What is the difference
between hypomania and mania? That's what I'm talking today. I'm Dr. Tracey Marks, a psychiatrist, and I make a 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 one and bipolar two? This video is to help you
understand what mania is. It's not to help you diagnose yourself. If you think you may
have 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 are at the stage of wondering, do I have bipolar disorder, the first question 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 friend 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 does your mania or
hypomania look like like? If you've never been manic or hypomanic, it's not bipolar disorder. And here's how we define a
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 persistently increased
activity or energy, lasting at least one week
and present 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 a 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 gonna end world hunger with this one idea that
you just came up with. An irritable example
would be you're gonna 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 gonna put
in the comments 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
time to do these things, and you may stay up all
or most of the night, working on these projects
for multiple 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 four days in a row and then, crashing and not wanting to go anymore. That four days you went to the gym is not evidence of manic behavior. Instead, this might look like
spending four to five 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
cleaning 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 and
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 four days for hypomania. Both can last much longer than that, but that's the minimum amount of time. So if you wake up one day and think, I wanna 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, nevermind, you didn't have one day
of mania or hypomania. Hypomania is a constellation
of multiple symptoms that last a minimum of the four
days as defined by the DSM. And that's why I don't support the idea of an 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 change and energy and activity changes, that
you must have at least three of the following seven symptoms, and if your abnormal 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 gonna be the
next president in 2020, even though you haven't
even started to work on getting a following to
support you for that endeavor. Decreased need for sleep. This could be going a few
days without sleeping at all or it could be sleeping two
to three hours each night and still feeling rested the next day. And this is different
from trying go 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 even not
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 three to four hours every night, then your poor
sleep is not a sign of mania. It's just 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 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 hypomania, it's very hard to jump in and interrupt. Flight of ideas or subjective experience that your thoughts are racing. 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 as flight of ideas, your thoughts are just
going a mile a minute and instead of this being
a positive experience, that your thoughts are
just flowing nicely, it becomes a negative experience, that your thoughts are disjointed
and all over the place. Distractibility. 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, in and out of rooms, in
and out of the house, and if the 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 feel nervous. You just need to move about and do things. Then, the last one of the
seven is excessive involvement in 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 abnormal energy level along 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 it requires hospitalization to keep you from harming
yourself or 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 it didn't say. You can experience that,
but that's different. That's a hallucination, where 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 coworkers
are trying to get you fired. 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 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 and 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 four 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 it may be 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 hypomania
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 your 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 a hypomanic episode, your diagnosis it's bipolar two 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 two to bipolar one. In other words, if you
later on develop mania, you would upgrade from two 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 one 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 one can
have recurring manic episodes back to back and very
few depressed episodes. Whereas, people with bipolar two, can have longer and more
frequent depressed episodes. I did a video comparing bipolar
one to bipolar two 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 watch my bipolar playlist. Whenever I make new videos
on bipolar disorder, I add them to the playlist, so subscribe and click notifications and you won't miss 'em. See you next time.
