Mood Instability and Your Characters


You're putting together a character who's mood simply bounces all over the place, happy one moment, in a fit of rage the next.  Researchers at King's College London note that this sort of mood instability is part of a number of mental health disorders. 

So how do you structure the personality and behavior of a character like this? 

Below is the King's College report, along with a brief description from mentalhealth.com, of typical behavior, sometimes in the extreme, of a person who is very emotionally unstable.  This is offered strictly as a guide for crafting character in fiction - and NOT for the amateur diagnosis of the state of someone's mental health.  That is always best left to trained professionals.

Another note about emotionally unstable behavior:  as any parent will tell you, this is how adolescents and teen-agers often behave.  It's a normal part of growing up - but it is a matter of degree.  In the extreme, however, this behavior can be diagnosed and treated.  (If you have any concerns, please see a mental health professional.  Emotionally unstable people do commit suicide, and that last thing anyone wants.)

Here's the King's College story with a sidebar from mentalhealth.com listing symptoms.  This is offered as a reference for the development of characters in your story:
*  *  *  *  *


Mood instability common to
mental health disorders,
associated with poor outcomes

"Mood instability can affect people with a wide range of
mental disorders but the symptoms are not always recognized."

Mood instability occurs in a wide range of mental disorders, and is not exclusive to affective conditions such as depression, bipolar disorder and anxiety disorder, new research confirms. The research also found that mood instability was associated with poorer clinical outcomes.

A study by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London has shown that mood instability occurs in a wide range of mental disorders and is not exclusive to affective conditions such as depression, bipolar disorder and anxiety disorder.

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The research, published in BMJ Open, also found that mood instability was associated with poorer clinical outcomes.  Taken together, these findings suggest that clinicians should screen for mood instability across all common mental health disorders. Targeted interventions for mood instability may also be useful in patients who do not have a formal affective disorder.
This study is the first to use an automated information extraction method to acquire data on mood instability from electronic health records. The sample included almost 28,000 adults who presented to the South London and Maudsley NHS Trust (SLaM) between April 2006 and March 2013 with a psychotic, affective or personality disorder.

The presence of mood instability within one month of presentation was identified using natural language processing (NLP). Outcome measures included the number of days spent in hospital, frequency of hospital admission, compulsory hospital admission and prescription of antipsychotics or non-antipsychotic mood stabilizers over a five year follow-up period.

Mood instability was documented in 12 per cent of people presenting to mental healthcare services. It was most frequently documented in people with bipolar disorder (23 per cent), but was also common in people with personality disorder (18 per cent) and schizophrenia (16 per cent). Mood instability was also associated with a greater number of days spent in hospital, higher frequency of hospitalization, greater likelihood of compulsory admission and an increased likelihood of prescription of antipsychotics or non-antipsychotic mood stabilizers.
______________________________ 
Mood instability in the extreme in the absence of other disorders is commonly know as Borderline (Emotionally Unstable) Personality Disorder, a condition characterized by rapid mood shift, impulsivity, hostility and chaotic social relationships. People with borderline personality disorder usually go from one emotional crisis to another. 
In the general population, rapid mood shift, impulsivity, and hostility are normal in childhood and early adolescence, but disappear with maturity. However, in Borderline Personality Disorder, rapid mood shift, impulsivity, and hostility intensifies in adolescence and persists into adulthood. In early adulthood, individuals with this disorder have highly changeable moods and intense anger. Fortunately, in their 30's and 40's, the majority develop emotional stability and adequate coping skills.
Borderline Personality Disorder is quite different from Bipolar I Disorder. The mood swings seen in Borderline Personality Disorder seldom last more than one day; whereas mood swings in Bipolar I Disorder last much longer. Borderline Personality Disorder doesn't exhibit the prolonged episodes of decreased need for sleep, hyperactivity, pressured speech, reckless over-involvement, and grandiosity that are characteristic of Bipolar I Disorder.
The core features of this disorder are:
  1. Negative emotions  (emotional lability, anxiety, separation insecurity, depression, suicidal behavior),
    • Emotions spiral out of control, leading to extremes of anxiety, sadness, rage, etc.
    • Has extreme reactions to perceived slights or criticism (e.g. may react with rage, humiliation, etc.).
    • Expresses emotion in exaggerated and theatrical ways.
    • Emotions change rapidly and unpredictably.
    • Feels unhappy, depressed, or despondent.
  2. Antagonism (hostility), 
    • Intense anger, out of proportion to the situation at hand (e.g. has rage episodes).
    • Often angry or hostile. 
  3. Disinhibition (impulsivity, risk taking). Self harm and repeated, impulsive suicide attempts are seen in the more severely ill individuals with Borderline Personality Disorder.
    • Need for stimulation/proneness to boredom
    • Impulsivity
    • Promiscuous sexual behavior
    • Irresponsibility  
Socially, individuals with this disorder often form "love-hate" relationships that alternate between extremes of idealization and devaluation. They may make frantic efforts to avoid real or imagined abandonment. Frequently they feel that their life is empty and lacking in meaning and purpose. Many don't know "who they are" (i.e., identity confusion) or "where they are going in life" (i.e., goal confusion).
Source: mentalhealth
 ______________________________

Rashmi Patel, Department of Psychosis Studies at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London, said: 'Mood instability can affect people with a wide range of mental disorders but the symptoms are not always recognized. We have developed an innovative text mining tool to identify the presence of mood instability in almost 28,000 people receiving mental healthcare in South London. We found that mood instability affects people with a wide range of common mental health disorders and is associated with worse clinical outcomes. Our findings highlight the importance of screening for mood instability and the need to develop better strategies to treat these symptoms.

Related stories:

Story Source:  Materials provided by King's College London.  Rashmi Patel et al. Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open, May 2015





 

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