Physical aggression rarely occurs as part of bipolar disorder. It is more often connected with drug or alcohol problems, personality disorders and only very occasionally with psychosis.1 Although most people with bipolar disorder do not become physically aggressive, occasionally, if a person is manic or in a mixed episode and very angry, they may act impulsively on this emotion.2 If you experience fear when the person is acutely ill, very angry and does not have much control over their emotions, don’t deny the possibility of danger. If physical aggression has occurred previously, be especially alert to the possibility of it occurring again.
Never compromise your own or others’ safety due to concerns about hurting the person’s feelings, as later the person might feel very relieved that they were prevented from hurting their loved ones. Make sure you are safe first and contact the emergency services (see dealing with a bipolar crisis).
Ways to protect yourself if the person has become aggressive before
- Learn to recognize the warning signs of impending aggression.
- Take even casual threats of violence seriously.
- Work out in advance how to ensure your safety and that of others (e.g. have locks on rooms, leave the house and get help when warning signs of aggression appear).
- Remove objects that could be used as weapons if the person is likely to become aggressive.
For more about what to do if aggression has occurred, see dealing with negative consequences of risky behaviour.
- Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence’s in a total birth cohort: results from the Dunedin study. Archives of General psychiatry 2000; 57:979-86.
- Jamison K R. An Unquiet Mind: A memoir of moods and madness 2005; Vintage Books: New York.