Mood Congruence and Incongruence in Bipolar Disorder

Table of ContentsView AllTable of ContentsMood-Incongruent vs. Mood-CongruentPsychosis in Bipolar DisorderHallucinations and DelusionsTreatment

Table of ContentsView All

View All

Table of Contents

Mood-Incongruent vs. Mood-Congruent

Psychosis in Bipolar Disorder

Hallucinations and Delusions

Treatment

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.

At a GlanceMood incongruence in bipolar disorder means that a person’s mood does not align with their behavior, such as having an elevated mood during times of stress or feeling depressed during positive events. Mood congruence happens when a person’s mood matches their behavior, such as euphoria during a manic episode. Keep reading to learn more about how mood congruence and incongruence can affect symptoms of bipolar disorder.

At a Glance

Mood incongruence in bipolar disorder means that a person’s mood does not align with their behavior, such as having an elevated mood during times of stress or feeling depressed during positive events. Mood congruence happens when a person’s mood matches their behavior, such as euphoria during a manic episode. Keep reading to learn more about how mood congruence and incongruence can affect symptoms of bipolar disorder.

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:

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:

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.

Psychosis is simply a break from reality, a condition which more often happens during a manic episode and even a depressive episode (but never with a hypomanic episode). Psychosis involveshallucinations(experiencing things that are not real) and/ordelusions(believing things that are not real).

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.

Psychosis Symptoms, Causes, and Treatment

Mood-Congruent HallucinationsThemes such as guilt or sadness in a depressive episode, for example, hearing a voice that tells you that you’re worthlessGrandiosity in a manic episode, like seeing the president in your living roomMood-Incongruent HallucinationsExperiencing sensations in a depressive episode contrary to your depression without any feelings of guilt, death, disease, inadequacy, or deserved punishmentVoices telling you that you’re unworthy or deserve punishment

Themes such as guilt or sadness in a depressive episode, for example, hearing a voice that tells you that you’re worthless

Grandiosity in a manic episode, like seeing the president in your living room

Mood-Incongruent HallucinationsExperiencing sensations in a depressive episode contrary to your depression without any feelings of guilt, death, disease, inadequacy, or deserved punishmentVoices telling you that you’re unworthy or deserve punishment

Experiencing sensations in a depressive episode contrary to your depression without any feelings of guilt, death, disease, inadequacy, or deserved punishment

Voices telling you that you’re unworthy or deserve punishment

Most people tend to associate hallucinations withschizophrenia, 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.

Managing Incongruent and Congruent Moods

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

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 andsuicide is far greater.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

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

Medicationsthat may help with mood episodes in bipolar disorder include mood stabilizers (such aslithium,carbamazepine, andvalproic acid) and antipsychotics (such asrisperidone, 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 therapythat can be helpful includecognitive-behavioral therapy(CBT),dialectical behavior therapy(DBT), andinterpersonal 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.

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5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Elowe J, Vallat J, Castelao E, et al.Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder.Int J Bipolar Disord. 2022;10(1):31. doi:10.1186/s40345-022-00280-6National Institute of Mental Health.Bipolar disorder.Simonetti A, Koukopoulos AE, Kotzalidis GD, et al.Stabilization beyond mood: stabilizing patients with bipolar disorder in the various phases of life.Front Psychiatry. 2020;11:247. doi:10.3389/fpsyt.2020.00247Novick DM, Swartz HA.Evidence-based psychotherapies for bipolar disorder.Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Elowe J, Vallat J, Castelao E, et al.Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder.Int J Bipolar Disord. 2022;10(1):31. doi:10.1186/s40345-022-00280-6National Institute of Mental Health.Bipolar disorder.Simonetti A, Koukopoulos AE, Kotzalidis GD, et al.Stabilization beyond mood: stabilizing patients with bipolar disorder in the various phases of life.Front Psychiatry. 2020;11:247. doi:10.3389/fpsyt.2020.00247Novick DM, Swartz HA.Evidence-based psychotherapies for bipolar disorder.Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004

Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527Elowe J, Vallat J, Castelao E, et al.Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder.Int J Bipolar Disord. 2022;10(1):31. doi:10.1186/s40345-022-00280-6National Institute of Mental Health.Bipolar disorder.Simonetti A, Koukopoulos AE, Kotzalidis GD, et al.Stabilization beyond mood: stabilizing patients with bipolar disorder in the various phases of life.Front Psychiatry. 2020;11:247. doi:10.3389/fpsyt.2020.00247Novick DM, Swartz HA.Evidence-based psychotherapies for bipolar disorder.Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004

Burton CZ, Ryan KA, Kamali M, et al.Psychosis in bipolar disorder: Does it represent a more “severe” illness?Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527

Elowe J, Vallat J, Castelao E, et al.Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder.Int J Bipolar Disord. 2022;10(1):31. doi:10.1186/s40345-022-00280-6

National Institute of Mental Health.Bipolar disorder.

Simonetti A, Koukopoulos AE, Kotzalidis GD, et al.Stabilization beyond mood: stabilizing patients with bipolar disorder in the various phases of life.Front Psychiatry. 2020;11:247. doi:10.3389/fpsyt.2020.00247

Novick DM, Swartz HA.Evidence-based psychotherapies for bipolar disorder.Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004

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At a Glance#

Incongruent Mood in Bipolar Disorder#

Congruent Mood in Bipolar Disorder#

Mood Congruence/Incongruence and Psychosis#

Managing Incongruent and Congruent Moods#

Medications#

Therapy#

Summary#