How to Recognize a Manic or Hypomanic Episode

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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 symptoms of shortness of breath, chest pain, or bleeding are.

It's not necessarily important to know all of the signs and symptoms or the diagnostic criteria for bipolar disorder. 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.

Signs of a manic episode
Illustration by Brianna Gilmartin, Verywell

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.

One of the main differences is that mania is more severe and often requires hospitalization, whereas hypomania is managed on an outpatient basis. 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 that you are prepared to stand by until that help is provided.

Here is a brief checklist of some of the common behaviors associated with mania or hypomania—behaviors that you may likely 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 they have lots of energy in just a few hours of sleep. Does your 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 loved one restlessly searching for ways to work off extra energy? Someone once described this symptom as "multitasking on steroids." You may find yourself becoming tired just listening to what your loved one 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. This could be another symptom, especially if their 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 with most of these symptoms, the most important element is a change from your loved one's usual speech. Some people talk faster than others, but if someone who usually carefully chooses their 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 rhyming of words such as 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, they are out of context of out of character for the person with manic symptoms.

Increased Desire for Sex

If your partner is suddenly more sexually demanding, it could be a symptom of mania. Hypersexuality is a common manic or hypomanic symptom and may include uncharacteristic or risky sexual behavior such as using prostitutes, pornographic websites, online interactions seeking liaisons, and more.

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 loved one stocking up on a number of items that aren't needed, watch her spending carefully.

Rapid Thinking

Notice if your friend or family member complains that their thoughts are racing uncontrollably. Outwardly, a person with bipolar disorder may appear to be talking fluidly and pleasantly, while on the inside he is having repetitive, unquieted thoughts. Don't be afraid to ask what they mean if they talk about their 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. An example is, "I wonder what the weather will be like tomorrow. What is the purpose of life? Oh, I forgot to feed the cat." 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 loved one'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." Grandiosity is often experienced by people with bipolar disorder during the manic or hypomanic phases.

Grandiosity is defined as an exaggerated sense of importance which may be in power, knowledge, or identity, and which often has religious overtones ("I was sent to be a shepherd for my flock"). It's 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's 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.

Mania in Children

Sometimes people may notice symptoms 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.

If you are concerned about a child in your life, talk to your pediatrician. If the child happens to be a relative or a friend's child, this conversation needs to be gentle and thoughtful. You may wish to talk to a mental health professional first for ideas on how to approach the topic without sounding judgmental.

When to Seek Help

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 that isn't real) contact their psychiatrist immediately. These are serious manic symptoms.

Hallucinations and delusions are psychotic symptoms, that indicate a separation from reality. Note that hallucinations and paranoid delusions are not present in hypomania.

If your friend or a family member has had a recent change in medications, or if they have stopped taking their medications and exhibits any of these symptoms, contact their 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 that 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 from bipolar disorder, have her share her experiences so that you can journal for her.

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, break up, 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. You may want to learn about the diagnostic criteria for bipolar disorder or the symptoms of mania or hypomania in greater depth. Another excellent resource is the book "When Someone You Love is Bipolar: Help and Support for You and Your Partner" by Cynthia Last.

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