Pressured speech is when you talk in a fast, frantic, or urgent way. This symptom is common in bipolar disorder manic episodes.
Many people with bipolar disorder experience manic episodes, which are periods of at least one week where you feel euphoric, full of energy, and need less sleep. Pressured speech is a common characteristic of mania.
During a manic episode, you may feel a compulsive urge to talk rapidly without interruption. Understanding pressured speech can help you learn to manage its symptoms.
Pressured speech is when you speak rapidly and with a sense of urgency. Others may be unable to understand what you’re saying. You might talk about several ideas at once and be unable to think clearly while you’re speaking.
“Pressured speech occurs on a continuum and may range from extremely fast talking to completely incoherent, garbled speech,” says psychotherapist Melissa Bennett-Heinz, LCSW, LICSW.
“It is talking done too fast, erratic, irrelevant, or too tangential for the listener to understand — unrelenting and loud,” Bennett-Heinz says. “It can convey an urgency that is not relevant to the situation, and can be very difficult for a listener to interrupt.”
In many cases, the person with pressured speech is unaware they are speaking in this way.
“Often, people with pressured speech are minimally aware of any of their own urgent feelings underlying it, or they feel a sense of urgency from outside themselves without identifying with that feeling as their own,” says Dr. Thomas Adams, a board certified psychiatrist.
“They are also often not aware (or have an inaccurate understanding) of the effect their pressured speech has on others around them,” says Adams.
Some signs and symptoms of pressured speech
- a compulsive need to speak
- rapid speech
- speaking without pauses
- talking even when interrupted
- talking in a nonsensical manner that’s difficult for others to understand
- speaking about inappropriate topics
- being unable to talk quickly enough to keep up with your thoughts
Pressured speech is a common symptom of bipolar disorder manic episodes.
According to Adams, there’s a connection between the speech regions of the brain and the behavioral systems involved in aggression, fear, reward-seeking, and motivation. More research on these connections is needed.
People with bipolar disorder who experience pressured speech may have difficulty prioritizing thoughts, which can become pressing as soon as they appear in their minds.
The concept of “flight of ideas” is often mentioned alongside pressured speech. While pressured speech and flight of ideas are both hallmarks of mania, there are some differences.
“Flight of ideas is a bit more abstract since it refers less to the concrete characteristics of speech (e.g., specific sounds, tone, volume) and more to the content and flow of the ideas the speaker is presenting with their speech,” Adams says.
Compared with pressured speech, a person with a flight of ideas tends to make larger jumps from topic to topic, covering a large area of meaning in a short period.
The experience of anxiety and fear is common to various mental health conditions, Adams says. The brain systems that have evolved to sustain anxious behaviors probably play a large role in “causing” pressured speech, Adams adds.
Conditions related to pressured speech
Pressured speech in itself is not a disorder but is associated with underlying conditions, such as:
“For mania, the most effective treatments tend to be antipsychotic medications, especially those that strongly block dopamine receptors,” Adams says.
Medications that can treat acute mania and pressured speech include:
- mood stabilizers
Psychotherapy can help treat conditions with pressured speech-like symptoms, but medications are much more important for people who experience a manic episode, Adams adds.
Additionally, a thorough medical evaluation is necessary to determine the underlying cause of the symptom.
“If it is determined that [pressured speech] is a result of bipolar disorder, there are a range of treatment options depending upon the severity,”Bennett-Heinz states.
“Most acute manic episodes may require hospitalization to stabilize the mood with medication, especially if there are other symptoms present that can be life threatening.”
When it comes to outpatient treatment, several treatment methods can help people with pressured speech manage their symptoms, Bennett-Heinz explains. They include:
- medication management
- psychoeducation, which can help identify causes and risk factors
- good sleep hygiene
- deep breathing
- grounding exercises
- a balanced diet
It’s especially important for anyone who has a diagnosis of bipolar disorder to get enough sleep and rest, to eat a balanced diet, and exercise regularly.
During bipolar disorder manic episodes, a person may experience pressured speech, which is needing to speak at a fast pace. This speech is uninterrupted and can be nonsensical.
Treatment options include medication, getting enough sleep, eating a balanced diet, and exercising regularly to regulate mood.
To learn more about bipolar disorder, its symptoms, and treatment options, check out Psych Central’s bipolar disorder hub.