To start with, who is this blog post for? This blog post is for someone who wants to learn about what mania is. It is not for diagnostic purposes (if you feel that you are bipolar, speak to a professional. I am just a 20-something with a keyboard and a bipolar diagnosis) and it should not be considered a source for any school work.

Manic episodes are, succinctly put, episodes of elevated energy and mood that last for at least one week, although longer is possible OR that lead to hospitalization OR that have psychotic features. Personally, I’ve had one (maybe two?) manic episodes. They didn’t meet the definition of mania due to the length of the symptoms but due to their severity: in both episodes, I had psychotic features and in one episode I was hospitalized.

One important thing to note about mania and mood states, in general, is that they’ll look different for everyone. It’s a difference from your baseline, and everyone’s baseline looks different.

What is the Criteria for a Manic Episode?

Well, for a hypomanic episode the DSM 5 requires that 3 of the following be present (or four if someone is just irritated instead of having an expansive/elevated mood).

“Inflated self-esteem or grandiosity.

Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

More talkative than usual or pressure to keep talking.

Flight of ideas or subjective experience that thoughts are racing.

Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.

Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity).

Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).”

DSM-5 page 124

Additionally, the DSM requires that the symptoms are observable by others, that the symptoms are uncharacteristic, that they last 7 days OR have psychotic features OR require hospitalization. If you feel that the above describes you or that you’ve had periods of mania, speak to a doctor/psychiatrist/psychologist.

Symptoms in Depth

But what do each of the above symptoms mean? What might they look like?

Inflated self-esteem or grandiosity

One of the hallmarks of bipolar disorder is periods of feeling “on top of the world” or as though you could do anything. I’ve never personally experienced this in mania (my episodes of mania have included anxious agitation, which caused me to feel awful) but I have in hypomania.

Decreased need for sleep

This is one of the strongest symptoms I experience during mania. In my most recent manic episode, I slept a total of 3 hours in 4 days, and I didn’t feel tired. I felt like I “should” sleep or felt that I wanted to sleep to make my symptoms go away, but I wasn’t tired. In essence, I just didn’t need to sleep.

More talkative than usual or pressure to keep talking

The DSM defines pressured speech as follows: “Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually, it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.”

Flight of ideas or subjective experience that thoughts are racing

There are two parts to this criteria: either flight of ideas OR racing thoughts.

The DSM 5 defines flight of ideas as follows: “A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When the condition is severe, speech may be disorganized and incoherent.” DSM 5, page 821

Racing thoughts are similar, but not quite the same. Racing thoughts, at least for me, show up as thoughts that move so quickly I can’t say them all. This can manifest as me talking really fast (pressured speech) or slowing down as I’m unable to “catch” the thought and say it out loud before the next one comes.

Distractibility

You probably know what this one means, as it’s not too different from normal distractibility.

Increase in goal-directed activity…. Or psychomotor agitation

There are two parts to this one: an increase in goal-directed activity and psychomotor agitation.

An increase in goal-directed activity can look like extra strong involvement in projects, school, work, etc. For me, I experience this symptom in hypomania (I’ve done things like reorganize the closet at 2 am, complete an entire week’s worth of work in a day, and get weeks ahead in school work) but in mania, I am so out of it that I am not capable of completing work. That’s not everyone’s experience, it’s just mine.

Instead, I experience psychomotor agitation. I pace, I twitch, I fidget – I do anything to relieve some of the energy that I’m experiencing.

Excessive involvement in activities that have a high potential for painful consequences

This is one of the scarier symptoms of mania because it can lead to permanent life decisions that are destructive and dangerous. Some examples of these behaviors might be driving too fast, spending too much money, gambling, doing drugs, binging alcohol, etc. For me, I’ve become preoccupied with suicide in the past during a manic episode, which I believe counts as an activity with a high potential for painful consequences.

I’m in a manic episode…what do I do?

Everyone has different tolerances, different behaviors, different experiences and all of that leads to different plans for what to do if they’re hypomanic. In a perfect world, we’d all have crisis plans made before we have episodes and these would tell us exactly what to do when we’re struggling.

Unfortunately, that’s not everyone’s experience. My personal crisis plan, if I’m manic, involves alerting my partner, roommate, parents, psychiatrist, and therapist and going to the ER. I have medications that I know will knock me out if I’m manic that the ER is able to give me.

Alert your Loved Ones

Let those close to you in life know that you are/think you might be manic. Do this as soon as you can, even if you’re not sure if your symptoms amount to hypomania/mania. This will allow everyone in your life to be on the lookout for destructive behaviors and will help them understand why your behavior might be a bit different.

Alert your Care Team

Everyone’s care team looks a little different but for me, it’s my therapist and psychiatrist. For you, it might include a primary care physician, psychologist, or social worker. In essence, this ensures that the people responsible for your medical care are on top of your symptoms and know if medication changes need to happen, if hospitalization is necessary, etc.

Try and Sleep

Sleep can feel impossible in a manic episode but it is truly “nature’s medicine”. Even if it doesn’t make your symptoms go away, when you’re asleep you can’t engage in any destructive behaviors and it lets your body rest.

Curb Destructive Behaviors

This will look different for everyone. If you’re someone who spends a lot of money, give your credit cards to someone else. If you’re someone who drives recklessly, give your key to someone else.

Know your Threshold for going to the Hospital

For me, a manic episode requires that I go to the ER. For you, it might be psychotic features that are the threshold for the ER. Work with your care team to develop a plan for when to go to the hospital.

Avoid Caffeine/Alcohol/Drugs

Eat 3 Meals a Day

For some, eating becomes less necessary during a manic/hypomanic episode. If that’s the case (or even if it’s not) it’s important to make sure you’re giving your body the nutrition it needs: eat 3 healthy meals.

Additional Sources

DSM-5