What Is Hypomania? How Is It Diagnosed?

Marcia Purse
Bipolar Disorder Guide / http://bipolar.about.com

Hypomania is a state of mind, mood and behavior that may express itself as unusual gaiety, excitement, flamboyance or irritability. In addition, hypomania is accompanied by such behaviors as restlessness, talking nonstop, feeling fresh on only a few hours of sleep, furious focus on a single activity or being much too easily distracted, and/or a variety of other symptoms. The diagnostic criteria for a hypomanic episode are quite specific, but the way the symptoms appear can vary widely from one person to another.

For a person to be diagnosed as hypomanic, the first requirement is that there must be a sustained, elevated, expansive or irritable mood, plus unusually and persistently increased activity for most of the day over at least four days. The mood and the activity must be observable by others and clearly different from the way you are when you are not depressed. That means there isn't just a big contrast to a depressive state, but there's also a marked contrast to your everyday state when you're not having any bipolar symptoms. Before you can be diagnosed as having a hypomanic episode, you'll also have to be experiencing at least three of the following symptoms - or four if your unusually sustained mood is only irritable:

You don't need much sleep.
You're more talkative than usual or feel pressure to keep talking.
You are experiencing a flight of ideas or feel that your thoughts are racing.
You are easily distracted.
You are driven toward accomplishing specific goals (either socially - at work or school - or sexually) or you are experiencing psychomotor agitation.
You have grandiose thinking. For example, you believe you are better than anyone else at doing something or that you can accomplish a difficult task in hours instead of days. For more, see "What Is Grandiosity?"
You've become excessively involved with pleasurable activities that have a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions or foolish business investments.

There are also three factors that can't be present in hypomania. These are possible characteristics of a "manic" episode:

Symptoms of psychosis. In hypomania, a person doesn't have hallucinations or delusions such as paranoia.

The symptoms of hypomania aren't so severe as to require hospitalization.

While hypomania may interfere with daily life to a degree, the impairment in functioning is not marked. A simple example is that while a hypomanic person might talk a great deal more than usual at a company meeting, a manic person might jump on the conference table and break into loud singing.

Some Expressions of Hypomania

Though the diagnostic criteria for a hypomanic episode contain just seven sets of symptoms along with the mood requirements, there are many ways hypomania can express itself. No two people will have exactly the same symptoms. Here are just a few examples of hypomanic behavior:

Hypersexuality, which may take many forms such as making unusual demands on your partner, making inappropriate sexual advances, having affairs or spending a great deal of money on phone sex, Internet pornography or prostitutes.

- Unusual irritability, excitement, hostility or aggression.
- Behaving inappropriately; for example, making crude remarks at a dinner party.
- Spending recklessly, such as buying a car when you can't possibly make the payments.
- Talking so fast that it's difficult for others to understand.
- Dressing and behaving flamboyantly.
- Jumping from one subject to an unrelated subject while speaking to someone.
- Taking chances you normally wouldn't because you "feel lucky."

Hypomania and the Bipolar Disorder Diagnosis

For a person to be diagnosed with either bipolar I or bipolar II disorder, he or she generally must experience depressive plus manic and/or hypomanic episodes. If evaluation of the symptoms shows that a patient experiences both hypomania and depression, but not mania, a diagnosis of bipolar II disorder will by considered. Other factors may determine if another diagnosis such as cyclothymia is appropriate.

Hypomania Needs 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 illnesses. Reckless spending can lead to severe financial hardship. Inappropriate behavior can cause someone to lose a job or alienate friends and even family members.

Medications in the form of mood stabilizers are the most common and effective way to treat hypomania.