Many many different things trigger my episodes. Stressful life situations (stress at work, death in family, anxiety-provoking obligations, wrong thing said that upsets me, fight with someone, having too many things to handle, holidays/family relations, sickness, vacations, and more), medication changes, sleep issues, change in seasons, too much alcohol, eating poorly, excessive exercise, pleasurable excitements that rile me up too much, a particularly bad menstrual period, loneliness, others?, mystery causes.