Recognizing Hypomania

John McManamy Health Guide
  • Is it mania or hypomania?  Consider the DSM-IV’s first symptom for mania, listed under “Criterion B”:

    1. Inflated self-esteem or grandiosity

    Now contrast this with the DSM-IV’s first symptom for hypomania:

    1. Inflated self-esteem or grandiosity

    OK, let’s give the DSM the benefit of the doubt. Second mania symptom, please:

    2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

    And for hypomania:

    2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

    Wait a second. Surely, the DSM cannot possibly be copying and pasting mania symptoms directly onto hypomania?

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    Following are rest of the mania symptoms on the list:

    3. More talkative than usual ... 4. Flight of ideas ... 5. Distractibility ... 6. Increase in goal-directed activity ... 7. Excessive involvement in activities that have a high potential for painful consequences ...

    And the rest of the hypomania symptoms on the list:

    No, I’ll spare you. You know exactly what’s coming.

    Maybe we should just forget the symptoms entirely, along with any symptom-counting exercise, and get straight to the nitty-gritty of the matter, spelled out in the two (blessedly different) versions of “Criterion C.” For mania:

    The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others ...

    And for hypomania:

    The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

    Now we’re getting somewhere. In mania, we are clearly doing an excellent job wrecking our lives. In hypomania, we’re merely acting a bit funny. In mania, our erratic and inappropriate behavior at work is about to get us fired. In hypomania, our super-powers may get us promoted (or at least not fired). In mania, our loved one is filing for divorce. In hypomania, three people may have fallen in love with us.

    But if the consequences of mania and hypomania are so markedly different, why has the DSM not taken the trouble to spell it out? Never mind. Let’s figure this one out for ourselves. In numerous articles on my website, mcmanweb, I break it down into control and  presentation. Thus, for the control factor in mania:

    Behavior must be out of control to the point that subject can no longer responsibly manage his or her affairs or reasonably interact with others. ... Thinking must be out of control to the point where subject has a grossly distorted perception of him or herself and his or her surroundings, and is no longer capable of making realistic or responsible decisions.

    In hypomania, it’s more like this:

    Subject may exhibit unusual or unexpected behavior, but is still capable of responsibly managing his or her affairs and interacting with others. ... Subject may have a mildly distorted perception of him or herself and his or her surroundings, but is still capable of making realistic and responsible decisions.

    Meanwhile, with presentation, we are contrasting a "magnanimous larger than life presence" (euphoric mania) with a rather more diminutive "sociable charismatic presence" (euphoric hypomania). In dysphoric states, I would contrast a "hostile menacing presence" with an "unpleasant mildly threatening presence."


  • World of difference. You know it. I know it. But does your doctor know it? We’re only just getting started ...

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    ***

    This is the eighth article in my series on “Up” that investigates mania, hypomania, hyperthymia, and any state that can be regarded as higher than “down.” Previous pieces:

     

    First Up: Mania
    Does Anyone Truly Understand Up?
    Dysphoric Mania
    Mania and Hypomania’s Dark Side
    Mania, Hypomania, and the Dark Side of Bipolar
    Mixed Bipolar States, Dysphoric Mania and Hypomania
    Treating Mania



    All of my pieces are the result of vital input from the true experts - you. Your feedback is highly encouraged. Comments below ...

Published On: May 29, 2011