Caging the Lion: Identifying and Managing Bipolar Triggers
While episodes of bipolar disorder are often cyclical, for many people with bipolar disorder, episodes are often brought on by what are called “triggers.” A trigger is something that often precedes an episode, and managing triggers is one an important part of managing bipolar disorder. However, in order to manage triggers, it is necessary to identify them.
Given the apparently random nature of bipolar disorder, how do we identify them? Fortunately, there are several techniques that can be used to identify our triggers and reduce their presence or at least their influence on our bipolar disorder. In this article, I will look at some ways of identifying triggers and how to handle them once discovered.
Keeping Track of Our MoodsTriggers can be identified by looking at some of the changes or events that repeatedly occur in our lives right before we have episodes. However, unless we identify when our episodes are actually happening, we won’t be able to identify them. This is one of the reasons that tracking moods is so helpful in identifying our triggers.
The way that I have discovered to help with this is the use of a mood chart. There is a very good one at this link (the chart is the second page of the .pdf). It’s a simple way of keeping track of what it is that we feel on a given day.
I have found that it is helpful to track four symptoms especially: high moods, low moods, irritability and anxiety. One of the reasons for tracking these four rather than simply high and low moods is that episodes can manifest themselves in different ways, even in the same person. So, I may have a hypomanic episode that involves hypomania, but then have another one that is primarily irritable. Depressive episodes may include anxiety.
Sleep schedules are especially important, as there seems to be a large correlation between mood and sleep.
Once moods are tracked, I can start to look for the triggers.
Keeping a Journal
It can be helpful when tracking triggers to keep a journal of what has happened in our lives. The journal doesn’t need to be kept every day in order to be useful. However, when a new mood episode starts to occur, it is helpful to go over the few days before the episode.
There are two things that are useful to keep track of. One is the events of the days. What exactly did I do over those days? Was I teaching, going out of town, visiting someone, having a birthday, have an argument with my friend? Just writing down some of the basic events can help me find things that might trigger an episode.
The other thing that’s useful to keep track of is what I was thinking during those days. Was I especially worried about my career? Did something someone said upset me somehow? At the end of the day, our triggers are not caused by events but how we interpret events. When writing down an event, I find it’s useful to write down what I thought at the time.
Common TriggersThere are a few triggers that are common, and are useful to look out for:
- Sleep patterns
- Alcohol or other drugs (including caffeine and nicotine)
- Season Changes
Not everyone has the same triggers. For myself, I find that there is no seasonal pattern, but that stress can be a real problem.
Of these, stress is the most problematic to keep track of, since it is the only one that isn’t really measurable. What to look for here is what kind of event or thought leads to the stress that triggers the episode. Often it is a relationship with a particular person, work or school events or even something as specific as leaving the city (that one’s mine).
Avoiding and Managing Triggers
Some triggers can be avoided, especially sleep patterns and alcohol or other drugs. Others are impossible to avoid, like seasonal changes. Others are in the middle, like stress. So, there are different strategies one can take with respect to each.
If it is an avoidable trigger, like sleep patterns, alcohol or something stressful that can be withdrawn from at minimal cost, often I find the best strategy is to avoid that trigger. So, if sleep patterns are the issue, it may simply be best to go to bed at a certain time.
Other triggers can’t be avoided or we might not want to do so. Seasons won’t change. Also, there are a lot of things that we might not want to avoid, like a particular parent.
In these cases, even though the trigger can’t be reasonably avoided, once it identified, it can be brought up in therapy as a source of episodes to be dealt with. Sometimes, it is a matter of being especially cautious during a given season (so, for instance, I may need to avoid stress in February). At other times, it is a matter of developing insight about a relationship. What to do here is a little outside of the scope of this article, but at least the identification of triggers can give something on which to focus therapy.
Putting It All Together
The identification of triggers can be very helpful in managing my bipolar disorder and in giving a focus and direction to therapy. Identifying them is a matter of looking for patterns, which are often unique to each individual. At that point, I can look for ways of avoiding or managing those triggers, so that they do not have such a disruptive effect on my life.
How do you convince others being bipolar is real and the treatments are not like taking illicit drugs?Also,how does one explain to a certain person they display symptoms of being bipolar?
I think it would really depend on the person. If you can figure out what it is about the possibility of being bipolar that is worrying someone, it is a lot easier to start a conversation.
Wonderful insight and helpful (as usual), Dr. Danial. In regards to seasonal triggers, I experience depression almost every time the seasons change.
This winter in Vancouver, BC, it was particularly rainy, chilly and dark. Walking from the front door of our home to my car required energy I did not have.
I thoroughly researched “light therapy” (at least it gave me something to do with all my time!) and spoke with my psychiatrist, who was very supportive. I purchased a “goLITE BLU” energy light made by Philips from Costco for approximately $179.00. Within three days, it is my belief that the natural power of the UV-free blue light was the primary reason my energy increased, my craving for unhealthy carbs. decreased and my sleep became more stable (I was tired at the end of the day because I was going out!).
If anyone is interested, I would recommend consulting with your Dr. first, as I did end up feeling a bit Too good…The website is:
Hopefully, anyone dealing with seasonal mood changes or triggers will find this a beneficial tool.
Thank you for the discussion of light therapy. In retrospect, I should have included something about it, since in at least one sense, one can control the seasons by using light therapy. I think you’ve given me a good idea for a future post :).
This article is very practical. This is a major part of the therapy I am trying to apply to my life right now. I understand BP is very hard to deal with, and even more severe for some, but we have to understand that TRIGGERS are important to realize, and that seeing what does affect us is a powerful tool to help strengthen us. I appreciate your efforts, again I say it, but being as humble as you are, it is good to know you have our interest at heart in this BP journey through life. Thanks! Steven
You’re welcome, Steven. It’s something I hadn’t been paying sufficient attention to recently, and it was good to revisit some of these methods.
I have found that with the HELP of my therapist (we are taking a cognitive behavioural approach) has really gotten me to analyze episodes and identify the triggers. It is a very “cost efficient” method to manage. Also, my therapist gave me an acronym to help me through emotional events that trigger my BP. COPING…Control emotions, Orient facts, Patterns of behaviour exhibited,Investigate possible solutions, Negotiate solutions, Give time for empowerment.
Thanks, Michael. That’s a great mnemonic :).
A trigger for me is noise. Too much of it coming from all directions. I avoid sports bars with music blaring, a dozen television sets on different channels and people who have to scream to make themselves heard.
That’s interesting, Lillian. I find noise really problematic, too, though I find I already need to be a little bit symptomatic before it is a problem.