Differentiating Hypomanic and Manic Episodes From Other Psychiatric Concerns
Introduction:
Bipolar disorder is characterized by significant mood changes that, by definition, include manic and hypomanic episodes. Bipolar disorder is often over-diagnosed by practitioners who incorrectly label “mood swings” as bipolar disorder. Understanding the differences between these states and other psychological conditions that lead to mood swings is crucial for accurate diagnosis and treatment.
What is a Manic Episode?
A manic episode is a period of abnormally elevated, expansive, or irritable mood and persistently increased activity or energy lasting at least one week. Most friends or family members would see you as acting very differently from your baseline if you are manic. Key features include:
Exaggerated self-esteem or grandiosity
Decreased need for sleep (e.g., feeling rested after only 3 hours of sleep)
More talkative than usual or feeling pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Increase in goal-directed activity (either socially, at work or school, or sexually) or intense physical restlessness
Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
What is a Hypomanic Episode?
Hypomanic episodes are similar to manic episodes but are less severe and do not cause significant distress or impairment in social, occupational, or other important areas. These episodes last at least four consecutive days.
Differentiating Manic and Hypomanic Episodes from Other Conditions:
Affective Instability vs. Bipolar Mood Episodes: Affective instability typically seen in personality disorders involves rapid mood swings usually triggered by external events, lasting a few hours to a couple of days. In contrast, mood changes in bipolar disorder last days to weeks and are not always linked to external stimuli.
Depression: Depression can involve insomnia, but also includes persistent sadness, lack of interest in enjoyable activities, and withdrawal, contrasting with the high energy levels and excessive activity in manic or hypomanic episodes.
ADHD: ADHD is characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. Many patients with ADHD have a much higher incidence of mood swings and temporary, short bouts of depression. While distractibility and restlessness are common in both ADHD and bipolar episodes, the significant and sustained mood elevation and decreased need for sleep are distinctive of bipolar disorders.
Previous Trauma and Intense Anxiety: Trauma and anxiety can lead to hyperarousal states that might mimic hypomania or mania but are typically associated with high anxiety levels, avoidance behaviors, and other PTSD symptoms, unlike the euphoric or irritable mood in bipolar episodes.
Insomnia from Anxiety vs. Decreased Need for Sleep in Bipolar Episodes: Insomnia in the context of anxiety involves difficulty falling asleep or staying asleep due to worry or nervousness. In contrast, during manic or hypomanic episodes, the decreased need for sleep is not due to difficulty sleeping but rather a reduced need for sleep to feel rested.
Conclusion:
Recognizing the differences between bipolar episodes and other psychological conditions is vital for effective management and treatment. If you suspect you or someone you know is experiencing a manic or hypomanic episode, it is important to seek professional help.
Sources:
National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/bipolar-disorder
American Psychiatric Association: https://www.psychiatry.org/patients-families/bipolar-disorder/what-is-bipolar-disorder
