My Brother's Sudden Mood Swings: When to Seek Help?

Q: My Brother's Sudden Mood Swings: When to Seek Help?

Hello, Xiao Jing： The diagnosis in psychiatry generally revolves around three main areas： "interpersonal," "occupational," and "social." These three areas are interrelated, meaning that if one is affected, over time, all three will likely suffer. <br>In other words, when a person

My brother?

Hello Dr.
Chen, my brother has been acting strangely for the past few months, which has created a gloomy atmosphere in our family.
I would like to ask if this situation requires medical attention.
He is 25 years old and usually has a very good temperament, but he is very addicted to online gaming, a hobby he has had since childhood.
In recent months, he has been having sudden outbursts, which typically occur at night when the whole family is usually at home.
The content of his outbursts often revolves around events from his childhood, but upon closer observation, we have noticed that his timeline is very confused.
He expresses feelings of being bullied by our entire family, even accusing his loving grandfather and aunt of having verbally abused him in his childhood with harsh words.
He is always angry and cries like a child during these episodes, and his speech is often unclear, making it difficult for us to understand what he is saying.
On one occasion, he threw the house key at us in anger and left home for several hours, returning exhausted and injured in the middle of the night.
The day after each outburst, he returns to normal as if nothing ever happened, which leaves us all baffled.
However, this behavior has caused significant stress for our elders and me.
Could this situation indicate a mental health issue?

Xiao Jing, 20~29 year old female. Ask Date: 2008/06/02

Dr. Chen Wenyu reply Psychiatry

Hello, Xiao Jing: The diagnosis in psychiatry generally revolves around three main areas: "interpersonal," "occupational," and "social." These three areas are interrelated, meaning that if one is affected, over time, all three will likely suffer.
In other words, when a person's mental state deviates from the norm and impacts their interpersonal, occupational, and social functioning, it can be determined that they have a "mental disorder." Mental disorders can be broadly classified into "personality disorders," "neurotic disorders," and "psychotic disorders," among others.

Based on your description of your brother's situation, it can only be said that there is "a problem." As for what the problem is, a medical evaluation is necessary.
If it is a personality issue, which refers to "character," there should have been signs long before, and it shouldn't be something that has just emerged in "the past few months," as personality development begins in childhood and is gradual, not sudden.
If it is a neurotic disorder, it would be worth exploring whether there have been any recent stressors; perhaps in his other world (the virtual internet), he is experiencing significant distress.
Although he may have turned off his device, his mind may still be engaged, affecting his real-life social interactions.
This situation requires time for understanding, evaluation, and assistance.
If it is a psychotic disorder, it often presents with symptoms such as auditory hallucinations (which may manifest as talking to oneself, as if conversing with someone) or delusions (a deep-seated belief of being followed, framed, or monitored, etc.).
Such cases require medication treatment, and early intervention is crucial.
However, a physician cannot assess him at home, nor can they prescribe medication based solely on family descriptions; he must be taken to a hospital for a proper diagnosis.
You can have a good discussion with your brother, addressing his distress, for example, by expressing concern about his poor sleep observed at night and encouraging him to see a doctor.
Through familial affection, you can gently express your feelings and concerns, helping him understand that when he feels bad, the whole family is affected as well.

Another option for seeking medical help is "involuntary hospitalization." When there is a strong suspicion of a mental disorder, especially if there are signs of "self-harm, harm to others," or "risk of self-harm, harm to others," and he refuses treatment, you can request assistance from public health nurses at the health department in coordination with the fire department to forcibly take him to a psychiatric hospital for evaluation.
Thank you for your letter!

Reply Date: 2008/06/02

More Info

It sounds like your brother is experiencing significant mood swings that are concerning not only for him but also for your family. Given the details you've provided, it is essential to approach this situation with care and understanding.
Your brother's sudden outbursts, particularly in the evenings when the family is together, could indicate underlying emotional or psychological issues. The fact that he is expressing feelings of being bullied or mistreated by family members, despite evidence to the contrary, suggests that he may be struggling with distorted perceptions or possibly even a mood disorder. His behavior, including the confusion about past events and the intensity of his emotional responses, raises the possibility of a mental health condition that warrants professional evaluation.

Mood swings can be symptomatic of various mental health disorders, including depression, anxiety disorders, bipolar disorder, or even stress-related conditions. The fact that he returns to a seemingly normal state the next day could indicate a cycle of emotional dysregulation, which is often seen in mood disorders. Additionally, his engagement in online gaming, while a common hobby, can sometimes serve as an escape mechanism for individuals dealing with stress or emotional turmoil.
It is crucial to consider the following steps:
1. Open Communication: Try to have an open and non-confrontational conversation with your brother. Express your concerns without judgment and encourage him to share his feelings. Sometimes, just knowing that someone is there to listen can make a significant difference.

2. Encourage Professional Help: Given the severity of his mood swings and the impact on family dynamics, it would be wise to encourage him to seek help from a mental health professional. A psychologist or psychiatrist can provide a proper assessment and recommend appropriate treatment options, which may include therapy, medication, or a combination of both.

3. Monitor Behavior: Keep track of his mood changes, triggers, and any patterns that emerge. This information can be valuable for a mental health professional in understanding his situation better.

4. Family Support: It’s essential for your family to support each other during this time. Consider family counseling, which can help everyone understand the dynamics at play and learn how to cope with the stress his behavior may be causing.

5. Crisis Plan: If his behavior escalates to the point where he poses a risk to himself or others, it is crucial to have a plan in place. This could involve contacting a mental health crisis line or seeking immediate help from emergency services.

In conclusion, your brother's behavior is concerning and suggests that he may be experiencing a mental health issue. It is essential to approach the situation with empathy and encourage him to seek professional help. Mental health is just as important as physical health, and addressing these issues early can lead to better outcomes for him and your family.

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