Hypomania And Hypomanic Episodes Defined

Not everyone who becomes manic experiences the full-blown syndrome of a manic episode. Hypomanic individuals show an expansive, energized and sometimes elated mood, with rapid thinking and pressured speaking in evidence. At a minimum (for the label hypomania to be appropriately applied), this expanded mood state must persist for at least four straight days.

As is the case with manic episodes, hypomanic episodes are also characterized by the presence of characteristic symptoms. At least three of the following must be present (for at least four days) before the diagnosis of hypomanic episode is appropriate:

  • an inflated or expansive and even grandiose (but not delusional; not completely out of touch with reality) sense of self
  • reduced sleep needs compared to normal
  • talks more than usual
  • subjective sensation of racing thoughts (often called a "flight of ideas")
  • distraction or derailment of thought occurring significantly more often than normal
  • an increase in goal-directed activity, or physical agitation
  • a marked increase in participation in risky but pleasurable behavior (such as unprotected sex, gambling, unrestrained shopping, etc.)

You'll notice that these are essentially the same criteria that are applied to manic episodes. What is suggested (and what is intended) by this duplication of criteria is that what separates a hypomanic episode from a manic episode is mostly the degree of intensity (or energy) present in the behaviors the manic person emits (and not in their variety). When the observed energy level is above average but still within normal limits, you have a hypomanic state on your hands. When the energy level goes off the normal scale entirely, you have a manic episode.

People experiencing a hypomanic state are not necessarily unrelentingly sunny in disposition; they may experience irritable mood states too, as is also the case with full manic episodes. However, whatever level of irritability may be present during a hypomanic episode is by definition nowhere near as severe as what might occur during a fully manic episode.

Since hypomania is less severe than mania, people experiencing a hypomanic episode may retain sound judgment and not engage in self-destructive behavior. In fact, their sharpened intellect and ability to function with little sleep contributes to hypomanic individuals' increased productivity compared to non-manic people. This is to say, hypomania can create a distinct advantage in the workplace, because it helps people to be maximally productive and get more things done than their peers. This positive aspect of hypomania is often seen as a benefit by people who have bipolar disorder. Hypomanic individuals are likely to be creative risk-takers, who can bring creative ideas to fruition. Numerous historical and contemporary figures, including composer Ludwig van Beethoven, pioneering physicist Issac Newton, authors Charles Dickens and Edgar Allen Poe, artist Vincent van Gogh, statesmen Abraham Lincoln, Winston Churchill and Theodore Roosevelt, and media mogul Ted Turner have been documented to have experienced severe and debilitating recurrent mood swings. Some authors (e.g., John Gartner, MD [Hypomanic Edge] have even suggested that America's unique entrepreneurial character and spectacular economic achievements achieved over the last century are due in large part to a high incidence of hypomania among American entrepreneurs. While we can neither confirm or discard this interesting speculation, we can say that there is more to hypomania than a simple business advantage. When you are hypomanic on a regular basis, you have a mild form of what can be a disabling illness. There is no guarantee that your hypomania will stay stable as hypomania. When left untreated, the underlying causes that produce hypomania can and do sometimes worsen until full manic episodes occur.

Comments
  • A friend

    Hello, a friend of mine was diagnosed with being bi-polar 2 just a couple of months ago (after only two visits at her doctor)- and I really wonder about this diagnosis - you state in your article that for instance hypomanic episodes must at least last for 4 days to be recocgnised as a pole within a bi-bopolar disorder ... but my friend´s behaviour and mood changes sometimes within minutes - depending on how she had something planned and whether or not it went good for her or whether she got the response she wanted - just like everybody else... Yes she shows ill judgement, especially within her social contacts and own behaviour and yes she shows her current mood and feelings in an extreme way and she doesn´t seem to be able to realize that other ppl act upon their moods and feelings as well - she´s often even doubting that other ppl have feelings - She either feels attacked and abused or utterly adored and loved...no matter if she´s sad or hyper and no this is not a matter of days but a matter of how she analyses other ppls actions...since she´s been given meds and sees a therapist she has changed her judgement about her own inapropreate behaviour in the past alright (it´s all due to her bi-polar disorder) but she still judges others and situation in the exact same way as before (with a lot of blaming and accusing included)...as if she can´t consider that others have feelings and emotions on which they act upon as well....she seriously claims - no matter if she´s hypermanic or depressed or both at the same time according to the ppl she´s with- that everybody else is in control of her/his doing, therefore responsible not only for their doing but also for her wellbeing AND actions...not even when she´s severely sad she wonders about guilt or lacks the energy to think of reasons why somebody else is to blame for her sad state... I´m sorry, but I seriously doubt this diagnosis and fear for my friend´s well being and mental health, for real...and I wonder how on earth can any doctore diagnose somebody that fast and quickly with any sort of mental health problem?

  • im not physcotic

    i have recently been diagnosed with bipolar disorder 2. my family and friends have always bene there for me. but sometimes i feel that i can do it alone. but i know i cant. and if it were not for sights like this i would still be thinking taht i need no one. thank you for helping me understand more about bipolar disorder and the medication.

  • Anonymous-1

    I think its a combination of everything. Behavior modification, the disorder and meds. I think doctors give out meds and don't follow up with the patient and family going through extensive behavior counseling. Common sense tells you the patient and the loved ones have a life time of pattern that have been learned, imprinted, etc upon one another. The behavior of interaction should be held accountable on both-all parties. Bottom line people are going to behave and treat us the way we allow them, bipolar or what. Question is.....is it the illness or the learned behavior patterns. It's both. The best way I see to approach this situation is again bottom line be accountable for your behavior with that person. Don't let them get away with bad behavior that hurts you or others. Are you tired of walking on eggshells? Yeh, me too. With family members it seems you can distance yourself for periods of time and then something happens within the family unit that ultimately brings you back with the illness of the person. And its like a drop of water in a bucket with the ripple effects that persons illness ripples out into everyones life that is close to that person. To end with its hard and almost unrealistic to think you can throw someone out of your life permanently even after death they are still in your mind and memory with either negative or happy feelings and emotions about events etc that you had no control over that can still live on and on. It has to be dealt with straight on but extremely cautious and gentle spirit and trying your hardest to get into their head to deal from their reality of thinking because they are not on your reality.

  • I have it to. S.

    I have just found out that I m bibolar two months ago. I can understand your concearn and I must say that I have similar thoughts about my self. What you say is true about your friend acting the same way as she did before on things that happen in her life. This is also logical. We still have mood swings depending on what is happening in our lives. The diffence is that we also have great moodswings for no reason at all. Nothing has to happen to me for my mood to swing but if for example something bad happens to me then it will probably bring me down. It is also said that bipolars are hypersensitive meaning that we experience our feelings a lot stronger. I think you should check when her mood swings for no reason as I think she is in what is called a mixed state most of the time as I am most of my time.

  • Melissa

    RE: How can a doctor so quickly diagnose the patient with BPD?

    Answer: Experience. The DSM IV is a diagnostic manual...like a car manual. When you take your car to be inspected, it'd be nice to know that the guy under your hood has a lot of experience. If he does, he'll know just what to look at when you tell him that your car is making a dinging sound here and a clanking sound there, etc. Your mechanic is well-versed in the specific make and model of your vehicle and its corresponding parts. He's spent many years studying the way they work together and has been in business a long time because he takes pride in his work and doesn't cheat people but is fair and objective.

    Although using a car analogy is overly simplistic, the truth remains the same. The doctor is a professional and has learned to see the symptoms for what they are--indicative of a disorder. When the brain is ill--it will act in certain obvious ways. Of course, there are so many disorders that seemingly have the same symptoms and psychology has been constantly critiqued for having vague and over-broad criteria for diagnoses, but please be patient with her caregiver and realize that there are medical tests that will be of help, too. She can get a scan of her brain and see if there are serotonin and or dopamine differences....that lead to brain illnesses.

    The fact is: She's on the road to treatment and a successful recovery and happy life. Be supportive and not so quick to freak out.

    God bless you

  • Deborah

    Countering the arrogant response implying that a doctor can diagnose a patient in the same way a mechanic can diagnose a car, many articles written in the previous 10 years point out that the diagnostic criteria in the DSM IV for bipolar and borderline personality overlap in many areas. Bipolar disorders are described as having more discreet boundaries than many psychiatrists observe in practice, where people who cycle far more frequently than 4 times a year or even every 4 days are now considered bipolar instead of borderline. Fortunately either diagnosis is treated in much the same fashion, but the causes are assumed to be different. Borderline personality is assumed to be a psychological maladaption to a stressful life while bipolar disorder is assumed to have a physiological etiology (though nothing definitive seems to have been determined). Just remember that words are not things. The observation that someone's way of behaving has negative consequences is reason to get help. Just be aware that for more functional people, practices like mindfulness practices like mindfulness based stress reduction, meditation or cognitive therapy have fewer side effects than the mental health system.

  • Anonymous-2

    Those symptoms are 'typical' symptoms. Everyone is different.

    Being a sufferer of Bi-polar Type 2, and not having days at a time where I'm elated and hyper active. Sometimes, it's an hour, or six hours. It depends.

    Typical symptoms aren't generally ones that are all the time. They are the type that were founded in a study of so many people, these symptoms occured more than others.

    Does your friend take any medicines?

  • jaimee

    you should put pictures up cuz im doin a power piont on bipolar diorders and pictures would really help

  • Brandy

    I find this extremely interesting. I am so confused. I was just released from the hospital after being diagnosed with bipolar II hypomanic. I, however, do not have depressive episodes. I am wondering how they so quickly diagnosed me as being bipolar. How can someone that doesn't know you from Adam be so quick to say that you are such and say here take this drug??! I am a person full of energy and not real sure that I am in fact mentally ill. I have done research and realized that I have symptoms of bipolar, but doesn't everyone? Really. So am I supposed to continue taking these drugs they have put me on feeling somewhat zombiefied? Please respond if anyone is listening. I was "labeled" as a unique case that is characterized strictly by hypomanic epoisodes. I do not have depressions. I have a hard time concentrating. I talk a lot. I always thought I had ADHD and thought that was the problem. I keep getting mixed signals. PLease someone repond. I feel lost in translation as an extremely intelligent person.

  • Jasmine

    After reading all these stories really helped i was recently diagnosed with AD/HD, and im confused im hyper but there are times where ill sit there and daze and not move for hours cause im listening to what my mind is telling me, at school im always known as crazy jasmine everywhere i cant sit down cheery and making jokes and making everyone laugh, but then it dosent last for long i start to feel like i want to cry and i hate everyone arond me and i dont know whats going on around me, i cant watch tv for more then 5 min and i will talk the whole time if not with somebody else, ill talk to myself which i think is pretty normal i will get nervus and edgy. im very confused about how im really high, i have to use alot a maraquana so i can concentrate on my work it slows me down, i cant read a book or write or go on the computer cause im not moving

    i hope someone can tell me if this is noramal or not or its just AD/HD, my parents tell me im noraml everytime i open up to them and i have no one to go to but my BF and teachers at school which submitted me to mental health they said they where going to put me meds for ADHD and see if that works first.

    i got to stop, because i wont i ramble for hours and talk obsevivly loud

    anyway i would love your opinions

    thank you and have a great day

  • Tom (5-24-2010)

    I empathize with your being "lost in translation," Brandy (see her 2-11-2010 comment below), for I have borderline Bipolar II hypomania now myself...

    I too am full of energy we all have so much to live for, whether it's people, the arts, literature, work, sports, or just making a positive difference in the world.

    Please see Dr. Daniel Carlat's insightful article in the Sunday 4-25-2010 New York Times Magazine (pp. 41-43 he gets right to the point). His title is:

    "Mind over Meds: how I decided my psychiatry patients needed more from me than prescriptions."

    D. Carlat is an associate clinical professor of psychiatry at Tufts University School of Medicine & the publisher of The Carlat Psychiatry Report. His book, "Unhinged: the Trouble With Psychiatry," just came out in May 2010. (He's rather unconventional, as you can see.)

    That said, please note that "refractory" (= stubborn, persistent, hard to treat) Bipolar II Disorder, with waxing & waning episodes of hypomania (&/or severe depression), may respond well to the 21st-century version of ECT (Electroconvulsive Therapy).

    ECT is controversial, but bilateral (not unilateral) ECT worked well for me in just a few months, after NO meds had definitively helped over a period of many years. Now if I could just sleep thru the night! :-)

    Good luck. We're all in this together...

    Tom

    Interesting - Brandy - Feb 11th 2010

    I find this extremely interesting. I am so confused. I was just released from the hospital after being diagnosed with bipolar II hypomanic. I, however, do not have depressive episodes. I am wondering how they so quickly diagnosed me as being bipolar. How can someone that doesn't know you from Adam be so quick to say that you are such and say here take this drug??! I am a person full of energy and not real sure that I am in fact mentally ill. I have done research and realized that I have symptoms of bipolar, but doesn't everyone? Really. So am I supposed to continue taking these drugs they have put me on feeling somewhat zombiefied? Please respond if anyone is listening. I was "labeled" as a unique case that is characterized strictly by hypomanic epoisodes. I do not have depressions. I have a hard time concentrating. I talk a lot. I always thought I had ADHD and thought that was the problem. I keep getting mixed signals. PLease someone repond. I feel lost in translation as an extremely intelligent person.

  • Kylie

    My daughter has been smoking marijuana now for 4 months. She started taking anti-depressants for 2 of those months due to emotional depression from past years. Recently she came home from a party after smoking marijuana very heavily and we thought that someone had drugged her. She was having hallucinations, saying she was really happy and also breaking down crying all at once. We had her hospitalised in the mental health hospital and had her urine and bloods tested. The results showed that she only had marijuana in her system. The doctors have been treating her with an anti psychotic drug to level her elevation moods. It has taken nearlly a full week for her to show signs of normality but she still is not fully there.

    The pyschiatrist has heard of her past and the symptons of her behaviour she has experienced and what he has experienced after closely monitoring her and came to the solution she has hypomania. I have now researched this and see all the symptons there and now know what we are dealing with.

    Please know that marijuana just not only has long time effects but surely does alot of damage to your brain short term. If she was to continue taking marijuana it could fully take her to manic which is more dangerous and could be full term.

    She has to take this medication for a few months now and seek counselling as she is still not her self as yet.

  • DC

    To whomever posted what I've pasted in below,

    Please don't post opinion as fact. There is nothing medically that supports what you say. You can learn more here: http://medicalmarijuana.procon.org

    I wish the best of health for your daughter and your family.

    Sincerely,

    DC

    "Please know that marijuana just not only has long time effects but surely does alot of damage to your brain short term. If she was to continue taking marijuana it could fully take her to manic which is more dangerous and could be full term."

  • JD

    Don't be an idiot. Marijuana contains THC, and THC is a mind-altering substance. Common sense dictates that any mind-altering substance carries great potential to alter the mind in negative ways. Whether it has been proved medically or not carries no merit because there is no medical evidence to suggest that marijuana has no negative effects. We don't currently understand the human mind well enough to prove anything about how it is affected by mind-altering substances. We can't even be sure about our most well known prescription medications that fall under this category.

  • Deena

    This is a great blog website- I have read so many insightful takes on the bipolar issue. It comes and goes like a dark cloud of bla- then the sun comes out again and shines shines shines. Bipolar episodes do not have to rule your life- do NOT give into this syndrome. It can peak and wane during many times in your life. This "wrinkle" is managable- However our bodies are so sensitive and have specific needs. So listen to the needs of your body. Here are just a few tips to get you started. Nutrition is the key!!! Omega fatty acids 1.8 grams daily. Vitamins and all minerals, Inositol and choline, amino acids, Acetyl L-carnitine that crosses the blood brain barrior, and Ginko Biloba. A gluten free diet has shown also to decrease inflammation in the body, which further decreases the episodes of bipolar attacks. Remember inflammation of the nervous system is the enemy. Sugar is another thing that increases inflammation of the nervous system. Acupuncture works in calming the Nervous System. I am not here to debate anything- have a medical degree and have years of personal experience. I just want to help people- please check with your MD - before trying any of the above information. Let us not forget massage therapy and good old fashioned exercise. Be kind to yourself- and get lots and lots and lots of rest. Oh just wanted to add....For women try and watch if bipolar episodes are more commen before your periods- most of the time they are...this is because of the inflammation the premenstration causes to out nervous sytem. Hope this helps someone- take care

  • Anonymous-3

    I've smoked marijuana since high school and I'm in my 40's now. I was diagnose with Hypomania when I was 23 and ignored it. Now I've been diagnosed again with hypomania again and i still refuse to take medicine. I have never had any bad side effects of marijuana. I own my own company and have a great family. I truly believe the marijuana has kept me even keeled and slowed down my racing thoughts. It has also helped me relax and get more sleep.

  • maria younas

    i guess my dad has been sufring frm sme kind of mental disordr n this one matches his most of symptoms some times he beco mes vry ambitious shopping continuous talking irritation n doesnot sleeps at night this articl has hlpd me to undrstnd his problm

  • Anonymous-4

    My son was diagnosed with bipolar About 5years ago. He lives with me because he can't take of himself. It makes me so sad because I can't get him to the doctor anymore. He won't take meds, has very poor hygiene and blames me for everything. Twice I had to call the police to get him to the hospital and he hates me for that and reminds me everyday. I don't Know What to do to help him.