Bipolar disorder is a complicated mental health condition that can go undiagnosed or misdiagnosed for years. Hypomanic episodes, one key aspect of the condition, can be especially tough to pick up on. This may make it even harder to receive an accurate diagnosis of bipolar disorder (or a related health issue) and get effective treatment. Here’s what you need to know about hypomania, including the subtle signs to keep in mind.
1. Hypomania means someone is experiencing an elevated, energized mood and accompanying behavioral changes.
Bipolar disorder causes a person to shift between periods of emotional and energetic highs (hypomanic and manic episodes) and lows (depressive episodes), the Mayo Clinic explains. In between those spells, they can experience little to no symptoms.
- Feeling abnormally upbeat
- Feeling jumpy
- Feeling euphoric
- Increased activity or energy
- Heightened self-esteem
- Trouble sleeping
- Talking more than usual
- Irritability or agitation
- Racing thoughts
- Taking behavioral risks, like making poor financial decisions
2. Hypomania involves the same symptoms as mania, but on a less intense level.
“Hypomania differs from mania only by degree of symptom severity and level of impairment,” Michael Thase, M.D., professor of psychiatry and director of the Mood and Anxiety Program at the University of Pennsylvania Perelman School of Medicine, tells SELF. As Dr. Thase explains, if the episode is severe enough to damage a person’s work, relationships, or home life; requires hospitalization; or includes psychosis (losing contact with reality), then it is classified as mania.
Episodes of hypomania, on the other hand, are subtler, the Mayo Clinic says. If you’re going through one, it might just feel like you’re way more “up” than usual, but not to a potentially harmful degree.
3. You can be naturally upbeat or energetic all or most of the time without experiencing hypomania.
It’s entirely possible for someone to exhibit certain aspects of hypomania without actually going through a hypomanic episode, Nassir Ghaemi, M.D., M.P.H., professor of psychiatry at Tufts University School of Medicine, tells SELF.
Remember, you need to present with at least three signs of hypomania—along with an extended and unusually upbeat mood—for at least four days to officially have a hypomanic episode. That “unusually” in there is key because the episode needs to be a pretty sudden change from your baseline mood and behavior, Samar McCutcheon, M.D., clinical assistant professor of psychiatry at The Ohio State University Wexner Medical Center, tells SELF. So, if you looked at that list of symptoms up there and realized you embody most of them most of the time, that doesn’t automatically mean you’ve experienced hypomania.
4. Not everyone with bipolar disorder goes through hypomania.
Bipolar disorder is separated into different categories based on the mix of episodes a person experiences.
In order to be clinically diagnosed with bipolar I disorder, you have to have at least one manic episode lasting at least seven days (or severe enough to require hospitalization), per the National Institute of Mental Health (NIMH). You may also experience episodes of hypomania. While the minimum is four days, these can last up to several months, Dr. Ghaemi says. Someone with bipolar I may also experience depressive episodes lasting at least two weeks, or mixed episodes with symptoms of depression and mania. Basically, someone with bipolar I may deal with a variety of mood phases that don’t necessarily include hypomania.
In order to be diagnosed with bipolar II disorder, you must have at least one hypomanic episode and one depressive episode, but no manic episodes, the NIMH explains. Hypomanic episodes are a non-negotiable part of this diagnosis.
5. A condition called cyclothymic disorder, which presents as a less severe form of bipolar disorder, also involves hypomania.
Much like hypomania is a less severe version of mania, cyclothymic disorder (also known as cyclothymia) is a less extreme version of bipolar disorder, according to the NIMH. If you have cyclothymic disorder, you go through alternating periods of hypomanic and depressive symptoms that aren’t severe enough to fulfill the criteria of having actual hypomanic and depressive episodes. In order to qualify as having cyclothymic disorder, you must experience these symptoms on and off for at least two years.
6. Some people with a condition related to bipolar disorder may only have hypomania.
“There [is] a small subset of people who experience only hypomanic episodes,” Dr. McCutcheon says. Since this doesn’t quite fit into the categories of bipolar I, bipolar II, or cyclothymic disorder, it’s diagnosed as Other Specified and Unspecified Bipolar and Related Disorders, Dr. McCutcheon explains.
7. Experts don’t really know what causes hypomania, but genetics and neurological factors seem to play a role in bipolar disorder in general.
If you experience hypomania (and any other symptoms of bipolar disorder), it could be because it runs in your family, Dr. Thase points out. Experts aren’t yet sure of which specific genes may be involved in bipolar disorder heritability, but having a parent or sibling with the condition can increase your risk, according to the NIMH. Similarly, it appears as though brain structure and functioning have some kind of impact in developing bipolar disorder, but researchers haven’t yet figured out the details.
8. Sometimes hypomania is so hard to identify that people with bipolar disorder are misdiagnosed.
The first issue here is that people with hypomania and mania may not recognize that the symptoms are indicative of a disorder. They can instead write off signs of these conditions as simply having more energy or motivation than usual and view it as a good thing.
Even if someone experiencing hypomania does seek medical attention, they might receive a misdiagnosis because it can be so subtle. For instance, someone with bipolar II—which involves hypomanic and depressive episodes—may get diagnosed with major depressive disorder if they or a doctor miss those hypomanic symptoms.
It’s key that doctors perform as thorough a psychiatric evaluation as possible if there’s a chance someone is experiencing bipolar disorder because so much of treatment hinges on an accurate diagnosis.
9. Several types of medications can help treat bipolar disorder, but mood stabilizers specifically are best for hypomania.
Mood stabilizers decrease levels of abnormal brain activity that contribute to hypomania (and mania), according to the NIMH. Other classes of drugs can help with different aspects of bipolar disorder. For instance, antipsychotics can help relieve persistent depression and mania that don’t respond to other drugs, the Mayo Clinic explains, and antidepressants, antidepressant-antipsychotics, and anti-anxiety medications can also do their part to treat bipolar disorder.