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Mood Episodes In Bipolar Disorder: What Is Typical For A Hypomanic Episode?

by — 2020-02-23 in Mental Health
Together with depression, hypomania is one of the two main episodes of bipolar disorder type II. It usually occurs for the first time in younger adult years and may be hard to diagnose because it can resemble the usual attitude problems of adolescents.

Bipolar disorder is still a fairly unknown and stigmatized disease. It was called manic-depressive disorder in the past due to one of its main episodes – mania – that comes in shifts with depression. People with bipolar disorder have difficulties carrying out everyday tasks, and often experience mood changes and shifts in energy levels, all of which affect the quality of their lives.

Bipolar disorder is a mood disorder that starts in early adulthood and usually lasts a lifetime, but with proper treatment and lifestyle changes it is possible to live a normal and fulfilling life. The symptoms sometimes even diminish with age. 

There are two main types of bipolar disorder – type I and II. Besides depressive episodes, bipolar I disorder is interspersed with episodes of mania, and bipolar II has less severe or hypomanic episodes.

Mood swings in bipolar disorder can range from exhilaration (mania or hypomania) to an extremely low mood (depression). They can become mixed, so a person might experience both at the same time, which might be the toughest form of bipolar disorder because it can be hard to identify and work out what a person is feeling.

The term “hypomanic” was coined in Ancient Greece by the famous Hippocrates, but he described a personality type rather than an illness. German neuropsychiatrist Mendel later suggested that the word should now describe a milder form of mania with a "less severe phenomenological picture". 

What is typical for hypomania?

The ICD-10 calls hypomania a “mild mania”, while the DSM-5 defines it as a period of abnormally elevated, expansive, or irritable mood occurring most of the day and lasting at least four consecutive days, but studies have found that almost 30 percent of hypomanias last two or three days and the four-day method would wrongly classify one third of bipolar disorders as major depressive disorder. 

At least three of the following symptoms of hypomania must occur for someone to get diagnosed with bipolar disorder:

  • Feelings of grandiosity
  • Lack of desire for sleep (even three hours feels enough)
  • Being extremely talkative
  • Being easily distracted
  • Racing thoughts
  • Focusing on a specific goal or purpose (creative ideas)
  • Engaging in risky behaviors
These are all symptoms of mania as well, but the main difference is their intensity. As long as the episode is not severe enough that it interferes with a person’s personal relationships, their work, and they are not losing contact with reality, it is classified as hypomania. The DSM-5 suggests that hypomania doesn’t bring significant functional impairment, while mania comes with functional impairment as well as psychosis.

Hypomanic episodes can be recognized by being very different than a person’s usual behavior. The onset is usually sometime in the early twenties for both men and women, but there are exceptions; it can occur in childhood or older age. If someone who is usually quiet and well-behaved suddenly has bursts of energy and starts to misbehave, it could be a sign that something’s going on, something more serious than “just a phase”. 

The main differences between hypomania and mania

Mania and hypomania are emotional states characterized by certain periods of elevated and/or irritable mood, heightened creativity, and hyperactivity in general. While manic episodes can be a scary to witness because a person might be detached from reality, hypomania is milder and can often go unnoticed, which is a different kind of problem.

While mania can hardly be missed, because a person's self-esteem skyrockets, they feel all powerful like they're a god-like figure destined for greatness, hypomanic episodes are — due to the fact that they’re not this intense — unfortunately often attributed to “hormones” or the sensitive adolescent age. A person with bipolar disorder sometimes remains untreated for years. Even though hypomania is a common feature of bipolar II disorder and cyclothymic disorder, it is sometimes part of narcissistic and schizoaffective disorders as well.  

It’s possible to experience symptoms of hypomania if you suffer from depression and use certain antidepressants, as well as if you are stressed, sleep deprived, or if you consume stimulant drugs.

The bottom line

If someone has significant mood fluctuations but they have never experienced a manic state, it’s possible that they have bipolar disorder type II. There’s certain stigma surrounding bipolar disorder in general, but especially hypomania. Even though there’s also fair amount of stigma surrounding mania, many people will better accept that someone is so sick that they can’t retain a job and relationships rather than hypomanic fidgeting and fast speaking without any serious damage to a person’s life.

If you suspect that you or someone close has bipolar disorder, it’s essential to get checked and diagnosed soon. It’s very important have a support network – people familiar with bipolar disorder who are able to foresee an upcoming episode – (hypo)manic or depressive, whichever one it might be. Someone who knows us well can provide a better perspective on how things are in reality, which is always better than relying solely on the voice in our head, especially if "the voice" suffers from a serious mental disorder.

Sources & Links

  • Photo courtesy of SteadyHealth

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