How to Recognize and Manage Hypomania

Hypomania is the term used to describe a period of elevated mood and unusual excitability. It is similar to mania, and the two types of episodes share the same symptoms, but there are significant differences between them, including the following: Symptom duration: Hypomanic episodes may only last a few days, while manic episodes can last weeks or months. Symptom intensity: Hypomanic episodes are not as severe as manic episodes. Symptom severity: Hypomanic episodes do not lead to psychotic breaks, while manic episodes can cause delusions, hallucinations, or breaks with reality that may require hospitalization. Effects on daily life: Hypomanic episodes generally do not affect a person's ability to function in their daily life, while manic episodes can cause severe impairment.

While mania and hypomania are two distinct types of episodes, they have the same symptoms, which include the following:

• Being uncharacteristically wired, upbeat, or jumpy
• Having an elevated mood
• Experiencing increased energy or agitation
• Having an exaggerated sense of self-confidence or self-esteem
• Needing less sleep
• Being unusually talkative
• Having racing thoughts
• Experiencing increased distractibility
• Making poor decisions

Symptoms can differ in presentation and intensity as they are generally interpreted against a person's baseline. Some people may experience more hypomanic symptoms than others, and hypomanic episodes can precede or follow manic episodes.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines hypomania as a milder, non-psychotic manic state with a short duration that lasts for at least four consecutive days and does not cause significant occupational or social impairment. The diagnositic criteria for hypomania in the DSM-5 also states that to be considered hypomania, someone with elevated mood must have three or more of the following symptoms and someone with irritable mood must have four or more:

• Increased goal-directed activity
• A diminished need for sleep
• Grandiosity
• Racing thoughts
• Distractability
• Reckless behaviors
• Increased/pressurized speech

These changes must also be observable by others and not be able to be attributed to substance use, like medications, drugs, or alcohol. Hypomanic episodes also cannot lead to psychotic features, like delusions or hallucinations, as this, by definition, makes them manic episodes.

Hypomania can be a symptom of bipolar disorder, but anyone can experience a hypomanic episode. A psychiatric evaluation may be required to determine the cause of the episode and what type of treatment is needed. During a psychiatric evaluation, a psychiatrist or other trained medical professional will interview the person and explore their personal history, feelings, thoughts, and behaviors. Then, they will assess the presence and severity of symptoms and how they impact the person's ability to function. They may present various situations to the person to evaluate how they behave and respond to understand the person's non-verbal cues, concerning behaviors, and emotional regulation.

Medical tests, like bloodwork, may also be necessary to rule out any physical health conditions that may be affecting behavior. When diagnosing someone with hypomania or bipolar disorder, other causes must be ruled out to ensure proper treatment.

In addition to bipolar disorder, hypomania may also be caused by seasonal affective disorder, schizoaffective disorder, brain injury, stroke, brain tumors, dementia, lupus, multiple sclerosis, drug or alcohol use, and some medications, including antidepressants. Some research has found that hypomania may have a genetic component, so people with a family history may be more at risk. Stress, overstimulation, lack of sleep, and major life events can also cause hypomania.

People can experience hypomania for other reasons, but it is a primary symptom of bipolar disorder. Bipolar disorder is commonly divided into two subtypes, bipolar I and bipolar IIbipolar I and bipolar II, and people with either type can experience hypomania. The primary differences between bipolar I and bipolar II are as follows:

• Impact: Bipolar I is likely to interfere with daily activities. Bipolar II can, but it generally has less significant effects.
• Depression: In bipolar I, depression lasts at least two weeks. In bipolar II, it lasts for at least two weeks but can be longer lasting.
• Mania: To be diagnosed with bipolar I, someone must have experienced at least one period of mania lasting at least a week or requiring hospitalization; people with bipolar II have never had a manic episode.
• Hypomania: People with bipolar I may experience hypomania, whereas people with bipolar II experience only hypomania, not mania.
• Psychosis: In bipolar I, people may experience hallucinations or delusions; people with bipolar II do not. Extreme symptoms of bipolar I may require hospitalization, while bipolar II does not.

Studies have found that people with hypomania experience both favorable and unfavorable characteristics. Research shows that higher hypomania scoreshigher hypomania scores may be associated with higher pain tolerance, self-efficacy, coping, physical activity, and creativity. This same study also found that people who experience hypomania may also develop physical and social overactivity, irritable and elevated mood, and increases in sexual interest, extraversion, and risk-taking behaviors, but they were also more likely to be married and had high monthly incomes.

Research has also found that substance abuse and sleep disturbances were more common in people with hypomania.

treatment options for hypomania can include medications, therapy, and lifestyle changes. If hypomania is mild, it may not require treatment. In this case, healthcare providers may suggest lifestyle changes and self-care, including relaxation techniques, exercise, and getting enough sleep. People with more intense symptoms or those who have hypomania as a symptom of bipolar disorder may require medication and therapy.

Medications may include benzodiazepines, mood stabilizers, and antipsychotics can help balance symptoms relatively quickly, but bipolar disorder requires lifelong treatment to avoid relapses into full-blown mania or depression. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are commonly used to treat symptoms of bipolar disorder.

To manage hypomania, work with your health care provider to develop a treatment plan and adjust it as needed. Asking friends and family to help you keep you with your treatment plan can also be helpful.

Planning activities and having a routine for sleeping, eating, and exercising can help. Vigorous activity, like swimming, jogging, and bicycling, can help with symptoms like disrupted sleep, anxiety, and depression. Tracking moods, activities, and overall health can help identify signs and triggers that may lead to hypomania and allow for adjustments that may reduce the risk of episodes.

Children and adolescents can experience hypomania, but may have different symptoms than adults. Signs of mania or hypomania in children may include having extended periods of silliness or happiness, a short temper, or extreme irritability. They may talk fast, have difficulty sleeping without feeling tired, and may have trouble staying focused. Children or adolescents experiencing hypomania may also experience racing thoughts, have difficulty staying focused, or engage in risky or reckless activities. These symptoms and behaviors can affect school performance and peer relationships.

To diagnose hypomania and bipolar disorder in adolescents and children, healthcare providers will ask questions about their behaviors, sleeping patterns, mood, and energy levels. Diagnosing these conditions in these age groups can be challenging as symptoms may overlap with other disorders, like oppositional defiant disorder, ADHD, conduct disorder, and anxiety disorders.

Older patients with mania or hypomania may have some of the same symptoms, including mood disturbances, grandiosity, flight of ideas, distractibility, and decreased sleep, but they may also show increased confusion and irritability. Some research indicates that the severity of manic and depressive symptoms in bipolar disorder appear to be reduced in older adults. This study also found that older age is associated with lower psychosocial functioning in bipolar disorder, including independence, autonomy, interpersonal relationships, and work performance. Treatment in older adults is the same as in other age groups but should also include improving social and personal functioning and increasing quality of life.

Long-term treatment of hypomania depends on the severity and if it is associated with bipolar disorder or other mental health conditions. Mild symptoms of hypomania without any other mental health conditions may not require extensive treatment. Generally, treatments for severe hypomania are the same as those for mania and bipolar disorder. They may include lifestyle treatments, therapy, and medication. Bipolar disorder is a lifelong condition, and maintaining and adjusting long-term treatment can help prevent relapses and improve quality of life.

Research has found that creativity and hypomania may be connected. Choosing a creative profession may indicate that a person is behaving more impulsively, but having success in that profession may have more to do with confidence and ambition than hypomania. Many famous artists are believed to have bipolar disorder, including Vincent Van Gogh, Virginia Woolf, Ernest Hemingway, and Winston Churchill.

Many misconceptions surround hypomania. People may believe that hypomania merely means that someone is in a good mood and being productive or that it is a fun, happy feeling. However, the truth is that hypomania can be a symptom of severe mental health conditions that can significantly impact a person's life.

Research has found that there are some effective ways to address the stigma around people living with bipolar disorders. Some of these methods include providing education to improve positive attitudes toward psychological disorders, increasing patient understanding of psychiatric disorders to improve self-esteem, and highlighting the importance of hope, optimism, empowerment, and identity.

There are many resources available for people living with bipolar disorder and symptoms like hypomania, including: The Depression and Bipolar Support Alliance (DBSA) National Alliance on Mental Illness (NAMI) Substance Abuse and Mental Health Services Administration (SAMHSA) 988 Suicide & Crisis Lifeline

Hypomania can be considered a milder form of mania, and while it is frequently seen as a symptom of bipolar disorder, it can occur for several other reasons. While hypomania does not lead to psychotic breaks, it can affect how people live their everyday lives. If you are experiencing signs of hypomania or bipolar disorder, talk to a mental health professional for a proper diagnosis and to establish an individualized treatment plan.