Hypomania as a Symptom of Bipolar Disorder

A Key Feature of Bipolar II Disorder

Hypomania
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Hypomania is an abnormally revved-up state of mind that affects your mood, thoughts, and behavior. This commonly manifests with unusual gaiety, excitement, flamboyance, or irritability. Restlessness, extreme talkativeness, increased distractibility, reduced need for sleep, and intense focus on a single activity are other characteristic features of a hypomanic episode. The specific signs and symptoms experienced during hypomania vary from one person to another.

A hypomanic episode often signals the possibility of bipolar disorder, particularly type II. However, this state can occur for other reasons.

Diagnosing a Hypomanic Episode

Diagnosing a hypomanic episode related to bipolar disorder depends on the presence of a combination of key symptoms and features, as defined by the American Psychiatric Association in the ​Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There must be a persistent abnormally elevated, expansive, or irritable mood, accompanied by unusually increased activity for most of the day over at least four days.

The mood, activity, and behaviors that accompany hypomania are clearly different from your normal, everyday state—and are readily noticeable by those around you. The lack of mood fluctuation and persistence of your mood state helps distinguish a hypomanic episode from normal mood variation. In addition to an elevated or irritable mood and increased activity or energy, other symptoms must also be present to diagnose bipolar hypomania.

Three of the following symptoms accompanied by a persistently elevated mood—or four symptoms in association with a sustained irritable mood—are considered diagnostic for bipolar hypomania.

  • Being easily distracted
  • Feeling intensely driven to accomplish specific goals
  • Fidgetiness, pacing, or restlessness, also known as psychomotor agitation
  • Grandiose thinking, meaning unrealistic thinking about your powers, talents, or abilities
  • Excessive involvement in activities associated with a high potential for negative consequences, such buying sprees, gambling, sexual indiscretions, or risky financial investments

By definition, certain characteristics and features rule out a diagnosis of hypomania and often point toward a manic episode instead. Symptoms of psychosis, such as ​hallucinations or delusions, exclude the possibility of a hypomanic episode. Additionally, symptoms so severe that they significantly interfere with your daily functioning or necessitate hospitalization exclude this diagnosis. Finally, it's important to rule out medications or recreational substance use as a possible source of your symptoms.

Expressions of Hypomania

The diagnostic criteria for a hypomanic episode include just seven types of symptoms in combination with the characteristic mood and energy alterations. However, hypomania can manifest with a wide variety of behavioral expressions that vary broadly from one person to another.

Examples of hypomanic behaviors and characteristics include:

  • Hypersexuality, which may involve making unusual demands on your partner, inappropriate sexual advances, engaging in an affair, or spending a lot of money on phone sex, pornography, or prostitutes
  • Unusual irritability, excitement, hostility, or aggression
  • Behaving inappropriately, such as making crude remarks at a dinner party
  • Spending recklessly, like buying a car you cannot afford
  • Dressing and/or behaving flamboyantly
  • Talking so fast that it's difficult for others to follow the conversation
  • Jumping from one subject to an unrelated topic while speaking
  • Taking chances you normally wouldn't because you "feel lucky"

Hypomania and a Bipolar Disorder Diagnosis

To be diagnosed with bipolar I or bipolar II disorder, a person generally must experience depressive plus manic and/or hypomanic episodes. Experiencing symptoms associated with hypomania and depression— but not mania— suggests a diagnosis of bipolar II disorder. Other factors may determine if another diagnosis, such as cyclothymia, is more appropriate.

Treatment

Even in the absence of psychosis and wildly exaggerated moods, hypomania can have serious long-term consequences. Hypersexuality can lead to ruined relationships and sexually transmitted infections. Reckless spending can result in severe financial hardship. Inappropriate behavior can cause you to lose a job or alienate your loved ones.

Medications called mood stabilizers are the most common and effective way to treat hypomania.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Washington, DC: American Psychiatric Association; 2013.

Hypomania Diagnosis. Family Practice Notebook website.   http://www.fpnotebook.com/Psych/Bipolar/HypmnDgns.htm

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