No One Can Explain My Emotional Mood Swings

Reader’s Question

I’m a 16-year-old girl and for the past two years I have had severe mood swings. I have been to several doctors and all of them have said they are not a 100% certain what I have. I can go from being on top of the world, really happy and overly confident to the point I can annoy people and get into arguments. Sometimes I even get to the point of feeling worthless, self-harming, and suicidal. I almost feel like two different people and I don’t know what I should do.

Psychologist’s Reply

I’m not surprised that doctors have been unsure what is wrong. Childhood is a time of developmental change and it’s always difficult to know how much will improve as the individual matures, hormones even out, and so forth. For that reason, the diagnosis of personality disorders is limited to adults — the theory being that it’s premature to be able to conclude that a child’s personality is going to be a problem when that child grows into adulthood. For adults, intense mood swings can be associated with borderline personality disorder. The assumption is that the individual did not develop a firm sense of self, and so whatever is happening at the moment has too much influence on the person’s emotions.

I bring up the issue of personality or temperament simply to highlight that people vary in how emotional they tend to be. Still, that doesn’t mean we’re at the mercy of our mood swings and dangerously negative emotions. The most common psychiatric medications, such as sertraline, are used to help make people less prone to negative emotions such as anxiety and depression. Sometimes simply making those negative emotions less intense goes a long way toward being able to further control our reactions to things. So, mental health professionals typically start with such medications. Also, there is a class of medications known as mood stabilizers, although they generally apply to specific disorders, such as bipolar disorder. Depending on how quickly your moods change from one extreme to the other, this disorder may be something to consider as a possibility.

Developmentally, maturation usually involves becoming less emotional, or at least becoming more skilled at controlling the extremes of our emotional reactions. Some people seem to be able to more easily regulate their emotions compared to other people, but it is a skill all of us can practice. So, when you find yourself feeling irritated with others, or extremely critical of yourself, the first step is to stop yourself from reacting right away. Putting a few seconds between the impulsive emotion and your reaction to it can be enough to start to catch your thinking or self-talk. We usually react in extreme ways because of how we’re interpreting what is happening to us. The more extreme our interpretation (for example, “This is the worst!”) the more extreme our reaction (rage, despair, worthlessness).

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The skill involves catching ourselves between the impulse and the reaction and reining in the interpretation by applying our rational selves. No matter how irritating something is, it’s usually not as bad in reality as our feelings about it are in the moment. And even if we’re sure another person intentionally is trying to make us miserable, we don’t have to let them succeed. Instead, we can remind ourselves that we are the one to suffer most by getting so upset.

This process of catching our initial reactions and applying a bit of rational reflection is at the heart of what’s known as cognitive-behavioral counseling. A therapist starts by helping us learn this process, but then it’s up to us to practice and continue to do it in the heat of the moment. It’s not easy at first, but like any skill, it gets easier and eventually becomes automatic. By then we may no longer be able to imagine what it is like to become emotionally bent out of shape by something that happens to us. That’s true maturity indeed.