Hypomanic Episode Vs. Manic Episode - The Main Differences

Hypomania and mania can both be signs of bipolar disorder and lead to similar symptoms, but the two phenomena are unique in terms of their severity and how they can impact a person’s overall well-being. Regardless of whether you’re experiencing a manic or hypomanic episode, it can be vital to seek professional help for your symptoms. Hypomania and mania aren’t often recognized as potentially harmful as they can be, leading many to overlook or downplay their effects. Understanding each medical condition, why they have some of the same symptoms, and when to seek out a bipolar mania diagnosis may help you manage mania more effectively.

Bipolar disorder, mania, and hypomania

Bipolar disorder, historically known as “manic depression,” is a mental health disorder that typically causes intense, extreme mood swings that range between emotional highs (mania) and lows (depression). In addition to these two primary types of mood episodes, periods of hypomania—a less severe form of mania—can occur in people with bipolar disorder. 

While the symptoms that correspond with both mania and hypomania do not necessarily have to indicate bipolar disorder, it is true that the condition is perhaps the most common reason that an individual might experience either. To understand mania and hypomania, then, it’s often beneficial to also understand bipolar disorders.

There are several subtypes of bipolar disorder, each of which may contribute to manic or hypomanic episodes of varying intensities and lengths. Below is a brief breakdown of the most common types of bipolar disorder:

• Bipolar I disorder is characterized by at least one manic episode that’s preceded or followed by a hypomanic or depressive episode. Those with this type of bipolar disorder may also experience mixed episodes where both mania and depression occur at the same time. 

• Bipolar II disorder is characterized by one or more major depressive episodes, with at least one hypomanic episode. Bipolar II disorder is often considered to be the most challenging type of bipolar disorder to diagnose, as it can be difficult to distinguish it from major depressive disorder and other mental illnesses.

• Cyclothymic disorder is characterized by at least two years of several hypomanic and depressive symptoms, though these are typically less severe than those associated with major depression, mania, or hypomania. 

• Bipolar disorder NOS (Not Otherwise Specified) is characterized by depressive and hypomanic-like symptoms that meet too few criteria or are seen for too short a duration, to qualify for a diagnosis of BD I or II.

To understand which type of bipolar disorder you might be experiencing, identify early warning signs, and distinguish hypomania, mania, and depression from each other, it may help to first consider the ways in which these experiences can overlap, differ, and mimic the symptoms of other mental health disorders. 

Symptoms of both hypomania and mania

According to a medically reviewed American Psychiatric Association article, mania and hypomania are characterized by an “intensely happy or irritable” mood. While both mania and hypomania can produce similar effects in people with bipolar disorder, hypomania is generally considered to be less severe than mania. The word to remember when observing a person's behavior for any of these symptoms is “uncharacteristic.” If more than three of the following criteria are uncharacteristic of their usual behavior and are observable by their friends, family members, and colleagues, they may be mania symptoms or hypomania symptoms.

Below are some examples of changes that might come about as a result of mania or hypomania:

1. The person's mood changes and they become excessively irritable or euphoric and expansive.

2. They display distorted self-esteem or self-confidence, i.e., inflated, grandiose opinions or false beliefs about their status and abilities.

3. The person is engaged in significant goal-directed activity, ranging from work to a social or sexual context.

4. The person needs less sleep or does not feel tired after only a few hours of sleep and wakes up full of energy.

5. The person is more talkative than usual.

6. The person is easily distracted or seems to have a hard time focusing.

7. The person engages excessively in pleasurable, reckless activities with a high potential for consequences, such as shopping sprees, excessive substance use, or risky sexual behaviors.

8. The person subjectively experiences their thoughts as racing or even out of control.

9. The person displays anxious distress.

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Symptoms exclusive to hypomania

1. The change in mood lasts at least a few days (four). Hypomanic episodes are usually shorter in duration than manic episodes.

2. While distinctly different from the person's usual behavior, the listed symptoms don't impair their working or socializing capacity, and only in rare cases will hospitalization be necessary.

3. The person never displays psychotic features.

Symptoms exclusive to mania

1. The change in mood lasts a week or longer. Manic episodes are usually longer in duration than hypomanic episodes.

2. The symptoms experienced are more pronounced or intense than with hypomania and can reach a point where work and socializing are significantly impaired. Severe mania may even lead to hospitalization.

3. The person's elevated self-esteem may reach delusional proportions, such as claims of having supernatural powers or having a special relationship with a religious or public figure.

4. Psychosis can occur, which means the individual in question may seem to lose contact with reality.

5. The person may display severe psychomotor agitation, like pacing around a room, wringing hands, repeatedly taking off and putting on clothing items, uncontrolled tongue movement, nail-biting, lip chewing, and pulling of the skin.

Overall, hypomania is a milder form of episode to experience. Mania differs from hypomania in its severity, longevity, and potential to lead to serious consequences like hospitalization.

Causes of bipolar disorder

As with many mental health conditions, the exact cause of bipolar disorder is still unknown; but experts believe that multiple factors likely play a role in its formation. There is evidence that suggests that genetics may be at least partially behind the development of bipolar disorder; having a family history of the condition or a known family member living with bipolar disorder may increase your chances of experiencing it yourself. Likewise, environmental factors may also influence a person’s individual risk level. 

Challenges with diagnosis and early detection

The primary challenge doctors experience with bipolar disorder diagnoses is differentiating the disorder from recurrent major depressive disorder or other mental illnesses. People with bipolar disorder often present only with depression when they seek professional help or have no clear, clinically observed history of mania or hypomania. This may be because the highs experienced during mania or hypomania may not be obviously distressing or harmful to those who experience them, which may mean the person in question is unaware of their influence or simply views them as something that isn’t an area of concern, thereby inadvertently withholding information during a physical exam. 

To address this and other diagnostic challenges, researchers believe that the identification of "objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression" may be helpful. The idea is that finding a physical marker for the disorder could aid more straightforward diagnosis and facilitate targeted intervention and medication development to treat mania. A  promising study demonstrated that EKGs might show features that could differentiate bipolar disorder from major depressive disorder, but much research is still needed in this area.

While there may be some obstacles to overcome when it comes to receiving a diagnosis that’s accurate to you and your symptoms, it’s still an effort that can be well worth pursuing.  The potential consequences of untreated bipolar disorder can be significant in terms of safety risks, health risks, and potential damage to a person’s ability to function, particularly if they are unaware of how to identify the signs of an oncoming episode. 

Looking for help with a manic or hypomanic episode

Both manic and hypomanic episodes, while they may seem harmless or even beneficial on the surface, can pose significant risks to a person’s mental and physical health. Understanding how to distinguish them from one another may help you receive a diagnosis and treatment plan that can make a difference. Even if you’re unsure about which label best fits you, it can be helpful to speak to a medical professional about your concerns and what steps to take next. For example, if your primary care doctor suspects you may be living with bipolar disorder, they may refer you to a psychiatrist who is trained to support patients who experience hypomania, mania, or depression due to BP.

In addition, reaching out to a mental health professional, like a therapist, may help you not become better aware of your symptoms, but also learn to manage them more healthfully as well. Therapists can help you develop better habits, such as eating a healthy diet, practice positive coping skills, and learn to discern symptoms that might mimic mania. Many people find that in-person therapy can be intimidating, cost-prohibitive, or simply too inconvenient to fit into a busy schedule. If that’s the case, online therapy, which allows you to connect with a therapist at a time and from a location that you choose, may be an ideal solution.

Aside from being convenient online therapy can also be highly beneficial. One recent review of 17 studies focused on online cognitive behavioral therapy found it to be just as effective as in-person treatment for improving mental health symptoms, particularly those tied to depression. The same review also noted that online therapy options are more cost-effective for clients, which may make it easier to pursue treatment for as long as you need to. 

In addition, reaching out to a mental health professional, like a therapist, may help you not become better aware of your symptoms, but also learn to manage them more healthfully as well. Many people find that in-person therapy can be intimidating, cost-prohibitive, or simply too inconvenient to fit into a busy schedule. If that’s the case, online therapy, which allows you to connect with a therapist at a time and from a location that you choose, may be an ideal solution.

Aside from being convenient and easy to avail, online therapy can also be highly beneficial. One recent review of 17 studies focused on online cognitive behavioral therapy found it to be just as effective as in-person treatment for improving mental health symptoms, particularly those tied to depression. The same review also noted that online therapy options are more cost-effective for clients, which may make it easier to pursue treatment for as long as you need to.