Mood-Congruent and Incongruent Features of Bipolar Disorder

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Mood involves a subjective emotional state that persists for a period of time. In bipolar disorder, mood-congruence or incongruence describes symptoms of psychosis that are in alignment or in conflict with a person’s mood state. When psychotic symptoms are present, it's important to determine whether they are mood-congruent or incongruent.

Read more to learn about psychosis in bipolar disorder, including mood-congruent and incongruent features.

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Psychosis in Bipolar Disorder

Psychosis is defined by a loss of touch with what is real. It is a symptom of psychotic disorders and can be present in mood and other psychiatric disorders.

Individuals with bipolar disorder can have psychotic symptoms such as hallucinations, delusions, or disorganized thoughts and speech during a bout of mania (a heightened, elevated mood) or depression.

Symptoms associated with psychosis in bipolar disorder include:

  • Pressured or disorganized speech
  • Issues with concentration
  • Isolation or withdrawal
  • Hallucinations
  • Delusions
  • Incoherent thoughts
  • Difficulty functioning at work, school, and home

Mood-Congruent Examples

When psychotic symptoms are mood-congruent, the content of a person’s delusions or hallucinations aligns with the person’s mood state.

There is often a sense of grandiose or inflated sense of self-esteem with mania, while depressive episodes can involve sadness, powerlessness, guilt, shame, and other difficult emotions. 

During a manic episode, examples of mood-congruent psychotic features could include a person believing they have superpowers or are best friends with a celebrity. Conversely, beliefs of having committed some unforgivable crime or hearing voices criticizing them can present during depression.

Mood-Incongruent Examples

With mood-incongruent symptoms, the content of a person’s delusions or hallucinations does not match their mood. For instance, a person may believe they are being targeted, persecuted, or controlled during a depressive episode.

Mood-incongruent features may be associated with a poorer prognosis and response to treatment, so it's essential to monitor symptoms and share information with medical and mental health providers to support the best outcomes for stabilization and treatment.

How They Present

Mood-congruence and incongruence are associated with learning, memory, and the speed of information processing.

Research indicates that people with bipolar disorder (during a depressive or manic episode) have a bias in their attention based on their mood. In other words, a person who is manic is more likely to attend to a face with a euphoric expression than one with a sad demeanor.

There is also research supporting individuals processing content more quickly and prioritizing content that aligns with their mood state.

Why Does It Happen?

Approximately half of the people living with bipolar disorder will experience psychotic symptoms. Hallucinations, delusions, or a combination of both can accompany other symptoms of bipolar disorder.

Hallucinations

Hallucinations are the perception or experience of something that is not actually present. They can be sensory, auditory, or visual in nature, meaning a person’s sense of sight, sound, hearing, taste, smell, and touch can be involved.

The content of a hallucination can vary and be pleasant, neutral, or frightening. 

Delusions

Delusions are thoughts or false beliefs that are not rooted in reality. A person may continue to hold these fixed beliefs even when they are presented with evidence to the contrary.

Themes that can occur in delusions include the belief that one is being persecuted or at risk of harm, has special abilities or elevated status, believes major events or situations are directed at themselves, or that another person has romantic feelings for them.

Differences in Schizophrenia

Psychotic symptoms can occur with bipolar disorder and schizophrenia. However, one of the differences between these conditions is that bipolar disorder is a mood disorder and schizophrenia is a psychotic disorder.

The main features of bipolar disorder are mood episodes characterized by mania, hypomania, or depression, while delusions, hallucinations, and disorganized thoughts and speech are key features of schizophrenia.

Research indicates psychotic symptoms in bipolar disorder as being more typically mood-congruent and lasting for shorter periods of time when compared to presentation in individuals with schizophrenia.

Managing Mood Instability in Bipolar Disorder

Medication, therapy, or a combination of both can help patients manage shifts in mood or psychotic symptoms that can accompany bipolar disorder.

Key goals in treatment may vary from patient to patient, but often include psychoeducation, stabilization of mood, reduction in psychotic symptoms (if present), safety planning, and developing coping skills.

Medication

Mood stabilizers and antipsychotics may be prescribed to treat bipolar disorder symptoms.

  • Mood stabilizers such as lithium, valproic acid, and carbamazepine have been shown to reduce symptoms of mania and mixed episodes.
  • Antipsychotics like quetiapine, olanzapine, and risperidone also work to stabilize manic symptoms.

Adherence to medication can help get symptoms to a manageable level for patients and aid in periods of recovery.

Therapy

Talk therapy can be effective in treating people with bipolar disorder. Therapy creates an opportunity for patients to:

  • Get more information about their diagnosis
  • Identify triggers
  • Learn to cope with symptoms and problems
  • Develop healthy thinking
  • Receive support from a mental health professional

Forms of therapy utilized in the treatment of bipolar disorder may include cognitive behavior therapy, family-focused therapy, interpersonal and social rhythm therapy, and techniques from dialectical behavior therapy.

Advice for Loved Ones

Witnessing a loved one’s struggle with symptoms of bipolar disorder can be challenging and worrisome, but there are things you can do to be there for them.

These can include:

  • Be present, compassionate, and patient.
  • Listen and validate their experiences.
  • Be clear and kind when expressing your concerns.
  • Be aware of warning signs for mood shifts, psychosis, or suicide.
  • Develop a plan with your loved one when they are well to support them when they are unwell.
  • Have contact information for mental health professionals or crisis resources.
  • Remember to take care of yourself.

Help Is Available

If your loved one is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Summary

Mood-congruence or incongruence relates to symptoms of psychosis that either align or conflict with a person’s mood. Psychotic symptoms can influence a person’s ability to function in daily life. Treatment is available to help people with bipolar disorder manage these symptoms.

A Word From Verywell

Psychotic symptoms that accompany bipolar disorder can be a frightening experience. Hallucinations and delusions can be jarring and significantly affect your quality of life.

Treatment with medication and therapy are the primary methods for managing symptoms. In addition, working with a care team can help you identify and establish a routine with activities and strategies to support your well-being.

Frequently Asked Questions

  • How do you recognize mood-congruent symptoms in people with bipolar disorder?

    To recognize mood-congruent symptoms, it’s necessary to understand symptoms of mania and depression. Some symptoms of mania include periods of elevated mood, inflated sense of self, and grandiose thoughts. Depression can consist of prolonged sadness, withdrawal, or lack of pleasure in activities. Mood-congruent psychotic symptoms are delusions or hallucinations that are in alignment with the person’s mood.

  • What are the differences between hallucinations and delusions?

    Hallucinations involve the perception or experience of something that is not real. They can be auditory, visual, or sensory in nature. Delusions are false beliefs that may seem unshakable to the individual experiencing them even when there is evidence to the contrary.

  • Is the concept of congruence in psychology similar to its use in bipolar disorder?

    Congruence in psychology generally refers to alignment among a person’s sense of their ideal self and their perceived experiences of themselves. In bipolar disorder, mood-congruence or incongruence specify the nature of psychotic symptoms, indicating whether they align with the polarity (mania or depression) of the episode.

  • Does bipolar treatment help with mood-congruence?

    Mood-congruence describes psychotic features of a mood disorder such as bipolar disorder. Treatment for the condition consists of medication or therapy, with research showing a combination of both to be beneficial. To treat psychotic symptoms, a psychiatrist might prescribe antipsychotics, mood stabilizers, or a combination of medication.

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