Bipolar Disorder: Mania vs. Hypomania
What these "high energy" states may look like for folks living with this mental health condition
I’m addressing two of the most common questions I get as someone who works at a psychiatric hospital in a program that treats folks with bipolar disorder:
What is mania?
What’s the difference between mania and hypomania?
By the way, I’m not a clinician. I work as a peer specialist who connects with people at the hospital through my lived experience with bipolar disorder. Most of what I’ll share here is based on my own experiences or situations I’ve come across at the hospital, with several details changed to protect folks’ privacy.
I want to preface this article by saying I identify as someone who has bipolar disorder. For me, it’s like telling someone I have diabetes. Like diabetes, bipolar is a health condition I successfully manage with medication, therapy, and other coping skills.
I also want to note that I work in a clinical environment every day, so the verbiage I use might sound clinical. I’ve found it helpful to use clinical terms to speak with clinical staff and to help people who are newer to this diagnosis.
Many peer specialists and others in the community don’t identify with clinical terms. They sometimes find terms like “bipolar disorder” very limiting and don’t want to be placed in a box. Given that bipolar disorder can have nature and nurture components, some folks who are diagnosed with it may feel that their behavior is an understandable response to childhood trauma, for example, and will focus on addressing that trauma through therapy.
Also, it’s INCREDIBLY common for folks with bipolar to have their behavior pathologized, so I want to be respectful of that. I’ve approached this article with a lot of hesitation for that reason. Sometimes, people have attributed my anger and happiness to hypomania, when in reality, there was something I was justifiably angry or happy about. This happens a lot in hospitals and providers’ offices, leading people like me to feel misunderstood when they’re reaching out for care.
Comedian and Late Show host Taylor Tomlinson, who lives with bipolar disorder, put it best for me during her “arm floaties” joke in a stand-up special:
Like Taylor, I feel that as long as I have my “arm floaties” and do other things to keep myself well, I can live a very normal and happy life. Some people with bipolar take medicine, and some don’t. I’ve personally benefited from medications like lithium and lamotrigine, which are commonly prescribed for bipolar. Medication is a personal choice and sometimes there are unpleasant side effects, so it’s up to the individual if they want to pursue medication or therapy and coping skills, for example.
Like I did with my anxiety article, I’m going to share some positives about hypomania for me personally. It’s not ALL bad, as long as I keep it from getting out of hand, which I’ve thankfully learned how to do after like three decades of this crap.
What Are Mania and Hypomania?
In short, mania is common with Bipolar I and hypomania is common with Bipolar II. It may appear different in every individual. I experience hypomania as someone who has Bipolar Disorder II, which also means that I have more depressive episodes than someone with Bipolar I. Hypomania can give me more energy than usual, but it has not significantly altered my life like mania would.
Here’s what happens when I experience hypomania:
I clean and organize A LOT. Sometimes it’s a good way to get out that energy stored inside.
The average person can probably cross three things off their list per day. When I experience hypomania, I can cross off 12.
I have heightened creativity and can get a lot done, so it’s great for my writing.
I present as more charming, social, and confident.
Being in nature feels magical, and so does a good conversation with a patient at the hospital or with loved ones. It’s easier to feel transcendence in everyday situations.
I feel like I’m more “on” when it comes to social situations and the things I say and do go more smoothly than usual.
I’m more talkative, sometimes switching topics frequently or peppering people with questions. I can make everyone feel that what they’re sharing is very interesting and I’m also very compelled to learn more from them.
I have the ability to work long hours and have an incredible drive.
I’m more fun and loving.
I might wear makeup or clothing that captures more attention.
I feel like I don’t need as much sleep. At my worst, I’ve gone an entire night without sleeping a blink and felt rested up enough the next day.
I feel like my brain is operating at its highest level.
I’m more compelled to exercise.
I dream and believe that my dreams are possible.
I’m incredibly detail-oriented. This can be annoying to others at times, but every time I plan something, it goes very smoothly because I looked after each detail.
Honestly, hypomania can feel amazing at times, like I’m my best self. I believe this is why so many folks may struggle with what clinicians refer to as “insight.” Clinicians often hear from folks who experience mania and hypomania, “What do you mean I’m ill? I’m happy! I feel amazing!” even after mania threw their lives off the rails.
There’s a reason why some people with hypomania or mania don’t want to take medication. They’re afraid they won’t feel as happy with it. Some even complain that medication makes them feel numb and takes away their natural personality. Some medications CAN feel numbing, so it’s all about finding what works. Again, this is a personal choice.
Here’s where hypomania becomes unpleasant for me:
Hypomania usually starts off with the “good” things I listed above. But then…
I become extremely irritable. This is embarrassing now, but before I was medicated, I used to come home from work and be angry if my husband didn’t do the dishes because he got home an hour before me and it was his turn. So I’d just start angrily doing them myself while judging him and lamenting that I had to do everything. He loves my medication and often reminds me of this example to validate the need for it.
I get mouthy, telling people off or openly vocalizing my disdain for someone holding up the line at the grocery store in an effort to shame them into moving faster. Another example that isn’t mine: I recently went out to eat with my brother Larry, who also has bipolar disorder. There was a group of cyclists who just ended their ride and came into the restaurant, standing in line right by our table to get to the buffet. My brother was experiencing a medication change and became very frustrated. “Will you fucking move?!” he yelled to the cyclists by our table. He gets very stressed during crowded situations and avoids them as much as possible, which is why we picked this restaurant as soon as it opened for lunch, but we had no idea about the cycling event. It had been years since I’d see him do something like that. He told his provider about it and they adjusted his medication accordingly.
I clean obsessively. It’s really difficult to get much cleaning done when I’m hyper-focused on one aspect or one corner of my house. Then I get bent out of shape if people are coming over and I haven’t gotten enough done.
I can annoy people by talking very fast, switching from topic to topic quickly, and not doing my fair share of listening. It’s all about me and what I have to say, and I HAVE TO SAY IT. I leave no room for pauses or for someone else to jump in. Sometimes clinicians refer to this as “pressured speech.” A funny way in which this plays out at my workplace is that I’ll facilitate a group and have difficulty wrapping it up or inviting others to contribute because one person is doing so much talking, and sometimes what they’re sharing is really vulnerable and important, so it can be hard for me to say that we have to wrap it up.
I spend more than I should. I’m not a huge spender, but I might be more inclined to order food on the fly, spend more at Ulta, and put more things in my Amazon cart. In the past, when I was really struggling, spending felt like using alcohol or cannabis. I was kind of like, “Screw it, this will make me feel better,” and I’m now much more watchful of emotional spending.
I have an unrealistic outlook. For example, if I write a good piece while feeling hypomanic, I might have the idea that, “I’m going to go viral! This will make me famous!” And then I get like two reactions to it and one comment on social media. Another unrealistic thing: I once shared with my husband that I wanted to become a police officer or nurse. He viewed this as preposterous, and I would have as well if I wasn’t feeling hypomanic. I wasn’t even thinking about how I’d never want to be in a life or death situation, how I wouldn’t be able to handle shooting a gun, and how being a nurse didn’t make any sense because I was incredibly afraid of bodily fluids.
I take risks I wouldn’t normally take. When I was really struggling, I drove recklessly because I didn’t care about what happened to me.
I make impulsive decisions. The biggest one of these was dropping out of college during my senior year. I was having a really hard time and felt like I couldn’t “take” school anymore. I later looked back on this decision with a lot of regret and couldn’t understand why I did it. I finished school a few years later.
Some examples of mania:
I’m sharing some examples of mania I learned about at the hospital. Mania may lead to people experiencing delusions and other psychotic features. Once the person is well-treated, they can have regrets about what they did in the throes of mania. These were situations that sometimes led to dire consequences:
A man who moved out of the house where he and his wife lived, opting for a shed in the backyard. He eventually divorced his wife because his voices told him to.
A married woman who flew down to Puerto Rico to have an affair with a man she’d just met online. She spent thousands of dollars on a cruise with him and engaged in risk-taking behaviors as her husband and children worried about where she was.
A man who left his wife for a woman he met online. He moved out of their house so he could live in a car with this woman, which they kept parked outside of a grocery store, even though he had a 9-year-old son at home.
A man who spent $10,000 in a week gambling online, losing his entire monetary inheritance following his father’s death.
A wife and mother who was fired from her job as a pastor because she had an affair with someone who attended the church.
A man who spoke with me so fast and switched topics so frequently that I couldn’t follow what he was saying. When I had a confused look on my face, he became very irritable. “Why are you looking at me like that?” he demanded. I said, “I’m so sorry, I couldn’t follow what you were saying.”
People who have many different business ideas but lack realistic expectations about how to carry them out.
People who believe they are religious figures, like Jesus or Muhammad.
Someone who crashed a sports car they purchased three days ago due to operating under the influence.
A man who was arrested at Boston’s Logan Airport following troubling behavior (I know race can complicate these matters, so I’ll share that this person was white).
A woman who moved across the country from her family to live alone on the west coast, where she had no support system, to “be free.” She was eventually arrested for possessing psychedelics and her family had to drive across the country to bail her out.
A person who completely cut themselves off from all of their friends and said embarrassing things to them right before it happened, leaving the individual without any friends.
Given my own experience and that I work with folks like this every day, I often see that once people take medication or are further removed from their crisis, they deeply regret how they behaved. I often hear things like, “I can’t believe my personal photos are all over the internet now,” “I wish I didn’t say that to my friends,” “I wish I didn’t quit that job, because it gave me financial independence,” “I feel devastated that I treated my wife and son that way,” “I really thought I was the next Steve Jobs, how ridiculous is that?!” “I’m such a screw-up,” “I wish I didn’t leave my family like that,” “Will they ever forgive me?” and so on.
One great example showing this type of regret while embracing new insight is this video from musician Rob Scallon. It’s a half hour and worth its weight in gold. I recently showed it to a family group and most of them said, “Wow! He’s just like my child!” This video also goes into some detail about psychosis, which I’ll cover in a later article.
As Rob shares, it’s not ALL bad if managed well. The good aspects of bipolar offer him more drive and creativity. I feel the same way. Now that I’m well-treated, I can use aspects of this condition to achieve positive ends:
My creativity is still amazing, but kept in better check. I’m no longer focused on, “This story will make me famous!” I just write what I want to write.
I know that I’m naturally more of a night owl, so I’ve made my work and writing schedule more geared toward evening and nighttime.
Sometimes, not getting enough sleep can be helpful if I’m studying for an exam or preparing for a presentation.
A healthy amount of anger can inspire me to support a social justice cause, for example.
I now harness my obsessive cleaning to clean my house in a way that’s more realistic and reasonable.
It’s okay to still have pipe dreams, but I’m keeping them grounded. So I might say, “I hope to be a famous writer someday.” It’s nice to think about. But I can also say, “And here are the things I’m doing right now to help me achieve that goal.”
What’s great about the place where I work is that the clinical staff have started to address these things using non-clinical language and documenting them that way. So a nurse might say, “He seems to have higher energy today, I wonder why that is?” As opposed to, “He’s totally manic.” Most focus on the behavior and the person’s words, not the symptoms. So instead of attributing everything to the mania, staff might say, “She went to Puerto Rico after meeting a man online and leaving her children at home,” etc. They often say these things with a lot of concern and want the best for the person. They also celebrate the person’s wins, like a turning point in their recovery or being discharged from the hospital. It’s touching to see how much they care for the person. It’s also amazing to see people moving forward, and I’m grateful that I’ve been able to do the same.
I hope this helped you better understand bipolar disorder, hypomania, and mania. Follow me for more articles like this. All mental health content like this is free to raise awareness, and my creative writing pieces can be accessed for $5 a month.
Check out my recent piece about the depression side of bipolar disorder.
Take care and be well.
Lisa