Hypomania: What It Is and How to Recognize It

It’s easy to mistake some of the signs of hypomania as merely peculiar aspects of someone’s personality — but it’s hard for anyone to function optimally when hypomanic.

It seems the more we learn about mental disorders the more we appreciate how hard it is to neatly define and categorize certain illnesses. Many conditions appear to exist along a spectrum or continuum of intensity and severity. Over the past several years we’ve come to particularly realize the importance of this concept in understanding the various developmental delays such as the autistic disorders. Many are now coming to believe that even personality disturbances exist along a spectrum of severity. I have long advanced this notion in my books Character Disturbance and In Sheep’s Clothing.

Among the mood disorders, we’ve long known that depression occurs along a spectrum, from the chronic and low-level dysphoria that’s often been labeled dysthymia to the “angry depression” that seems to be the culprit in so many senseless acts of violence — anger that is not yet fully directed inward can appear in the early stages of development of a major depression or surface during the time such an episode is beginning to resolve. At the severe end is the full-blown Major Depressive Episode. We’ve also known that mania can exist along a spectrum, but only recently has some renewed attention been given to the sub-manic condition known as hypomania.

It’s sometimes difficult to recognize when someone is hypomanic. Most of the time, the hypomanic individual’s symptoms fail to rise to the level that they cause such social or occupational problems that it’s clear something is amiss. It’s also easy to mistake some of the signs of hypomania as merely peculiar aspects of someone’s personality; for example, a person revered as “always the life of the party” might actually be experiencing the low-level elation and grandiosity that can accompany the condition. Folks who suffer from Bipolar Disorder are particularly prone to hypomania. And perhaps they’ve even been treated for their illness with a variety of medications but still haven’t seen a complete remission of their symptoms.

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A person is considered to be hypomanic as opposed to fully manic when either they don’t show the required signs to warrant the diagnosis or their symptoms don’t rise to such a level (sometimes even to a psychotic level) that they cause serious impairments in their social or occupational functioning. But it’s hard to function optimally when hypomanic, so it’s important to recognize the signs and to get help for the person showing them.

Here are some of the more important things to look for:

Overly Positive or Elated Mood

Hypomanic individuals can seem overly optimistic and unrealistic in their outlook not only about things in general but also about themselves. They might even display some grandiosity, believing they will succeed in things that others might view as improbable. They might report feeling particularly “creative” and enterprising and may even resist attempts by others to bring them back down to earth.

Persistent High Energy Levels

A high energy person can appear “wired” or “hyper.” It might be hard to keep up with them during a conversation because their thoughts are racing so fast. They might talk very rapidly, talk over others or exhibit pressure to keep talking when it would be more appropriate to pause and take a breath between expressions of thoughts. They might also tend to go off on tangents and to have great difficulty focusing their attention. Folks infused with high energy typically report or display a decreased need for rest or sleep and feel a certain pressure to be engaged in goal-directed activities.

Increased Irritability and Anger

The person appears easily annoyed and overly prone to lash out over minor irritations.

Increased Sensation-Seeking and Risk-Taking Behavior

Manic and hypomanic individuals often lose their internal “censor” or controller and act without reasonable forethought. Excessive spending, gambling, substance use, and a general loss of inhibition is common. Outrageous and impulsive escapades and getting into intense but short-lived relationships that are later regretted is also common.

“Mystical” or Other “Unusual” Experiences

Folks who are manic or hypomanic can believe themselves to have special powers or abilities or to be aware of special connections between events that others might regard as mundane or relatively unimportant. For example, they might interpret a casual happenstance as another instance of God intervening in a dramatic and special way in their life.

Individuals suffering from hypomania generally need treatment that involves both medication and therapy. However, therapy — especially insight-oriented talk therapy — is unlikely to be particularly helpful while the person is still displaying active signs of their condition. While hypomanic, a therapy client is prone to misperceiving and incorrectly appraising the therapeutic efforts of the therapist. So patience, time, understanding, and above all, careful pacing of the therapy work on the part of the therapist in close coordination with the efforts of the prescribing medical professional is essential.

Getting someone the help they need when they’re in the throes of hypomania can be a real challenge. That’s because the hypomanic person is not only likely to disbelieve anything is wrong but also likely to resist what they perceive are attempts by others to put a damper on their mood. They have to be gently and empathically shown how their symptoms are negatively affecting their judgment and their relationships. They also have to believe that their talent and creativity will not be destroyed once their mood returns to a more normal state. So approaching them about treatment is a delicate matter indeed. But it’s well worth the effort, given how likely it is that a train wreck in their lives will eventually occur in the absence of appropriate professional intervention.

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