Mood Congruence and Incongruence in Bipolar Disorder

Classification helps differentiate psychotic episodes

Mood incongruence

Verywell / Catherine Song

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

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.

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.


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. The terms simply allow us to classify any false beliefs a person may have in order 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 involves hallucinations (experiencing things that are not real) and/or delusions (believing things that are not real).

Hallucinations and Delusions

Mood-Congruent Hallucinations
  • 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 Hallucinations
  • 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 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.

Bipolar Disorder Treatment

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.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for 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 our National Helpline Database.

1 Source
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  1. National Institute of Mental Health. Bipolar disorder.

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.