The book definitions of hypomania and mania seem to make the difference between the two pretty unclear. They generally either list hypomania as “mild mania”, or — the other way round — mania as “stronger hypomania”. Then list the same symptoms next to both.
Here in the Netherlands the definition is a bit clearer: mania requires hospitalisation (or arrest, but hopefully the former). Hypomania is what you can cope with by yourself; mania requires help. While this still isn’t a 100% clear division — how are you expected to know, especially when manic, that you have now crossed the threshold and you need hospitalisation? — it’s helpful, because it gives a clear and understandable difference.
For me personally the difference between the two boils down to a simple question: is the experience enjoyable? When hypomanic, I am energetic, lively, sleep less, work harder, think faster, my libido goes through the roof, I’m in love with everything and everyone (see previous post, “The Perfect Storm”). When manic, I no longer enjoy the ride. I can’t focus my thoughts, I become aggressive and violent (either towards myself or others), I can’t work because I can’t sit long enough to do anything; I don’t sleep at all without sleeping pills, and I feel tired and full of energy at once. In both cases, I lose the ability to experience fear, which sounds like fun but really isn’t — fear, in healthy doses, is an important signal. In hypomania I find myself using that lack of fear to talk to people and go places I’ve never dared to go before; in mania I come up with bright ideas such as starting fights with groups of drunken people or extreme self-harm. Which explains why hospitalisation is the key: as long as I remember to use protection while having sex and my credit card is hidden away from me, I am unlikely to put yourself in grave danger while hypomanic. When manic, my behaviour puts me and others at risk. Hypersexuality can be quite fun, but there is nothing funny about starting fights with people.
How do you know which side of the border you are on? There are three main things to think of:
- mood charting: plotting your mood either using an app or a paper printout, and writing down unusual things that are happening. Mood alone may not be enough of an indication — in dysphoric mania you don’t feel particularly upbeat, but everything irritates you instead. Important things to note, next to your mood: amount of sleep; libido level (if normally you’re a twice a week person, but now you’re a twice a day one, something is probably happening); irritability; suicidal/self-harm thoughts; medication. This may come very useful when you are no longer able to assess yourself correctly, as it shows the preceding trend.
- early warning signs (EWS): with time, you gain experience and start understanding what happens BEFORE the mood episode. For me, hypersexuality and irritability comes before hypomania and mania; I don’t really experience overspending. Self-harm/violent thoughts and racing thoughts mean mania — for me. In your case things might be different. Based on your experiences, think of how your behaviour changes before an episode; write it down.
- significant others: my doctor tells me I am extremely self-aware, meaning I should be really good at noticing changes in me, but if you happen to be an ultra-rapid cyclist (like me) sometimes it isn’t enough. Your partner, best friend or favourite teacher may notice the changes before you do. Don’t dismiss the “are you sure you can afford that new coat? you said you were skint three days ago” remarks without thinking — as much as you are capable. Share your EWS list and knowledge of mania and hypomania symptoms with people you consider closest; they might save you. Consider also giving them your doctor’s phone number — when you get past the EWS, especially into the manic state, you might need someone else to report your symptoms to your psychiatrist.
I’m going to cover mood charting in the next blog post. In the meantime… stay stable!