Hypomania: definition, signs, recognizing a hypomanic

Definition: what is hypomania?

Hypomania is a psychic disorder, transient or chronic, characterized by a dysregulation of mood. Hypomania literally means “submania” and corresponds to a minor form of mania: “This is a relatively recent usage word, hypomania derives from mania which, with melancholy, is an ancient and highly characterized psychiatric entity. This form is symptomatically less extreme, less crazy and closer to normal: it could correspond almost a personality trait“, emphasizes Jacques Angelergues, psychiatrist and psychoanalyst. The patients hypomanic can feel a strong sense of joy and well-being or irritability and hyperactivity (the person sleeps less but does not feel tired, can invest in a large number of new activities, is overflowing with energy and does more physical activity). Hypomania may be present in bipolar people.

In what disorders does it manifest itself?

When it manifests itself in fits of exaltation lasting a few days, this disorder is sometimes equated with bipolarity. Excitement may be accompanied by a euphoric mood, but the subject can also sometimes be irritable or even aggressive. This can result in impaired judgment resulting in moderate thought and behavior disorders. “This is a diluted version of mania: these are people who have times when they are a little more excitable, they are hyperactive either periodically or on a regular basis. They can thus be a driving force for their environment or sometimes quite the opposite be tiring for those around them or harmful by their too disjointed activities.“, explains J. Angelergues. But hypomania can also manifest itself as defense following a bereavement, for example. The reactions are paradoxical: the person who is expected to be downcast or depressed can find themselves in a state of reactive excitement. “Rather than condemning seemingly inappropriate behavior, one should then read things carefully and try to understand the reasons behind this unusual and sudden behavior. Hypomania can be the screen of a deeper difficulty”.

Unlike the true manic bout, hypomania can be quite productive and it does not constitute a psychiatric symptom. “For some people, it can even be a way of balancing and regulating their existence with periods a little hypomanic and others quieter. This balance can be quite unstable when the periods of hypomania are too continuous and too important.“. To speak of hypomania, several symptoms must be present. Patients may feel a strong sense of joy and well-being or irritability (susceptibility, crying, nervousness), and hyperactivity (the person sleeps less but does not feel tired, can invest in a large number of new activities, is overflowing with energy and does more physical activity). This mood disorder may be associated with at least three of the following symptoms:

• great self-confidence : “she’s more daring and usually the center of attention”;
• disinhibition important: “she is more sociable, she wants to go out more, to meet new people”;
• an increase in speech rate;
• greater intellectual efficiency to work or study:full of ideas and projects“;
• a stream of thoughts that goes very fast;
• an excessive increase in commitment in pleasant activities (consumption of food, tobacco, alcohol, drugs, excessive spending, risky behavior, etc.), but without really perceiving the risks.

Is there a test to diagnose hypomania?

There are no precise diagnostic criteria for hypomania, but lines of research. The only reference is that of excitement : its intensity, its duration, its causes and the risk of slipping into mania. “The clinic is the instrument of diagnosis through dialogue which allows questioning to understand and analyze the causes and the dimension of hypomanic excitation“, he adds. It is important to note if the symptoms differ from the person’s usual condition. It can be an episode, with a beginning and an end, which can last several days. However, unlike a manic episode (much more intense), the hypomanic episode generally has no no serious consequences on the professional and social life of the person. This explains the significant frequent delay in taking this disorder into account.

Psychotherapy helps to understand what lies behind these disorders

What is the treatment for hypomania?

As with all mood disorders, a distinction must be made between the two phases of treatment: symptomatic treatment, which may be necessary to calm the immediate state of the patient in the hypomanic phase, and basic treatment, to respond to hidden distress and avoid recurrences. When drug treatment is considered, we generally turn to anxiolytics or small doses of neuroleptics to avoid restlessness and calm their behavior and if sleep is difficult, melatonin may also be prescribed. And to that add a psychotherapeutic follow-up to understand what may be hiding behind these disorders.

“Do not hesitate to show interest, express concern especially when the person has difficulty sleeping and encourage him to consult“, stresses J. Angelergues. Accompaniment is fundamental in the management of this pathology: it is necessary to take the time to talk, make yourself available, listen and be kind, and especially advise to consult a psychiatrist and/or a psychologist. “Provide friendly and/or professional listening to allow the other to better consider these disorders, to apprehend them and to understand the meaning of this malaise”.

Thanks to Dr. Jacques Angelergues, psychiatrist, child psychiatrist and psychoanalyst in Paris, member of the Paris psychoanalytical society.