Mania and hypomania are states of elevated mood that occur with bipolar. Mania is the more severe of the two states. Mania only occurs in the context of bipolar type I. Hypomania can occur in both bipolar type I and type II, though people with type II are more likely to experience it.
If you experience symptoms of a mood episode, you may not be sure if you’re having a manic episode or a hypomanic episode. They present with similar symptoms, so it’s not always easy to tell them apart.
But it’s important to seek help, especially if mood episodes make daily life difficult, affect typical function, or put you at risk of harming yourself or others. Untreated bipolar can be serious. Suicide risk for people who have bipolar is about 15 times greater than suicide risk for the general population, according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
If you have symptoms of bipolar, including signs of a manic or hypomanic episode, and aren’t currently working with a counselor, we urge you to reach out. You can begin your search for a qualified therapist using our directory.
Hypomania vs. Mania
The DSM-5 lists the same criteria for manic episodes and hypomanic episodes. Three symptoms (four if your mood is only irritable) are required for diagnosis:
- Increased sense of self-esteem, feelings of grandiosity
- Feeling energetic despite getting less sleep
- Feeling unable to stop talking or be still
- Racing thoughts and ideas, jumpiness
- Easily distracted
- Risky or impulsive behavior
- Increased productivity or workflow, including creative work
One key difference between hypomania and mania is how severe or intense symptoms are. By definition, hypomania does not cause significant impairment in daily life and isn’t severe enough that you’ll want to consider going to the hospital.
During a hypomanic episode, your mood is more elevated than usual but not as elevated as a manic mood. You might feel euphoric, charged, and well-rested, even after very little sleep. Some people may experience an irritable mood. A period of hypomania lasts four days or longer, and you’ll experience symptoms most of the time during the episode.
Learning more about your condition can help you manage it more effectively. Mania describes an extremely elevated or irritable mood where symptoms persist most of each day for at least a week. Because mania symptoms can be severe, people around you will likely notice symptoms of mania more readily than symptoms of hypomania.
Mania has more serious implications than hypomania. A manic episode makes it difficult to go about your daily life as you normally would. You could also experience psychotic symptoms such as hallucinations or delusions. Hospitalization is usually recommended if you experience these symptoms or believe you might harm yourself or others.
Dysphoric mania, also called mixed mania, is now more commonly known as bipolar with mixed features. You can experience mania and hypomania with mixed features. It’s also possible to experience a depressive episode with manic or hypomanic features.
Listed in the DSM-5 as a specifier for bipolar, bipolar with mixed features is diagnosed when you meet diagnostic criteria for a manic episode and also experience symptoms of depression at the same time. These symptoms include:
- Dysphoria and depression
- Not enjoying or being interested in most (or all) activities
- Lack of energy or feeling fatigued
- Moving slowly and feeling like your thoughts have slowed, to the point where others can notice
- Feelings of guilt and worthlessness
- Thoughts of death, suicidal ideation
Experiencing mania and depression simultaneously can cause significant distress. You could feel fatigued and weighed down while experiencing racing thoughts or jumping from one idea to another. Or you could be energized and unable to sleep while feeling disinterested in life events or having thoughts of suicide. Your symptoms might also shift rapidly. For example, you could suddenly make an impulsive or risky decision after a period of feeling empty or hopeless.
This specific type of bipolar has an even higher risk of suicide than bipolar without mixed features. Thus, it’s important to get help right away if you or a loved one has mixed symptoms of mania and depression. Even if mood symptoms are hypomanic, it’s still important to seek professional support since symptoms can rapidly get worse. Tell your health care provider about all of your symptoms, even if some don’t make sense or seem less important.
Treating bipolar with mixed features can be challenging, especially when symptoms are severe, because treating only depression or mania could make the other issue worse. It’s important to get an accurate diagnosis and treat all features at the same time. Treatment may involve a combination of an atypical antipsychotic drug, a mood stabilizer, and therapy.
Hypomania Can Occur Outside of Bipolar
Some people who don’t have bipolar also experience hypomania. Symptoms of hypomania (or mania) may develop after a period of insomnia or sleep deprivation. They might also be an effect of substance abuse.
Some research has shown other potential causes of hypomania. For example, a 2017 study found that traits of borderline personality and attention-deficit hyperactivity (ADHD) in childhood could indicate greater risk for hypomania in young adulthood. Results of a 2018 study suggest teenage use of cannabis (pot) could increase risk for hypomania in young adulthood. It’s important to understand that these risk factors won’t necessarily cause hypomania, but they can contribute to its development if you are at risk.
Getting Help for Hypomania or Mania
If you experience hypomania or mania, you might not always realize your mood has shifted. If you do realize, you may find the state favorable. Mania often leads to euphoric feelings. Many people experiencing hypomania feel more productive, creative, and confident.
However, these positive feelings often have a cost. During hypomania or mania, you could act impulsively or make decisions you later regret. A period of depression is likely to follow a manic or hypomanic state. Even when mood symptoms don’t seem serious, it’s still essential to seek support. Untreated hypomania can increase in severity and may develop into mania.
It’s not possible to prevent hypomania or mania. But lifestyle changes can help lower your chances of having a mood episode. These may include:
- Getting enough sleep on a regular basis
- Eating nutritious foods
- Avoiding caffeine and alcohol
- Making time for daily physical activity
Learning more about your condition can help you manage it more effectively. For example, keeping track of your moods can help you recognize patterns and avoid triggers. Eventually you may be able to notice warning signs of mania or hypomania. Catching an episode early can help you take steps to reduce its severity.
If you’ve been diagnosed with bipolar or another condition where you experience hypomania or mania, it’s important to carefully follow your treatment plan. Hypomania can often be managed with lifestyle changes and therapy, but mania may be so severe that medication is recommended. If you’re taking medication, it’s important to keep taking it. If you experience side effects that cause distress, work with your care provider to make changes instead of skipping doses.
If you’re experiencing symptoms of mania or hypomania, reach out today. You can begin your search for a trained, compassionate counselor at GoodTherapy.
- Akiskal, H. S., & Benazzi, F. (2005). Toward a clinical delineation of dysphoric hypomania – operational and conceptual dilemmas. Bipolar Disorders, 7(5). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16176439
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
- Bipolar disorder. (2016). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
- Do, E. K., & Mezuk, B. (2013, June 2). Comorbidity between hypomania and substance use disorders. Journal of Affective Disorders, 150(3), 974-980. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080889
- Hu, J., Mansur, R., & McIntyre, R. S. (2014, April 17). Mixed specifier for bipolar mania and depression: Highlights of DSM-5 changes and implications for diagnosis and treatment in primary care. The Primary Care Companion for CNS Disorders, 16(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116292
- Hypomania and mania. (2016). Mind. Retrieved from https://www.mind.org.uk/information-support/types-of-mental-health-problems/hypomania-and-mania/#.XHTLoOJKjOQ
- Lazzari, C., Shoka, A., Papanna, B., & Rabottini, M. (2018, March 7). Insomnia induced brief manic-psychotic episodes. Sleep Medicine & Disorders: International Journal, 2(2). Retrieved from https://medcraveonline.com/SMDIJ/SMDIJ-02-00038.pdf
- Marwaha, S., Winsper, C., Bebbington, P., & Smith, D. (2018, October 17). Cannabis use and hypomania in young people: A prospective analysis. Schizophrenia Bulletin, 44(6), 1267-1274. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29207008
- McIntosh, M., Sussmann, J., & Goodwin, G. M. (2010). Mood disorder. In Companion to Psychiatric Studies, 8th ed. London, England: Churchill Livingstone.
- Miller, M. C. (2010). Ask the doctor: What is hypomania? Harvard Mental Health Letter. Retrieved from https://www.health.harvard.edu/newsletter_article/what-is-hypomania
- Mistry, S., Zammit, S., Price, V. E., Jones, H. J., & Smith, D. J. (2017, October 15). Borderline personality and attention-deficit hyperactivity traits in childhood are associated with hypomanic features in early adulthood. Journal of Affective Disorders, 221, 246-253. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28662455
- Richards, P. (n.d.). What is dysphoric mania? Retrieved from https://www.dualdiagnosis.org/mental-health-and-addiction/what-is-dysphoric-mania
- Tohen, M. (2018). Expert Q & A: Bipolar disorder. American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/bipolar-disorders/expert-q-and-a
© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.