When people think of bipolar disorder they often think of mania and the extremes that can happen. However, bipolar disorder exists on a spectrum with 2 main types: Bipolar 1 and Bipolar 2. Bipolar 2 is a milder (yet still uncomfortable!) form of bipolar. People with Bipolar 2 Disorder experience hypomania instead of mania. So what is hypomania and how is it different from mania?
In order to explain Bipolar 2, I will review the DSM-5 (the diagnostic manual for psychiatric conditions) criteria used to diagnose it and add the personal perspectives of someone who has experienced hypomania.
Lauren is a mental health blogger at Mentally Interesting: Live the Life You Want. Lauren was diagnosed with depression at age 12 and later was re-diagnosed with pregnancy-induced bipolar 2 disorder. She has been kind enough to share what it was like for her when hypomanic.
Read more about Bipolar Disorder in my post: Coping with Bipolar Disorder to learn tips for how to help manage symptoms and work on prevention of cycling.
According to the DSM-5, Bipolar 2 Disorder is the presence of one or more major depressive episodes and at least one hypomanic episode. The hypomanic episode must last most of the day for at least four days.
The DSM 5 describes hypomania as a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy.
During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (4 if the mood is only irritable), represent a noticeable change from the usual behavior, and have been present to a significant degree:
(The italicized sections are the criteria in the DSM-5. Following it is Lauren's experiences with hypomania.)
A hypomanic episode is similar to a manic episode but the symptoms are less severe. A manic episode must last 7 days in a row to qualify (hypomania requires 4 days). Unlike mania, hypomanic symptoms do not lead to marked impairment in social and occupational functioning and don't necessitate hospitalization. Psychotic symptoms do not happen during a hypomanic episode but can during mania.
The main treatments for Bipolar 2 Disorder involve mood stabilizing medications. The goal of these medications is to minimize mood swings- both to prevent the hypomanic and the depressive episodes.
Bipolar disorder is a recurrent condition. Medication is used to treat the current episode and also to prevent future hypomanic episodes. To do this, generally, medications are taken long-term. Ideally, the medication will prevent (or minimize) both the "ups and the downs" i.e. the hypomanic and major depressive episodes that happen in Bipolar 2 Disorder.
"Caring for myself during a hypomanic episode means that I have to really monitor my mouth because I'm much more likely to say what I'm actually thinking. This isn't all bad, but I try to avoid talking about controversial subjects. I remind myself that once words are spoken, they can't be taken back. I put my "hypomanic filter" in place when I feel irritated with the world and use it to try to keep myself from hurting someone's feelings or saying something I'll regret later."
"Just because hypomania isn't full-blown mania doesn't mean it's harmless. These symptoms (racing thoughts, irritability, etc) are very uncomfortable to sit with. If you find yourself in a hypomanic mood state, be gentle with yourself. Try to slow down. Take deep breaths and think twice before making decisions. If your symptoms last longer than 4-5 days, consider contacting your doctor to let them know you are having an episode."
Thank you, Lauren, for sharing your experiences with us!
If you believe you have experienced a hypomanic episode it is important to seek out a psychiatric physician to discuss your symptoms. Although Bipolar 2 Disorder doesn't cause the same level of dysfunction as Bipolar 1 Disorder it can still be disabling and diminish quality of life. Treatment, although often not perfect, can be effective at improving your health and well-being.
A version of this article first appeared here.
Dr. Melissa Welby is a psychiatrist that participates in people’s process of discovery, empowerment, and search for satisfaction and happiness. She treats a variety of illnesses including depression, anxiety & panic attacks, adult ADHD (Attention Deficit / Hyperactivity Disorders), bipolar disorder, OCD (Obsessive-Compulsive Disorder) and borderline personality disorder. She is also the current president of the Connecticut Psychiatric Association.She completed her Internship & Residency at Cambridge Hospital, affiliate of Harvard Medical School, 2000 to 2004. Dr. Melissa Welby is Board Certified in General Psychiatry by the American Board of Psychiatry and Neurology, 2005 to present.