Mood Congruence and Incongruence in Bipolar Disorder

Mood incongruence is a term used to describe a serious symptom of bipolar disorder. It is a psychotic feature of the disorder wherein the person's belief or action, whether by hallucination or delusion, does not match with their mood.

By contrast, mood congruence also describes a psychotic symptom of bipolar disorder, but, in this case, the belief or action is consistent with that person's mood.

While the difference between mood congruence and incongruence may seem of little consequence given that they both related to a psychotic episode, the way in which each impacts a person's ability to function and thrive can be strikingly different.

Mood-Incongruent vs. Mood-Congruent

In order to understand the disctinction between congruent and incongruent moods in bipolar disorder, it can be helpful to look at what each term means and explore a few different examples.

Incongruent Mood in Bipolar Disorder

Incongruent means "conflicting." As such, mood incongruence implies that the symptoms conflict with the person's current mood. Examples include:

• Believing you have superpowers despite going through a major depressive episode
• Laughing when your dog dies

In each case, the actions of the person do not match either the situation or emotional state. The delusion of superpowers, for example, in no way coincides with themes of powerlessness that are common with depression.

Congruent Mood in Bipolar Disorder

By contrast, congruent means "in agreement." In this case, any symptoms, however extreme, are considered mood-congruent when they in agreement with the person's current mood.

Examples include:

• Believing you have superpowers when you are going through a manic episode
• Feeling suicidal when your dog dies

No matter how unreasonable the responses may be, they nevertheless match the circumstance or emotional state of that person at that moment.

Mood Congruence/Incongruence and Psychosis

Mood congruence and incongruence are associated with psychosis, which can occur as part of bipolar disorder. Research suggests that around half of people who have bipolar disorder experience symptoms of psychosis.

Within the context of bipolar disorder, both mood congruence and incongruence are used to describe a psychotic feature of the disease. We don't use mood congruence, for example, to describe a person with bipolar disorder who has a reasonable response to a situation.

Instead, the terms allow us to classify any false beliefs a person may have to provide appropriate treatment. We refer to these false beliefs as psychoses.

Experiencing psychosis featuring mood incongruence is associated with a more severe course of illness. Research suggests that the presence of mood incongruence is associated with more severe, difficult experiences with bipolar disorder. 

Hallucinations and Delusions

Most people tend to associate hallucinations with schizophrenia, but they can happen in bipolar disorder, as well. Hallucinations involve experiences or perceptions that are not real, whether they be things a person sees, hears, smells, tastes, or physically feels.

Delusions, by contrast, are firmly held beliefs that are neither true nor based in reality. They do not involve hallucinations but instead play out in beliefs and actions that are contrary to reality.

Managing Incongruent and Congruent Moods

Treatment typically involves the management of symptoms and the prevention of mood episodes. This includes the use of medication (mood stabilizers, antidepressants, antipsychotics) and psychotherapy.

It is important that any person with bipolar disorder receive ongoing care and medical oversight. This is especially true for those experiencing mood-incongruent symptoms in whom the risk of hospitalization and suicide is far greater.

The goals of treatment for bipolar disorder often focus on helping people learn more about their condition, stabilizing mood, reducing psychotic symptoms, developing coping skills, and establishing a safety plan.

Medications

Medications that may help with mood episodes in bipolar disorder include mood stabilizers (such as lithium, carbamazepine, and valproic acid) and antipsychotics (such as risperidone, quetiapine, and olanzapine). If you have been prescribed a medication to treat bipolar disorder, it is important to adhere to your doctor's recommendations.

Therapy

Psychotherapy can also help people with bipolar disorder adopt healthy thinking patterns and learn to cope with their symptoms. Types of therapy that can be helpful include cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal and social rhythm therapy.

Summary

Mood congruence or incongruence is a facet of psychosis and involves either an alignment or conflict between a person's behavior and their mood. Such features can affect a person's ability to function and have been associated with more serious disruptions in a person's life.

Tracking your symptoms and seeking help when you notice changes in your mood can be important for managing your condition. Medication and therapy can help you manage these sympotms of bipolar disorder.