Hypomania is not a familiar attribute of bipolar disorder for most of the general public. It’s a characteristic of bipolar II, which, again, isn’t quite as well-known as bipolar I. “Hypo-” is a prefix derived from the Greek word “hupo,” meaning “under.” In medical jargon, it’s used to describe a symptom or state that is “beneath” or “below” normal. So, when we talk about hypomania in bipolar disorder, one can infer that it is below the normal threshold of mania. This is technically correct, but what does it actually mean?
Hypomania, compared to mania, is one reason that bipolar goes undiagnosed or misdiagnosed for so long. People with bipolar II most often seek help for depression and might not recognize they have experienced hypomania until they are screened for bipolar disorder. Unfortunately, patients see an average of five doctors and wait an average 10 years before receiving a correct diagnosis of bipolar disorder. It’s frequently misdiagnosed as major depressive disorder. This is especially harmful since antidepressants have a high likelihood of triggering mania or hypomania.
Similar to mania, you can still experience euphoria and hyperactivity with hypomania. Some people say that they actually enjoy it. For them, you get some of the perks of mania, like higher energy, without fully losing control. For others, it’s not as great, bringing with it feelings of increased anxiety and dysphoria along with the extra energy. Those with bipolar II only experience hypomania. They do not experience mania. However, people with bipolar I can have periods of hypomania in addition to manic episodes.
What does hypomania look like?
The diagnosis tool that medical professionals use for diagnosing mental health is called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Here is what the latest edition, the DSM-5, has to say about a hypomanic episode:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
- During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
There are some stipulations that go along with diagnosing these symptoms as a hypomanic episode. For example, behavior has to be outside the norm. If you are a generally talkative and hyperactive person, you may not be hypomanic. It has to be a distinct period of uncharacteristic behavior that doesn’t exist between episodes. The behavior also has to be noticeable to others, even if they don’t call you out on it. Finally, the symptoms can’t be due to substance use. This includes alcohol, medication, recreational drugs, etc., though these substances can induce hypomania.
What is the difference between hypomania and mania?
There are a few differences between mania and hypomania:
- In hypomania, the mood swing is not terribly long. It lasts at least four days, but not much more. If the symptoms persist for more than a week, a medical professional may start to consider whether or not it’s actually a manic episode.
- Hypomanic episodes do not cause drasticimpairment socially, at work, at school or otherwise. If there is drastic impairment in these areas, it’s considered mania. Whether it’s drastic or not is a little subjective, but it’s one of those instances of you know it when you see it.
- They do not require hospitalization. If you are hospitalized, it automatically becomes a manic episode.
- Manic episodes may include psychotic symptoms. Hypomanic episodes do not.
It is possible for someone with bipolar II to develop bipolar I. So, if you notice changes in your behavior or usual symptoms, contact your doctor. You may need a new diagnosis and/or a change in treatment.
Photo credit: Hamad AL-Mohannna