Living with bipolar disorder can feel like riding a mood roller coaster. The “high” of mania is the flip side of depression. But, what is hypomania?

The hypomania of bipolar II, according to the DSM IV, psychiatry's diagnostic bible, is characterized by at least three symptoms from a list (the same list as for bipolar I mania) that includes inflated self-esteem, decreased need for sleep, racing thoughts, distractibility, increased drive and risky behaviors. The DSM IV also says that hypomania doesn't last as long as mania and doesn't create significant impairment in one's life or work, as bipolar I mania does.

Many of those living with bipolar II would disagree.

This official diagnostic definition leaves many living with the illness confused and frustrated. The square peg of their debilitating symptoms doesn't fit into the official round hole. The DSM, the latest version of which was published in 1994, uses narrowly-defined, standard classifications that leave little room for variation.

But, many mood experts today, says psychiatrist Jim Phelps, author of Why Am I Still Depressed?, recognize that the degree to which hypomania can cause impairment in work or relationships varies widely.

The "good" side of hypomania can be increased energy, improved performance, enthusiasm and creativity, although it isn't likely to include the "euphoria" of classic mania.

The "down" side: The individual's judgment may be impaired. They may be unable to concentrate on any one thing, irritable or argumentative, even agitated, unaware of the needs and feelings of others. Or they may be ultra-sensitive to criticism or perceived rejection. See chart.

"I usually don't recognize it until afterward,” says a woman who experiences hypomania. “I can be paranoid, defensive and angry. ‘I know what you meant by that,’ I’ll snap. He’s bewildered. And, so am I."

Individuals who experience the highs and lows of bipolar disorder may chalk up their moodiness to personality traits. They may not report their symptoms to a doctor, especially when they're "up," which makes an accurate diagnosis difficult. Those close to them, however, recognize their mood swings.

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An individual with bipolar II also experiences episodes of depression. And when depression occurs together with hypomania, the resulting "mixed state" can cause the person to swing rapidly from feeling “up” to feeling sad and hopeless, then irritable and agitated.  

Bipolar disorder, says Phelps, is becoming more commonly viewed as a spectrum disorder with a range of symptoms. It’s commonly misdiagnosed or overlooked.

If you think you may be experiencing hypomania, see a doctor. Without treatment, hypomania can spiral into severe mania or depression

Related articles
Bipolar II and the bipolar spectrum
Understanding bipolar disorder
What is the DSM IV?
Book review: Why Am I Still Depressed?

Sources
Daniel J. Smith and S. Nassir Ghaemi, Advances in Psychiatric Treatment (2006) 12: 110-120, Hypomania in clinical practice
National Institute of Mental Health (NIMH)
Jim Phelps, MD, author of Why am I Still Depressed? and PsychEducation.org

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