll mention only a few: Brain damage of some kind, such as physical trauma to the head, stroke, tumours, toxins (e.g. from abused or even prescribed substances), some STD’s, or degenerative neurological disorders, can cause moderate to severe mood swings and also, conversely, ‘numbing’ of emotional experience (or ‘flattened affect’).  Similarly, diseases that could influence the chemical or hormonal balance of the brain could create emotional disruption, for instance, kidney failure.  It is therefore absolutely essential to consult properly trained, licenced, and clinically experienced specialists whenever mood swings persist or suddenly appear.

In our modern western society, however, many people feel that they are not entitled to experience upsetting emotions related to, for instance, loss and grief, and unfortunately, the suppression of such natural and necessary emotional distress can also lead to later disproportionate or explosive emotional expression.  We are not robots, and we do need to feel.

So, enjoy your feelings and survive them; if you need help, consult a relevant practitioner.  And, whether your feelings are ‘normal’ or much more distressing, using hand-writing to express your feeling and to describe the preferred situations and feelings you would like to enjoy, will always be of great help.

Reinette Steyn

(Clinical Psychologist)

www.selfgrow.co.za

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Clients may book psychotherapy or life coaching sessions in Milnerton, Cape Town by phoning Reinette at 021 555-4248.

People who live far from Cape Town and who wish to book Skype consultations with Reinette, may send an email to bookings@selfgrow.co.za ; please use ‘Skype consultation’ as your subject heading.