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 Marcia Purse

What Is Dysphoric Mania?

By August 29, 2012

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James HolmesTwo weeks before he killed 12 people and injured 58 during a midnight shooting rampage in a Colorado movie theater, James Holmes texted a classmate asking if she had heard of "dysphoric mania." When she replied asking if it was something treatable, he replied, "It was," and said she should stay away from him "because I am bad news."

The New York Times article that broke this story says, "The psychiatric condition [dysphoric mania], a form of bipolar disorder, combines the frenetic energy of mania with the agitation, dark thoughts and in some cases paranoid delusions of major depression."

This description is vivid enough to give readers a glimpse of what might be going on in the mind of a person such as Holmes (we have to be careful about making psychiatric judgments based entirely on the observations of others). It's a bit misleading, though. For one thing, agitation and paranoia can be symptoms of mania as well as depression.

Also, dysphoric mania isn't a "form" of bipolar disorder. Rather, it's a specific type of episode that has mixed features - one where mania symptoms are combined with depression symptoms like the social withdrawal described in the Times article. (See the last paragraph in part 1 of Bipolar Depression Symptoms, Social Withdrawal.)

One problem in understanding all this is the elusive definition of the term "dysphoria." Dictionaries disagree, using terms from depression and discontent to anguish and agitation to simply "sadness." At bottom, the definition changes depending on the context, and in this case, the dysphoria in "dysphoric mania" isn't the same as the dysphoria in "dysphoric depression."

I've never found any official psychiatric definition of "dysphoric mania." The description in the Merck Manual, a highly respected medical textbook, doesn't give any sense of how devastating the condition can be.

So I've put together a lot of information about dysphoria for you. These resources show how that single term's meaning can change depending on how it's being used.

We all want to understand why when something as terrible as the "Dark Knight" shootings occurs. We're a long way from understanding James Holmes' state of mind at present. I am pleased to see that the media seems to be handling the "dysphoric mania" subject responsibly, emphasizing the severe nature of this state.

Photo: Getty Images News

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August 29, 2012 at 7:57 pm
(1) alex says:

i have bipolar disorder and i’m sure you “might” be able to tell what’s going on in my mind. But i think it’s pretty messed up to say that he did this because of his bipolar disorder. There’s over 1 million people with bipolar disorder that haven’t shot up a whole movie theather, so id like to attribute this event on the fact that is MOST LIKELY psychotic rather than bipolar…thank you.

August 29, 2012 at 8:08 pm
(2) paul hill says:

.What I want to know was what Holmes was eating and drinking. Combine Coca Cola with the big doses of paracetamol he was taking causing liver damage and you’ve got a lotta moodswing. Swig after swig after swig. Blood sugar very high equals manic high. Come the crash, panic attacks, terror of impending death, going berserk etc.followed by suicidal depression at the inevitable prospect of going completely insane, which of course he did go, compliments of psychiatry. The worse the liver pathology the greater the Coke craving and the shorter the cycle.

Looking at my stuff on the blood sugar swing, the peak is euphoric (manic?) and the trough is associated with tiredness and depression, but with very poor liver storage of glycogen there is the release of noradrenalin and panic attack accompanying the depression. Dysphoric mania? Fast cycling schizophrenia, with BIG highs (mania) and big lows (depression with panic). Coca Cola contains a lot of sugar, caffeine and threobromine, a caffeine like substance and is thus extremely addictive as well as the combination causing a very fast rise in blood sugar to a high peak followed by a rapid fall to a deep low (reactive hypoglycemia). Single sugars (monosaccharides) enter the blood stream faster than polysaccharides (sucrose) which first have to be split by enzymes in the duodenum.

However, with Coke this limiting factor is bypassed. To hydrolyze the double sugar sucrose to single sugars fructose:glucose which are absorbed more rapidly into the bloodstream requires acid and heat. Coke contains a lot of phosphoric acid and must be boiled in the cooking process. The PERFECT combination for huge swings in blood sugar. Coke, a deadly poison. The juice of schizophrenia.

For the full picture on Holmes, schizophrenia etc. my blog.


August 30, 2012 at 12:08 am
(3) micky says:

I agree with Alex. My sister has lived with bipolar disorder her whole life. She is intelligent, has had the same job for the last 20 years and manages the disorder well. As soon as the incident hit the news, she predicted that this monster would say he was bipolar. Unfortunately she has had to deal with the prejudices of society because of monsters like Holmes claiming to be bipolar. Alex is right, there are many, many people who have bipolar disorder and they do not commit acts of atrocity like Holmes.

August 30, 2012 at 10:21 am
(4) Angel says:

@Alex- I have psychotic ideations and I am bipolar 1 . Psychotic is also very bipolar, and yes, why not blame it on bipolar? Bipolar is no pick nic and Bipolar 1 w/ psychotic ideations often ends with murder suicide….there is your stigma which everyone is trying to hide…

August 30, 2012 at 12:32 pm
(5) Dr. Jay Carter says:

After a lifetime of experiencing bipolar disorder with members of my family and over 30 years of treating bipolar disorder in my practice, I have come to realize how DESPERATE a person can become with the condition that we can only vaguely label as “dysphoric”. It’s bad enough that mania, agitation, sleep deprivation, depression, fatigue, and internal rage can exist one by one. But when they exist together, all at once, the only word I can think of is DESPERATION in the highest degree. I remember being a narcissistic teenager and watching my mother go through this. My brother and I were used to it and would just pass off her comments, knowing she would “get over it”. She did get over it, but when I think back to the utter anguish she must have suffered, it makes me realize how heroic she truly was to overcome these periods of time. She had faith and purpose, which was the only thing that got her through. She was undiagnosed and unmedicated. God bless her.

August 31, 2012 at 12:14 am
(6) Jim says:

He should’ve just drank tons of beer.

September 4, 2012 at 12:20 pm
(7) Marion says:

The article says that James Holmes asked if his friend had heard of dysphoric mania. Which sounds to me like he self diagnosed the symptoms, it doesnt say he was diagnosed with this by a professional. So, I think I will wait to hear what the docs say on this one. Either way it is sad situation.

September 4, 2012 at 1:20 pm
(8) Marcia Purse / Bipolar Disorder Guide says:

Yes, there’s nothing yet to say what’s going on with Holmes. I hope I made that clear.

September 4, 2012 at 4:15 pm
(9) Sheldon Cooper says:

When a BP person senselessly kills someone, I can see why the average norm may be more fearful of those have BP.

A lady on a support site posted that a few months ago she tried to commit suicide by driving into oncoming traffic at 50 mph. Neither she nor the other driver were hurt.

She was posting because she had just gone to pick up her new car. It was her first time driving since the accident and on her way home she had the urge, three times, to drive into oncoming traffic.

She was proud and happy that she resisted the urge to do so.
She became very angry when we were a lot less thrilled.

I don’t feel safe knowing that there’s some BP people out there who are tempted to drive head on into my car at a high rate of speed. Why should a ‘norm’?
2 others on that support group have expressed the same desire.
And where I live, a young woman with BP tried to commit suicide by purposely slamming into a car that was sitting at a red light.
She lived, but she killed the three people in the other car.

If you don’t know everything there is to know about BP and you hear about this, is it really all that surprising to form a negative opinion of what a person with BP is like?

Obviously, education is the key.

Just as a norm’s view of BP may be skewed in an unfair way, I think we as people who have BP are expecting too much when it comes to wanting to be viewed ‘just like everyone else’.

None of us, no matter where we are when it comes to our mental health, should take an ‘us’ and ‘them’ attitude.
It hampers the progress that’s being made in educating and fostering a better understanding of Bipolar Disorder.

September 4, 2012 at 9:52 pm
(10) Bipolar Person says:

I think that when the world sees a tragedy such as this, they try and pin the wrongdoer with being Bipolar. The guy was working on a neuroscience degree. If he thought he had Bipolar or any other mental illness, working on that particular degree, he should have known to seek professional help before things got any type of out of control. It is just a shame that Bipolar is always the excuse for someone who does something violent. I also agree with the person that said that there are millions of people with Bipolar disorder that, even when they are manic or depressed, don’t go shooting up movie theaters. I have lived with Bipolar disorder most all of my life, and I am 47 years old, and I have never heard or read about any other Bipolar patient wanting to commit such horrid acts of violence. It is the stigma that puts the label of Bipolar on these people. Most of the general public are just simply uneducated when it comes to mental illness.

September 5, 2012 at 12:31 am
(11) Dr Billy Levin says:

Looking at an article on BP, half of the comments suggest ADHD. Which is the condition and which is the comorbid? Difficult and confusing. Either way neither tends to mass murder. There has to be something else. This devastating situaton has been described before with out final opinion and clarity. Unfortunately we still have a lot to learn about our human brain and the patient must be willig and able to be treated. .

September 5, 2012 at 7:33 am
(12) her in 3rd person says:

everyone and their next door neighbor who wants to screw everything that breathes, spend their rent money, flash a passing stranger, and threaten people can not blame bipolar. What’s next? The air is causing everyone to have asthma or lasagna caused my diabetes. get treatment, get help, but don’t mess around and do something you want to and then peg a bipolar tag on it. everyone has a choice. and schizophrenia is not bipolar. so…no one is saying mental illness doesn’t exist, but everyone and their mother is not heading for a meltdown…nor should be sensitive regarding stigma just cause person b wants to zap out and feign going bonkers for a slap on the wrist. meh.

September 7, 2012 at 12:38 pm
(13) Unknown says:

I am a bit surprised by some of the reactions written by bipolar people who immediately say JH cannot be bipolar. First of all, it is unknown whether JH is bipolar or not, apparently there is no diagnosis yet. Second, that one bipolar patient commits terrible violence does not mean other bipolar patients will do the same. It could be possible that he indeed has this disorder and that the symptoms provoked his deeds. If this is true, people have to realize that inductive reasoning towards the whole BP population is the last thing they should do, as is the problem with any other stereotype. A small percentage never should be generalized to a whole population. Realizing this makes a whole lot more sense than just denying possible effects of dysphoric mania.

September 8, 2012 at 5:09 am
(14) LJ says:

This isn’t a detailed enough article on Holmes, its just talking about the diagnoses to make sure no one misunderstands it… Not Holmes. From the details I’ve read about his case is that he was seeing a psychiatrists, and that leads me to speculate that she diagnosed him. I also think that mental illness is different for everyone. I can only imagine the rage he felt when killing people in the theater and how witnesses talked about hearing him clearly yell “Stand up” and then grabbing a man to make him stand up and then shooting him. He was one angry enraged person who then confessed to the police that his apartment was booby trapped. I also read that what witnesses had to say about his behavior in school and his interviews with professors to apply to colleges. All of the symptoms were surfacing at hind site. But, no one was skilled to diagnose him because students can’t diagnose students. Teachers or professors not skilled in psychiatry were not qualified to diagnose him either. Only his psychiatrist was. So, with that said, he was already socially withdrawing and unable to communicate with others while attending college. He was slipping right before people’s eyes and now the students wish they could have tried harder to pull him out of his shy lonely world where he lost his smile, his humor and could only communicate in one word sentences. He just simply deteriorated and at the same time could still be capable of making complex plans to carry out a shooting spree. From my understanding of this form of mental illness… You can be just functional enough and yet make elaborate plans to harm others.

September 9, 2012 at 11:40 am
(15) basil says:

Sheldon Cooper quote “She was posting because she had just gone to pick up her new car. It was her first time driving since the accident and on her way home she had the urge, three times, to drive into oncoming traffic.”
I have urges like that but I would never act on them. It’s kind of strange the way Holmes’ eyes look. It almost as if he is deliberately trying to make himself look sick. I have been in the hospital a couple of times and I don’t think I have ever encountered that look. Along with that, his hair makes him look even sicker. It’s hard to judge whether or not he is BP until the information comes out in a trial. I’m really hoping he is not BP as we get a lot of bad publicity when it comes to something like this.

October 29, 2012 at 8:04 pm
(16) Anon says:


Has anyone here ever heard of psychopathy?

Highly likely that it applies in this case… and it is known that psychopaths like to put on ‘an act’ of having other mental health conditions.

November 1, 2012 at 2:50 pm
(17) depression with anxiety treatment says:

Have you ever thought about adding a little bit more than just your articles?

I mean, what you say is valuable and all. However just imagine if
you added some great photos or video clips to give your posts more, “pop”!
Your content is excellent but with pics and videos, this blog could certainly be one of the greatest in its field.
Awesome blog!

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January 7, 2013 at 5:43 pm
(19) Chelada Charlie says:

Drinking tons of beer is always an option if you don’t want to go the pharmaceutical route.

March 7, 2013 at 7:04 pm
(20) Pricey says:

I was diagnosed with BPD about 10 years ago, after a short intial meeting with a ‘shrink’, after 10 years of inconsistency in shrinks a variety of meds/ hospital stays and a decade of nastyness, I met a new Dr who said that I have the ‘classic symptoms of dysphoric mania. I am wondering if you can have both:- or if I’ve wasted my time working on BPD which I may not have. However on a more positive note with an entirely different combination of meds, i feel normal- the anti-psyotics which i was forced to take are no more…..i have reclaimed my ‘me’!

June 12, 2013 at 4:48 pm
(21) haylee says:

I have BP and I can completely understand the stigma. I’m afraid of MYSELF when I don’t take medicine. It makes sense for people to be afraid, it’s a mix of suicidal depression and anger, leading to just not giving a damn about anyone or anything. It’s the scariest thing I’ve ever experienced and people should be afraid. There should be a stigma.

July 26, 2013 at 8:52 am
(22) Bipolarbear says:

Hi guys. I am a bipolar sufferer. I know these feelings well as i have often had them. My mind will have flashes of behaviour that can only be discribed as lunatic. Mixed states are no joke and can be extremely destructive. I know the urge for wanting to drive into oncoming traffic but i always looked out for bigger vehicles like trucks etc as to not hurt anyone. In my mind and indeed i believe in every person’s mind there is rests a psychopath . Untreated bipolar ppl though are at higher risk of exhibiting destructive behaviour, especially in these states. There are too many variables in bipolar and i believe as time goes on the diagnoses will differentiate different sub types… either way, i think society need to be better educated and facilities should be provided for ppl to seek medical help when they “are losing their minds”… bipolar and any other mental illness is nothing to mess around with…

April 10, 2014 at 1:56 pm
(23) Sue says:

There is no accounting for ignorance.
Most bi-polar people I know do not want to take medicine as it stifles their creativity and robs them of emotions. As a retired nurse that worked on a psychiatric unit and mother of a bipolar daughter it angers me to see such an idiotic statement by a clueless insensitive idiot.

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