Hypomania as a Symptom of Bipolar Disorder

Hypomania is an abnormally revved-up state of mind that affects your mood, thoughts, and behavior, and is a potential symptom of bipolar disorder, particularly type II. A hypomanic episode commonly manifests with unusual gaiety, excitement, flamboyance, or irritability, along with potential secondary characteristics like restlessness, extreme talkativeness, increased distractibility, reduced need for sleep, and intense focus on a single activity. The specific signs and symptoms experienced during hypomania vary from one person to another.

While hypomania could be a symptom of bipolar disorder, this state can occur for other reasons, including depression or being an effect of a drug taken. The two concerns are diagnosed separately, so receiving a diagnosis of hypomania does not necessarily mean also being diagnosed as having bipolar.

Expressions of Hypomania

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 what's being said
  • Jumping from one subject to an unrelated topic while speaking
  • Taking chances you normally wouldn't because you "feel lucky"

Diagnosis

Diagnosing hypomania 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 and abnormally elevated, expansive, or irritable mood, accompanied by unusually increased activity and energy 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 to those around you. A lack of mood fluctuation and persistence of your mood state helps distinguish a hypomanic episode from a normal mood variation.

Bipolar Hypomania

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.

Bipolar hypomania is considered present when one experiences three of the following symptoms accompanied by a persistently elevated mood, or four of these symptoms in association with a sustained irritable mood:

  • Reduced need for sleep without feeling tired
  • Unusual talkativeness or feeling pressure to keep talking
  • Flight of ideas or feeling that your thoughts are racing
  • 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 as spending sprees, gambling, sexual indiscretions, or risky financial investments

Differential Diagnoses

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 hypomania as a possible diagnosis. It's also important to rule out medications or recreational substance use as a possible source of your symptoms.

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; your doctor may prescribe one or more of the following:

  • Lithium (a mood stabilizer with antidepressant effects)
  • Valproic acid (an anticonvulsant)
  • Benzodiazepines (anti-anxiety drugs)
  • Antipsychotics (can reduce hypomania symptoms until the lithium or valproic acid take full effect)

Additionally, there are holistic approaches that can help, including:

  • Regularly eating meals
  • Exercising daily
  • Getting seven to eight hours of sleep each night
  • Avoiding stimulants that could act as triggers, such as caffeine, sugar, and loud, crowded social scenes

If you've been experiencing symptoms related to hypomania, make an appointment with your psychiatrist. They will determine if a diagnosis of hypomania is accurate, and if it's also a symptom of bipolar disorder.

View Article 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
  • Psychiatric Times. A More Nuanced View of Hypomania. http://www.psychiatrictimes.com/bipolar-disorder/more-nuanced-view-hypomania
  • Harvard Health Publishing. Ask the doctor: What is hypomania https://www.health.harvard.edu/newsletter_article/what-is-hypomania
  • Psych Central. Hypomanic Episode Symptoms. https://psychcentral.com/disorders/hypomanic-episode-symptoms/