Understanding Bipolar and Hypomania
With contributions from Bethany H.
If you know anything about bipolar disorder, you know extreme shifts in mood mark the illness. Depression is on one end of the spectrum and mania is on the other. Those of us who have been diagnosed with this condition typically swing from one extreme to the other. Thank goodness, we also have periods of “normalcy” in between.
Of course, being “in between” is where most people want to be because it represents emotional balance and mental stability. This is the place we feel the most comfortable in our own skin. However; many people confuse hypomania with this sacred space. They think that because hypomania feels good (as opposed to the despair experienced with depression), that it is a good place to be. This is not necessarily true.
Hypomania can be just as unsettling as mania or depression, and IT IS a manifestation of the illness. It can serve as a red flag that a more serious mood disturbance is lurking in the shadows. While many say they enjoy the experience of feeling hypomanic, this condition should not be so quickly ignored or perceived as harmless. It can cause ill effects that can cause someone to spiral into depression or full-blown mania.
It is just as important to be educated about hypomania as it is to be educated about depression and mania. In this article, Kiki will share her experiences with being hypomanic and offer some helpful tips and hope doing so will provide you with some insight into this aspect of bipolar disorder.
What Is Hypomania?
For some people, the word “hypomania” is misleading. Some minds may automatically want to process the word as “hyper-manic,” which would basically mean “extreme mania.” The prefix “hypo” actually means “under” in Greek. So, literally, the word means “under-manic.” In other words, this is the state that occurs somewhere between normalcy and full-blown mania.
In simple terms, hypomania is a less severe expression of mania. Many people who have bipolar disorder may never experience full-blown mania. They may only experience hypomanic symptoms. This especially true of people who have been diagnosed with bipolar II – they typically do not experience extreme mania like those who have bipolar I.
Hypomania may require treatment, a medication adjustment, or a trip to your healthcare provider. However; most people who experience this aspect of bipolar disorder are usually not hospitalized for it because it generally does not bring on psychosis.
What Are the Symptoms of Hypomania?
According to an article written by Michael Craig Miller, M.D. for Harvard Medical School, the formal DSM-IV diagnostic criteria for hypomania require at least three of the following symptoms several times a day for at least four days:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts or ideas
- Agitation or irritability
- Increased activity
- Recklessness or excessive participation in activities that are pleasurable but cause harm (shopping sprees, increased need for sex, impulsive business decisions, etc.).
As mentioned, mania and hypomania share the same symptoms. To be classified as “manic,” however; someone will have to have these symptoms almost all day every day for a week or longer. Mania often leads to psychotic episodes and hospitalization. Hypomania usually doesn’t. However; hypomania can be extremely uncomfortable. It can cause extreme disruption to our lives and cause us to make unhealthy decisions.
Hypomania: Fliss' Perspective and Experience
Fliss' perspective and experience with bipolar hypomania symptoms.
Hypomania is one area of bipolar that can sometimes be perceived as the 'less serious' side of mania.
I have to admit when I first started learning about my illness I didn't fully understand the symptoms. I knew depression inside and out, with its dark and somber moods and on the flip side, I had encountered the wonderful, inexplicable heights of mania with my secret relationship with God.
However, as I have lived by the hands of bipolar for the last eight years, I can say hypomania is a dangerous state to live in, indicating instability and potentially a transition towards mania or depression.
At times we have insight and are able to spot our hypomanic symptoms, but if they are making us feel good, they are a guilty pleasure. The main difference between hypomania and full-blown mania is the link to feeling invincible and experiencing bipolar psychosis, which is an altered perception of reality.
The Irritable Side of Hypomania
If I am experiencing the vulgar irritability side of hypomania, the frustration, snapping, shouting, anger blackouts, and tearing atmospheres to pieces is horrendous. After angry bursts, hypomania can generate so much guilt as you can hurt others and put relationships at risk.
I remember being on day release from the hospital and walking home feeling on edge. I walked into the house, and my mum was doing the washing — I immediately felt irritated by her lack of attention on my special day.
I snapped and asked why she had nothing planned for me and she turned around, looked at me and said it wasn't all about me. I launched myself at her, grabbing the washing and throwing it before my brother ran down the stairs and pulled me away.
I had aggressively launched myself at my own mother, who was clearly shaken up. I walked back to the hospital, cried for hours and was eventually sedated. The guilt was too much.
Hypomania and Recklessness
I suddenly want to do things out of the ordinary that feels risky in comparison to my normal behavior. I suddenly decided one day to take my young niece on a long drive to a horrendously busy shopping center to browse and buy.
It was peak time traffic, and we were gone for hours. While this sounds nice, I hadn't asked my sister, who I always speak to first.
Controlling these moments is difficult. I simply have to check myself and have an internal conversation where I ask whether it's a 'normal' thing I would do and if not, what the consequences are.
I force myself to consult a friend or family member who will always tell me the truth, and this makes me consider my actions.
Spending More Money
This is one of the first things I notice. Whatever I have in my bank account is at risk as I love to shop for clothes, accessories, and presents for other people.
I've become quite good at managing myself when I feel hypomanic and only buy cheaper clothing so when I have my random shopping trips, I don't do my bank account too much damage.
I also have a plan to give my credit cards to my mum for damage limitation, so I only have limited funds to spend. In the past, I have forced myself to look at my bills or passed them to someone else to help ensure they get paid.
Drugs and Alcohol
Many people self-medicate with drugs and alcohol when they live with bipolar disorder. This is not uncommon. I am definitely guilty of drinking more when I become hypomanic.
I suddenly love the thought of going out and drinking alcohol. I will visit the pub more and buy more drinks to consume at home. I wonder whether I subconsciously do this to bring my mood down.
I've recognized myself doing this now, so I manage myself by limiting the number of times I go out and not buying alcohol for the house. On bad nights where I've drunk a lot and feel irritable/upset, I've called The Samaritans, a U.K. helpline where I can talk to someone non-judgmental.
In my late teens and early 20s, I used to go out and recklessly take drugs. I loved music, and I loved dancing, so the two went hand-in-hand. In later years I used drugs to try and control my moods, particularly while I was in depression.
When I am hypomanic, I dream of big nights and taking drugs, but thankfully I don't act on those thoughts. I force myself not to listen to them. I have a social circle where buying drugs are not possible for me. I am glad of this as it protects me from my desires while my mood is a bit high.
Hypomania: Fliss' Perspective and Experience
In contrast to depression, I am suddenly able to do all the 'normal' things I've struggled with, like organizing, doing things, making things, walking, driving and having ideas. My body is filled with energy, which means I have to be on the go and I am usually highly productive.
It's hard to want to stop yourself when you are like this, but I am always mindful of this behavior. I try to combine using my energy with routine, relaxation and being calm.
I make sure I eat balanced, regular meals and always stick to my sleep routine, even if it takes a while to fall to sleep. Calming activities include practicing mindfulness, reading a book, listening to chilled music before bed, or something simple like painting my nails, which forces me to sit still.
Wanting to Be Sociable and an Increase in Talking
I want to be around people, and I really look forward to getting ready and going out. I will call, email, and message individuals or organize group trips so I can absorb the atmosphere of going out and have fun.
It's actually good for me to go out, especially if I have been struggling with depression. However, if being sociable includes reckless behavior and spending too much money, it is time for damage control.
In the past, I have told my friends beforehand that I am a bit high and to be patient with me. It has worked.
I am a natural talker anyway and love discussion. However, while hypomanic I am definitely more forceful with my views and often interrupt. If anyone doesn’t agree with my views, I can get very frustrated.
I can also say inappropriate things — I remember telling my friends who were with their boyfriends about a sexual experience I had. This was completely abnormal for me.
I think my forceful discussion is a symptom most people pick up and probably recognize before me. I think the only way to manage it is to ask people to be patient because you can't help it.
Once you are aware it is happening you can do your best to stay calm or remove yourself from a situation you may be getting irate over.
When I was single and high, I used to go online and chat to any man I was attracted to. I would quickly move on to meeting someone and was interested only in sex. It is the only behavior I have kept from friends to avoid judgment.
I am not single anymore, and I have not been hypomanic while in my relationship. However, if I were still single, I would try and limit myself to chatting online only or if I wanted to meet someone keep it to a public place telling a friend where I was at all times.
One option is to organize someone to potentially pick you up to avoid going back to anyone's house. Alternatively, I would take myself offline while high and if not, always practice safe sex.
Influx of Creativity
Hypomania has generated some of the best ideas I have ever had. However, they don't always materialize as it depends on how long I am feeling high for!
In the past I have planned trips, decided on a new career, contacted strangers for help on realizing my ideas, writing articles, creative projects — I have a whirlwind of thoughts.
This is a productive part of hypomania, and it's all about managing your ideas. I write lots down, and some become instrumental to my life. At the same time it is about checking yourself — are your ideas rational and achievable?
My need to do things creative can be overwhelming. I have made beautiful photographic memory books for friends and family, cards and made beaded jewelry to keep. And my focus is incredible and my hands don't stop working. This state can be enjoyable, but at the same time has made me irritable if people interrupt me.
I remind myself to take a break, don't miss meals and don't work late at night. The end results of creative projects can be beautiful to keep.
Mood charts are a great strategy, and I now have over eight months of daily recorded moods. It gives me empowerment to see whether my mood is going high or low because I can see a pattern emerging.
I am then able to approach my doctor, nurse or psychiatrist for discussion. If the chart shows an elevated mood for more than two weeks, it could indicate hypomania.
Life Tips To Avoid Slipping Into A Hypomanic Episode
As the old saying goes, “An ounce of prevention is worth a pound of cure.” It is much easier to avoid a hypomanic episode than it is to try and navigate it once it comes on. Here are just a few of the things I recommend incorporating into your daily life to avoid hypomania:
- Get healthy sleep and get on a regular routine. Don’t stay up late even if you want to. Healthy sleep is especially important for people who have bipolar disorder.
- Exercise for at least 30 minutes three times a week. You don’t have to become a body-builder! You can just walk around the neighborhood at a pace that works for you.
- Stay connected to your support circle. Having positive people in your life who care about you is essential. They can be your eyes and ears and tell you if they spot something “off” with you.
- Keep a mood journal.
- Take your medication at the same time every day and don’t miss a dose.
- Drink lots of water and maintain a healthy protein-rich diet. This helps keep your body chemistry in check.
You may have heard these suggestions before - and, you may be tired of hearing them! But, they really do help to stabilize mood.
Report Your Symptoms
It is always recommended, no matter how good hypomania feels, to report your symptoms. It can indicate a mood transition which could lead to further danger including psychosis, invincibility or risk of suicide.
I always remind myself that a mood change indicates instability and to always keep focus on staying within the ‘normal’ range. I don’t want my life interrupted by bipolar any more than it needs to be!