How To Tell what Mania and Hypomania Really Look like

what's the difference between hypomania and Mania that's what I'm talking about today I'm Dr Tracy Marx a psychiatrist and I make mental health education videos in today's video I will Define the difference between Mania and hypomania and I'll answer the question of can your diagnosis change between bipolar 1 and bipolar 2 this video is to help you understand what Mania is it's not to help you diagnose yourself if you think you have B bipolar disorder you should see a doctor or therapist to be evaluated bipolar disorder is really defined by the presence of mania or

hypomania depression is present in both bipolar disorder and unipolar depression so if you're at the stage of wondering do I have bipolar disorder the first question that you and your doctor or therapist have to answer is have you had a manic episode because Mania is the defining characteristic of bipolar disorder here's an example of how that question looks practically John comes to my office and says he hasn't felt well for years and his close friends say that he should really look into whether or not he has bipolar disorder because he's been depressed for years and

it just keeps coming back this is a common misconception that if you have depression that keeps coming back it must be bipolar disorder when I get this question what I try and figure out is what do your Mania or hypomania look like if you've never been manic or hypomanic it's not bipolar disorder and here's how we Define mania using the fifth edition of the diagnostic and statistical Manual of mental disorders a distinct period of abnormally and persistently elevated expansive or irritable mood along with abnormally and persistantly increased activity or energy lasting at least one week

and present for most of the day nearly every day or any duration if you need to go to the hospital before we go any further let's break this down the key terms here are abnormally and persistently so you have mood changes and energy and activity changes that are abnormal this means it's not happiness that may seem abnormal to you because it's been a while since you were happy we're talking about happiness or irritability that's way over the top and people notice it and it looks abnormal now yes abnormal is a relative term but probably the

better way to think of it is that is it behavior that stands out in a negative way this might look like you're planning to run for president even though you have no political experience whatsoever or you're feeling so on top of the world that you're going to end world hunger with this one idea that you just came up with and irritable example would be you're going to go to Dr Mark's mental Channel and make her know just how much she's pandering to Big Pharma and custom write a five paragraph discourse that you're going to put

in the comment section of every single video now all these things I talk about take a lot of energy but when you have hypomania or Mania you have the energy and the time to do these things and you may stay up all night or most of the night working on these projects for multi mple nights in a row what does the increased energy or activity look like it would be more than feeling motivated to go to the gym 4 days in a row and then crashing and not wanting to go anymore that four days that

you went to the gym is not evidence of manic behavior instead this might look like spending four to 5 hours at the gym every day and you're 50 if you do that at 20 that might not be abnormal or it could be excessive clean and organizing now if you have family visiting and you need to spend all week cleaning your house that doesn't mean you're manic this would be an excessive an abnormal amount of cleaning that generally has some negative impact on you like maybe you're not sleeping because of it okay the second part of

this Criterion is that these mood and energy changes need to last at least one week for Mania and 4 days for hypomania both can last much longer than that but that's the the minimum amount of time so if you wake up one day and think I want to be the next president and then you start researching what you need to do to be able to get this to happen and then tomorrow you're like never mind you didn't have one day of mania or hypomania hypomania is a constellation of multiple symptoms that last a minimum of

the 4 days as defined by the DSM and that's why I don't support the idea of ultradian version of bipolar disorder where you have one-day episodes of mania or depression I discussed this in a video that I did on Rapid Cycling bipolar disorder and I have a link for that in the description the next part of the criteria is that during this period of the mood and energy and activity changes that you must have at least three of the following seven symptoms and if your mood is irritable then you need at least four of the

seven symptoms and these are things that are a noticeable change from your usual Behavior inflated self-esteem or grandiosity this goes back to the example of knowing that you're going to be the next president in 2020 even though you haven't done you haven't even started to work on getting a following to support you for that endeavor decrease need for sleep this could be going a few days without sleeping at all or it could be sleeping 2 to 3 hours each night and still feeling rested the next day and this is different from trying to sleep but

having trouble sleeping because you're worried about a deadline that you need to meet or you're going over your to-do list for the next day this is losing track of time because you could be up doing things and not even realizing that it's 4:00 a.m. and you never got in the bed to go to sleep but then you do and you sleep a couple of hours and then you spring back up ready to go for the next day the operative phrase here is that this is a departure from your usual Behavior so if you're someone who

puts in a lot of hours at work or school and you routinely sleep 3 to 4 hours every night then your poor sleep is not a sign of mania it's your usual number three being more talkative than usual or pressure to keep talking some people are generally more talkative in fact some people with ADHD can be more talkative or have a degree of pressured speech I did a video comparing ADHD to bipolar disorder and I'll put a link to that in in the description this kind of pressured speech that we see with Mania tends to

be more noticeable to other people than it is to you your experience may be that you've just got a lot to say and the ideas are flowing the person listening can experience it as an assault of words they can feel trapped under just a wall of talking and this is different from the person who just talks a lot usually that person is interruptible but with Mania or hypo Mania it's very hard to jump in and interrupt flight of ideas or subjective experience that your thoughts are rasing as your Mania ramps up it can get to

the point where your racing thoughts outpace your ability to keep up with them and in this case internally you experience it as your mind is all over the place and you can barely think and this is what we refer to is flight of ideas your thoughts are just going a mile a minute and instead of this being a positive exper experience that your thoughts are just flowing nicely it becomes a negative experience that your thoughts are disjointed and all over the place distractability here your attention is too easily drawn to unimportant and irrelevant external things

increase in goal directed activity either socially work school or sexually or psychomotor agitation and psychomotor agitation would be purposeless non-goal directed activity psychomotor agitation can look like pacing lots of fidgeting when you're sitting or it can look like getting up to do things but not really doing anything so someone watching you may see you moving about a lot um in and out of rooms in and out of the house and if that person asks you what you're doing you may not be able to give them a meaningful answer because you're actually not sure what it

was you were intending to do but there is a subjective experience that you can't feel settled it's almost like anxiety but you don't really feel nervous you just need to move about and do things then the last one of the seven is excessive involvement and activities that have a high potential for painful consequences and this would be things like buying sprees sexual indiscretions and foolish business Investments so what do we have here we have an abnormal mood and an abnormal energy level along with with three or four of these things that I just listed and

with all of these things happening at the same time it causes severe problems in your social life your occupational life your school functioning or requires hospitalization to keep you from harming yourself for others or you have psychotic features like hallucinations or delusions a common kind of delusion is called ideas of reference a person will believe that the radio or television is specifically speaking to them and it's not that you hear the television say something that it didn't say you can experience that but that's different that's a hallucination where you think or you think you hear

something that doesn't exist with ideas of reference you're hearing what's really being said and assigning a different meaning to it that lines up with a delusion that you already have here's an example you believe your co-workers are trying to get you fired and and anytime you hear someone say the word projections you believe that that's a signal that there's a ring of people who are who are working to get you fired so saying projections is their covert way of letting you know that your days are numbered now even though you work in a marketing company

and the word projections is something that's used in that industry you can't be convinced that projections is not a code word that's an example of ideas of reference in a common way that delusions can manifest with Mania hypomania is all of the same that I just said except the symptoms only need to last 4 days and it doesn't cause the same problems with your functioning so with hypomania you still may be able to go to work or school the symptoms are still noticeable to others though but it's not as severe in fact some people enjoy

the hypomania because it's a relief from their depression and they feel better but you still will look amped up to other people and maybe causing a disturbance but you don't need to go to the hospital the police are not being called because you're showing up to work naked and you're not psychotic if you have psychosis it's Mania real Mania or hypo Mania is usually obvious it's like clear the room level of hype people can usually feel the energy in the room sometimes you may be talking loud and other people think you're angry or yelling but

to you you're just talking there's just so much power behind your voice that because of your energy and enthusiasm it comes off to other people as yelling or sounding agitated if you have a manic episode your diagnosis is bipolar one if you have hypomania it's bipolar too and you will have recurring episodes of hypomania and depression but once you have a bipolar one diagnosis it stays that way even if your future episodes are hypomania so you can have a manic episode this year and then have future episodes that are hypomania they never rise back to

the level of Mania in that case your diagnosis would remain bipolar one and it doesn't change to two on the other hand you could start out with hypomanic episodes and later on down the line become psychotic during one of your hypomanic episodes and your diagnosis would change from bipolar 2 to bipolar 1 and other words if you later on develop Mania you would upgrade from 2 to one but you never downgrade from bipolar one to two in the big picture though it doesn't matter that much that you don't get downgraded from 1 to two if

you never have Mania again the treatment or the medication treatment is largely the same what's different here really is the course of your illness and how much time you spend in the depressed state people with bipolar 1 can have recurring manic episodes back to back in very few um depressed episodes whereas people with bipolar 2 can have longer and more frequent depressed episodes I did a video comparing bipolar 1 to bipolar 2 disorder and you can watch it here and I'll put a link in the description and for more information on bipolar disorder you can

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