For example, one of our forum members, Lucie, wrote, "I went with my daughter to her pdoc [psychiatrist] on Tuesday and started talking about her dysphoria. The pdoc stopped me and asked me what I meant by dysphoria. I said that I understood dysphoria to be mania in the form of agitation, anger, etc. She said no, that is just mania. But I thought that mania came in a couple of forms - euphoric where you feel 'on top of the world' in one form or another and dysphoric where you are filled with rage, energy, agitation, rapid speech, etc. What's going on?"
Another forum member, Poetprose, responded, "I get confused about dysphoria, too. I thought it meant a crashing low depression." (Discussion from our forums).
The dictionary definition of dysphoria is actually very straightforward - a state of feeling unwell or unhappy. However, that could describe anything from PMS to raging flu to crying because your goldfish died. Many medical dictionaries define dysphoria simply as anxiety. But these definitions just do not describe properly the way dysphoria applies to the moods associated with bipolar disorder cycles.
As shown by the discussion above, many use dysphoria to define types of manic episodes while others associate it with depressive episodes. The truth is, it is actually quite valid as a description for either mania OR depression.
Dysphoric mania, as described in the Merck Manual, is "prominent depressive symptoms superimposed on manic psychosis." Symptoms include:
- curtailed sleep
- racing thoughts
- psychomotor restlessness
- suicidal ideation
- persecutory delusions
- auditory hallucinations
In everyday English, the complex terms above for symptoms of mania with dysphoria include - trouble sleeping, racing thoughts, grandiosity, mental and/or physical agitation, thoughts of suicide, feeling persecuted for no reason, hearing things, and having trouble making decisions (along with others).
Dysphoric depression, which many people think of as a mixed episode, consists of "intrusions of hypomanic symptoms or hyperthymic traits into a retarded major depressive episode" (Merck). Basically, this means that characteristics of hypomania or overactivity occur during a depression that in general has the patient sluggish or listless. Symptoms include:
- pressured speech against a background of retardation
- extreme fatigue
- guilty ruminations
- free-floating anxiety
- panic attacks
- intractable insomnia
- increased libido
- histrionic appearance with expressions of depressive suffering
Once again putting this into more common terms, the symptoms above for depression with dysphoria include: being easily angered, having pressured speech in spite of slowed thinking, being overtired, dwelling on guilt feelings, being anxious in general (for no specific reason), having serious difficulty in sleeping, having extra sex drive, and being melodramatic about feeling depressed.
Important Note: When associated with either mania or depression, dysphoria is linked with a greatly increased risk for suicide and should always be brought to the attention of a medical professional.
Another condition recently included in the dysphoria spectrum is PMDD - Premenstrual Dysphoric Disorder. It is characterized by severe monthly mood swings along with other common symptoms of PMS. The mood swings can include irritability to rage to homicidal feelings, and severe depression to hopelessness to suicidal thoughts and urges. PMDD is a very serious condition and should be treated by a doctor. Please see the excellent Premenstrual Dysphoric Disorder resources linked below.