Diagnosing a Hypomanic Episode

Marcia Purse Health Guide
  • The official criteria for diagnosing a hypomanic episode will change somewhat when the new edition of the Diagnostic and Statistical Manual of Mental Disorders - which will be DSM-5 - comes out in a couple of years. While the current criteria have some limits that the new version won't have, a good psychiatrist is probably already aware that the changes were necessary and is not letting those limits determine the diagnosis. The new criteria are still subject to revision, but I don't expect anything substantial to be changed.

     

    Criterion A (must be present): A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy. This mood must last for at least four days.

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    Criterion B (three to four of these symptoms must be present):

    • inflated self-esteem or grandiosity
    • decreased need for sleep
    • talking more or exhibiting pressure to keep talking
    • flight of ideas (skipping from one subject to another rapidly) or racing thoughts
    • easily distracted
    • increase in goal-directed activity (either socially, at work or school, or sexually) or physical agitation
    • Risky behavior (like spending sprees, sexual indiscretions, foolish decisions about money)

    Criterion C (must be present): There is a definite change in daily functioning compared to periods when the person doesn't have the other symptoms listed.

     

    Criterion D (must be present): Other people can see the mood disturbance and the difference in daily functioning.

     

    Criterion E (important differences from a manic episode): The episode is:

    • Not severe enough to cause marked impairment in social or occupational functioning,
    • Not severe enough to necessitate hospitalization, and
    • Does not include any psychotic symptoms (such as hallucinations and delusions).

    Criterion F: The symptoms aren't cause by drug or alcohol use, medication or treatment, or another medical condition. The exception to this is when a hypomanic episode happens while a person is being treated for depression.

     

    However, when only one or two symptoms show up after antidepressant use (particularly increased irritability, edginess or agitation), this is not sufficient for diagnosis of a hypomanic episode.

     

    As you can see, there's more to a hypomanic episode than just "feeling really good" - which is something the general public may not understand. Even more difficult for people to understand is that hypomania can interfere with functioning even though it's not so bad that you can't function at all. If you're easily distracted, have racing thoughts, and have a motor mouth, you may have difficulty accomplishing necessary tasks, annoy people or even say things that will get you into difficulty, and be very, very uncomfortable because your mind won't settle down.

     

    ~Marcia

    Published On: November 28, 2010