How to Recognize a Manic or Hypomanic Episode

When Might a Friend or Family Member Be Experiencing Mania?

hundred dollar bills flying out the window as a metaphor to the spending sprees sometimes seen with bipolar mania
What should you watch for in order to recognize a manic or hypomanic episode in a friend or family member?. Credit: Hiroshi Watanabe / Digital Vision / Getty Images

If someone you know has or may have bipolar disorder, it's a good idea to know the signs and symptoms of the condition. In fact, everyone should be aware of some of the signs of mania and hypomania in case they see a friend, family member, or even a co-worker experiencing these symptoms.

Recognizing the symptoms of mania is not simply academic. Symptoms of mania or even hypomania can be a medical emergency, just as can symptoms of shortness of breath, chest pain, or even bleeding.

It's not necessarily important to know all of the signs and symptoms, or the diagnostic criteria for bipolar disorder, though we will provide links where you can learn more. Instead, we will take a look at some of the more common and obvious signs you may witness if you should have a friend or family member develop mania. Then, depending on the severity of the symptoms, you may suggest to your loved one that they call their doctor, or call yourself for emergency medical assistance.

Symptoms of Mania or Hypomania

The symptoms of mania and hypomania are very similar, and for our purposes here you don't really need to know the difference. Mania usually lasts longer than hypomania, but at the onset of symptoms you won't know how long they will last. One of the main differences is that mania often requires hospitalization, whereas hypomania can often be managed as an outpatient. It's not important that you understand the sometimes subtle differences between mania and hypomania, only that you realize that your loved one needs help and be prepared to stand by until that help is provided.

If you are interested, you can learn about the diagnostic criteria for bipolar disorder or the symptoms of mania or hypomania in greater depth. Here we will share a brief checklist of some of the common behaviors associated with mania or hypomania—behaviors which you might easily observe—so you can recognize the need for help.

A Decreased Need for Sleep

Make note of any changes in your loved one's sleeping patterns, especially if your friend or loved one has lots of energy on just a few hours of sleep. Does you loved one stay awake until 3 am and then awaken at 8 am ready to go? A decreased need for sleep is common during the emergence of mania symptoms. Unfortunately sleep problems and bipolar disorder can feed off each other, with manic episodes leading to sleep problems and vice versa.

Being Engaged in Many Activities at Once

Is your friend or loved one restlessly searching for ways to work off extra energy? Washing the car every day? Someone once described this symptom as "multitasking on steroids." Do you find yourself becoming tired just listening to what your friend is doing or has accomplished in a short period of time?

Talking a Lot or Speaking Loudly, Rapidly or With Pressured Speech

Be alert to increased talkativeness. If her mouth runneth over, this could be another symptom, especially if her talk seems pressured. Talking loudly and quickly is a common symptom at the beginning of a manic or hypomanic episode. It's important to note that with rapid speech, as well as most of these symptoms, the most important element is a change from your friend's usual type of speech.

Some people talk faster than others, but if someone who usually carefully chooses her words and speaks slowly begins to talk rapidly, be aware.

Easily Distracted

Be aware as well if someone starts making "clang" associations (for example, gets distracted by the sounds of words such as going on about microphones, xylophones and ice cream cones.) Clang associations may at first sound like poetry, or at least a mediocre rap song. Yet, with bipolar disorder, there is no clear connection or relationship between the words spoken. It is the sound, rather, which is the only common denominator.

Increased Desire for Sex

If your spouse or partner is suddenly more sexually demanding, it could be a symptom of mania.

Hypersexuality is a common manic or hypomanic symptom, and may include sexually deviant behavior such as using prostitutes, pornographic websites, online interactions seeking liasons, and more. People with bipolar disorder are particularly vulnerable to online dating relationships. If you notice this behavior, keep a close eye on your loved one. In our current society this behavior can not only be a sign of a manic episode, but can be very dangerous as well.

Increase in Risky Behaviors Such as Spending or Gambling

Mania can cause disastrous spending sprees so if you're in the care of someone with bipolar disorder, consider taking the credit cards and checkbook away while your loved one is exhibiting manic behaviors. If you notice your friend "stocking up" on a number of items which aren't needed, watch her spending carefully.

Rapid Thinking

Notice if your friend or family member complains that his thoughts are racing uncontrollably. Outwardly, a person with bipolar disorder may appear to be talking fluidly and pleasantly, while on the inside they are having repetitive, unquieted thoughts. Don't be afraid to ask what he means if he talks about his thoughts racing.

Flight of Ideas

For someone entering the manic phase of bipolar disorder, the flight of ideas may be hard to follow. If you are finding it hard to make logical sense of the progression of a discussion, take notice. A common example is, "I wonder what the weather will be like tomorrow. What is the purpose of life? Oh, I forgot to feed the cat." Once again, we all have moments in which our words are thrown together in a non-logical progression. The important thing is to notice a change in your friend's presentation of her ideas.

Grandiosity

Be on the alert if your friend or loved one starts having delusions of grandeur (for example, making statements like "Justin Bieber is sending me love letters," or "We have to move to Yemen this weekend, I've been named president there.") Grandiocity is often experienced by people with bipolar disorder during the manic or hypomanic phases.

Grandiocity is defined as an exaggerated sense of importance which may be in power, knowledge (a PhD in every subject,) or identity, and which often has religious overtones ("I was sent to be a shepherd for my flock.") It is important to note that delusions of grandeur are not present in hypomania, but grandiose thinking like "I'm going to quit my job and write a novel" is a possible hypomanic symptom. Again, context is important. If it is a budding writer making this comment, it may be very normal. But the same words spoken by someone who does not enjoy writing and has never commented about writing a novel before is suspect.

​​Hostility and/or Increased Irritability

Watch out for unreasonable irritability or hostility. This is not just a symptom—it can be dangerous. Be cautious and get help if you see this type of behavior. Do not try to handle the situation on your own.

​​Excessive Religious Dedication

Increased religious zeal or involvement can be another manic symptom. Make note of this if you see it.

Bright Clothing

During a manic or hypomanic episode, a person is likely to wear brightly colored or flamboyant clothing. Of course, most people who wear bright colored clothing are not experiencing a manic or hypomanic episode. This is a subtle clue and can be helpful if it occurs with other manic or hypomanic symptoms. A change in dress may be related to hypersexuality as well, if your loved one begins wearing skimpy or revealing clothing.

When to Seek Immediate Help With Suspected Mania or Hypomania

If your friend or loved one describes auditory or visual hallucinations (seeing or hearing something that is not there) or shows paranoid or other delusional behavior (believing something which is not real,) contact their psychiatrist immediately. These are serious manic symptoms. (Hallucinations and paranoid delusions are not present in hypomania.) Hallucinations and delusions are psychotic symptoms (in contrast to neurotic symptoms like depression or anxiety) which indicate a separation from reality.

Mania in Children

Sometimes people may notice symptoms such as these appearing in a child. Unfortunately, with children the diagnosis of bipolar disorder is usually not known and the behaviors may be thought of as a behavioral disorder alone. In addition to the symptoms above you may notice night terrors, motor and verbal tics, and destruction of property. If you are concerned about a child in your life, take a moment to learn about the symptoms of bipolar disorder in children, and if concerned, talk to your pediatrician. If the child happens to be a relative or a friend's child, this conversation needs to be done gently and thoughtfully. You may wish to talk to a mental health professional first for ideas on how to approach the topic without sounding judgmental.

A Change in Medications

If your friend or family member has had a recent change in medications, or if she has stopped taking her medications and exhibits any of these symptoms, contact her prescribing doctor promptly.

A Word from Verywell

This list of symptoms is not an exhaustive list of mania or hypomania symptoms, nor is it diagnostic in any way. Instead, this is a list designed for friends and family members of typical behaviors they might easily be observed.

Be vigilant in observing behavior that resembles any of the aforementioned signs. You may consider keeping a notebook for recording manic (and depressive) symptoms for yourself. If a loved one suffers with bipolar disorder, have them share their experiences so that you can journal for them.

Unfortunately things can escalate very quickly with bipolar disorder, so pay attention and act to protect your loved one and yourself. If a life event happens, such as a change in job, breakup, move, or other change that's major, be on the lookout. These could be triggers to an episode.

If you have a loved one with bipolar disorder, there are many ways in which you can learn more about the disorder. One excellent resource is the book When Someone You Love is Bipolar by Cynthia Last. While we often want to respect our loved one's privacy, it's important to talk to a trusted friend if you are concerned about the possibility of bipolar disorder in another loved one. It's also important—especially if your loved one of concern truly has bipolar disorder—that you take care of yourself at this time.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 2013.

Blackman, K., Odom, A., Williamson, B., Miller, M., Tewari, M., and D. Weismantel. Self-Report Tool for Recognizing Mania (SToRM): A New Scale for Aiding in the Diagnosis of Bipolar Disorder. International Journal of Psychiatry in Medicine. 2014. 47(3):193-205.

Carbray, J., and J. Iennaco. Recognizing Signs and Symptoms of Bipolar Disorder. Journal of Clinical Psychiatry. 2015. 76(11):e1479.

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