Mania/Altered Mood and Compulsions in Bipolar and Mental Illness

I would definitely say that strong urges and compulsions are a part of highly altered mood. I will refer to it as altered since involves more than just elevation in a “happy” sense. The textbooks and the DSM refer to it as “impulsive behavior” but I don’t think that is entirely accurate. Impulsive, yes, it indeed can be. But an impulse is described as “an impelling action or force, driving onward or inducing motion.” while a compulsion is described as “a strong, usually irresistible impulse to perform an act, especially one that is irrational or contrary to one's will” (dictionary.com). So what is the difference?

I see being impulsive as simply not always looking ahead or seeing the consequences of your behavior. For example, having an impulse to eat chocolate cake when you’re on a diet might be because you’re thinking of the joy of eating it and not the consequences of gaining weight.

Compulsions, in my view, are not the same as impulses. Impulses can be controlled to an extent. Everyone has impulses to some degree. We wouldn’t eat, drink, talk to other people or in general do anything unless we had an impulse to do it.

I would say a compulsion is a very extreme form of an impulse, that is stronger in intensity and at times cannot be controlled either with mental or physical means. What I mean is, when you have a compulsion, simply telling yourself, “Don’t do it! It’s bad for you!” likely does nothing to curb the compulsion or make it go away. At times it can ruminate excessively within the mind to the point it becomes the sole focal point. If you are able to replace the compulsive thought with something else as a distraction, often the compulsion will simply return, but stronger.

With the cake example, a person can have a strong desire to eat cake but may be able to hold themselves back from the impulse to do so by telling themselves of the bad consequences. Compulsions often involve carrying out acts that a person may not even want to do yet feels compelled or pushed by some force to do so. If the person knew the cake was bad for their diet truly did not want to eat it, and tried to resist the urge to do it, yet was still overcome and ate the cake anyway, it would more likely be a compulsion rather than simply an impulse. People think of it as an issue of simple self-control. “Just don’t do it!” They say. But more is going on than that. Often the person is actively trying to control the impulse or compulsion. It’s more an inability to control the compulsion rather than a willingness to complete the act. Compulsive feelings are horrible because you do feel like you are out of control of your own body and mind, not that what you are doing is so awesome and incredible.

It seems that often compulsions are sensory in nature. In what is currently described as mania, what doctors call “impulsive behavior” generally refer to compulsions that involve sensory seeking/pleasure sensory input. The stereotypical example of a person being promiscuous is used often. However it usually is not elaborated on. I myself have never been a promiscuous person in my “normal” life. I can easily dismiss a temptation to do something wrong or what I would consider immoral in my NORMAL state. However when in an extreme altered state, I have realized that sexual compulsions begin to manifest. Many times it is unspecific – it is simply a form of sensory seeking, in any way or means available.

I believe that is why in bipolar disorder or people with extreme mood disturbance, these sexual pleasure seeking behaviors can run the gamut. A person may seek out pleasure by having a risqué conversation with a friend or stranger, they may dress provocatively to draw attention to themselves, they may have sex multiple times a day, either with their committed partner or with random partners, they may experiment with any number of things, people, or experiences. I personally have done some things that I never would have under normal circumstances. But looking back, the compulsions were like an obsessive drive that could not be curbed. And it did incite guilt for having been unable to control the compulsion.

Compulsions that result in pleasure seeking also relate to things like drugs and alcohol. I would describe it as an insane craving, much like the sexual pleasure seeking compulsion. It is another form of sensory seeking. A person may use/abuse any number of drugs or alcohol or other substances. Food can become an object of compulsion as well.

Much of this is well documented in bipolar disorder. However people seem to only discuss sexually related “impulses” or again the stereotypical “reckless driving” etc.

However, often the compulsions I have had are just random or nonsensical in nature. I would still consider them to be sensory seeking, but in a non-pleasure centered way.  They tended to center around the sensory components of taste and touch mainly, scent to a lesser degree.

For example, in my early altered periods years ago I spoke of having some very strange compulsions – the compulsion to eat garbage was particularly weird and gross when revealed to other people (thankfully I never went through with that one). I had compulsions relating to just about everything – compulsions to lick or taste things that are non-food objects (soap, engine oil, the walls of the house, etc.) Compulsions to touch things like people’s skin. I had self-harm compulsions but they weren’t purposeful self-harm (meaning, I didn’t consciously use it as a way to relieve anxiety or cope with pain). I recall walking around my backyard in a circular motion, scratching my arms repetitively with the sharp end of a cigarette lighter. This went on for awhile and my arms became red and raw in some places. It wasn’t a purposeful self-harm, but as I mentioned, a sheer compulsion, an uncontrollable urge. I felt that I needed to scratch myself and I did so continually.

I also had compulsions that involved repetition which I spoke of before. They mainly related to organizing things or movement. For example I would compulsively arrange things in rows or patterns, walk in patterns or speak in patterns. There was absolutely no sound reason for why I did this, other than the overwhelming and uncontrollable urge to do so. It served no real purpose other than to carry out the compulsion that was plaguing my mind and therefore “rid” myself of the compulsion.

However ridding myself of the compulsion only lasted a short while and it would return again, sometimes the same one, sometimes multiple or different ones. The result was, to an outsider onlooker, completely bizarre and nonsensical  behavior overall.

Only now after close to 5 years have I come to more of an insight and understanding about some of these things that I experience. I always tried to lump everything I experience under the heading of “bipolar” since my initial diagnosis. However, I currently believe that almost all mental illnesses are related. Just in this description alone one could say I had symptoms of bipolar disorder, schizophrenia, obsessive compulsive disorder, autism and more. And that is just talking about the compulsive aspect of mental illness without regard to the host of other factors that occur.

In my current altered state I have been experiencing some compulsions yet again along with a whole host of other manifestations, which I plan to write about. Right now I am in a coherent enough state to describe it but later today, who knows.