To start with, who is this blog post for? This blog post is for someone who wants to learn about what hypomania 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. 

Hypomanic episodes are, succinctly put, episodes of elevated energy and mood that last for at least four days, although longer is possible. These episodes should not be severe enough to lead to any hospitalization.  

One important thing to note about hypomania and mood states, in general, is that they’ll look different for everyone. I, for example, don’t use emojis in my texts (or if I do it’s with specific people and quite limited). However, when I’m hypomanic I use emojis in my texts. This is a sign of my expansive mood. For someone else, however, who uses emojis in daily life, using emojis is not a sign of expansive mood. Hypomania’s symptoms must be different from your particular baseline and they’ll look different for everyone. 

What does the DSM 5 say? 

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). 

Additionally, the DSM requires that the symptoms are observable by others, that the symptoms are uncharacteristic, that they last four days for the majority of the time, and that they are not severe enough to be considered a manic episode. For more on manic episodes see this blog post. If you feel that the above describes you or that you’ve had periods of hypomania, speak to a doctor/psychiatrist/psychologist. 

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

1. Inflated self-esteem or grandiosity

One of the hallmarks of bipolar disorder are periods of feeling “on top of the world” or as though you could do anything. In hypomania, these symptoms leave me feeling as though I can do anything. I am unafraid of challenges and feel capable of taking anything on. 

2. Decreased need for sleep

Describing the decreased need for sleep while hypomanic is hard because it is so different from the average human experience. Basically, sleep becomes not as necessary. I might generally go to bed before 10:00 but when I’m hypomanic I’m up till 2;00 or 3:00 working on “projects” (like reorganizing the closet, cutting my hair, etc.) Sometimes I’ll feel tired (especially after multiple days) so I’ll go to bed, but sleep just doesn’t come. Other times, I simply don’t feel the need to sleep. The thing to note, however, is that the following day I don’t feel as though I didn’t sleep. As the DSM puts it, there is simply a “decreased need for sleep”. 

3. More talkative than usual or pressure to keep talking

This is a pretty self explanatory one: basically talking more. Pressured speech, which is mentioned in the second half of the sentence, is when there is this “pressure” to keep talking which creates a distinct speech pattern. 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.”

4. Flight of ideas or subjective experience that thoughts are racing

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

Flight of ideas is when there is speech that changes topic quickly (often with loose connections between topics). 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. 

5. Distractibility

You probably know what this one means, as it’s not too different from normal distractibility. When you’re hypomanic your brain is working at a crazy fast pace – thoughts jump from one place to another with very little connection, stimulus doesn’t compute in the same normal way – and that leads to distractibility. 

6. Increase in goal-directed activity…. Or psychomotor agitation

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

Goal-directed activity includes things like reorganizing your closet, cleaning the bathroom with a toothbrush, writing essays, (all of these are things I’ve done!). Basically, when you’re hypomanic you get these ideas and you have to do them NOW. And you devote your entire being to accomplishing these things as quickly as possible, as well as possible. Sometimes these goals might be odd – and this is when people notice – but other times these goals are related to school/work or make sense. These are harder to notice. I used to use my hypomanic episodes to get weeks ahead in school and no one realized that this could be a symptom of a disorder, instead people (including me) thought that I was simply a high achiever. 

Psychomotor agitation are things like pacing, tapping your toes, basically it’s moving in an agitated manner. When I’m hypomanic, I can’t quite sit still. I generally grab fidget toys or will pace around my apartment. That’s an example of psychomotor agitation. 

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

This is one of the scarier symptoms of hypomania. All the other ones might take you out of your normal life, might make you feel odd or out of control, but they don’t have life changing consequences in the way that this symptom can. I’m incredibly lucky to not have done anything destructive to my life during an episode but I know that others aren’t as lucky. Some examples of these behaviors might be driving too fast, spending too much money, gambling, doing drugs, binging alcohol, etc. In essence, hypomania can make you engage in behaviors that are risky and that you might not otherwise engage in. 

So what might a hypomanic episode look like all together? 

In this blog I speak to my personal experience and understand it through the science of psychology/psychiatry. That means that, although my experience might share similarities with others, I can really only talk about my own experience so that’s what I’ll do here: explain what a hypomanic episode looks like by describing one of my own. 

In June/July of 2022 I had one of my first hypomanic episodes. I didn’t realize what it was at the time since I was undiagnosed, but looking back it’s a classic case. 

The strongest symptoms were goal directed activity and a decreased need for sleep. I spent at least one week staying up till 2-3 am (and waking up at 6 or 7!) and cleaning the bathroom, specifically the bathtub, with a toothbrush. 

At the time, it seemed normal. My girlfriend was working the closing shift at a restaurant and not coming home till 2 or 3 – so in my mind nothing was wrong with my sleep, I was simply staying up for her. 

I also had frequent moments of high intensity emotion. I would sit on the couch and sob because “the world was just so beautiful” (yes, that is exactly what I told friends/family when they asked what was going on). 

A lot of the other symptoms (distractibility, flight of ideas, etc.) were present but because I wasn’t tracking my experiences at the time and didn’t know I should, I don’t have enough information to talk too much about them. 

I’m in a hypomanic 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. 

I recently had my first semi-episode in about 6 months. I realized, as I sat there noting the symptoms of hypomania, that I didn’t know what to do. So this section is for someone in this scenario. 

1. Inform close people/loved ones

The first thing I do when I feel an episode coming on is inform my parents and inform my girlfriend. These people need to know since I need them to watch out for me and ensure that I’m not veering further into a hypomanic/manic episode. 

2. Inform your care team

I don’t know who your care team is but for me I inform my therapist and my psychiatrist. For you, it might also include a primary care physician or psychologist. 

3. Ensure you’ve taken your medication

This one is self explanatory but just double check – skipping medication can trigger episodes and knowing if you’ve missed a day, or even a couple, can be helpful for your care team to know. 

4. Avoid Alcohol/Drugs/Caffeine
5. Avoid Driving when Possible

Driving and hypomania aren’t the best mix. As I mentioned earlier, risky behaviors are upped when you’re hypomanic and driving quickly/driving recklessly is not uncommon for someone who is hypomanic. I do my best to avoid driving unless I’m going to work/running errands. 

6. Try and sleep, take sleep medications if needed

I know sleep may seem nearly impossible, so if sleep isn’t coming naturally, take sleeping medication. Talk with your doctor (wether psychiatrist or PCP) about this before taking it, as there could be medication interactions. You might also be able to get prescription sleep medications for as needed during hypomanic/manic episodes. I, for example, have hydroxyzine prescribed for me for hypomanic episodes if I can’t sleep. 

7. Eat Regular Meals

I don’t eat 3 meals a day – I’m a coffee for breakfast kind of girl, but when I’m hypomanic I force myself to eat 3 meals a day, even if I don’t feel like it. Although it’s not mentioned in the DSM 5, not eating or overeating can be signs of hypomanic episodes. Controlling your eating through routine meals can help. 

Additional Sources

Is Hypomania just less severe Mania? Inside Bipolar Podcast

DSM 5