The main difference between Mania, Mixed Episodes, and Hypomania is in terms of severity of symptoms and rapidity of cycling, that is, the length of time between bouts of Mania, Depression and remission. In the first example, Mania, symptoms tend to be more pronounced and cause a marked decrease in functioning. Manic episodes can frequently include psychotic features (visual and/or auditory hallucinations, delusions of grandeur, etc.)
Criteria for Manic Episode (DSM-IV, p. 332)1
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a Mixed Episode.
D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.
Many people who suffer from Mixed Episodes report that they are the most painful and debilitating form of the disease. It is often referred to as “rapid cycling”. Whereas in most instances of Bipolar Disorder, the moods last from several days to several weeks, moods can shift in Mixed Episodes within hours. For this reason, many persons having Mixed Episodes are misdiagnosed as having Borderline Personality Disorder.
Criteria for Mixed Episode (DSM-IV, p. 335)1
A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Hypomania is the mildest form of the manias. While the person is clearly seen by others as behaving in a manner different from his/her unsymptomatic state, the hypomanic person is still able to function fairly well and thus is more apt to be a resistant client — to deny that he/she is even ill, and is often less medicine-compliant. This is frequently due to the fact that the individual is feeling “euphoric” and enjoys the extra energy and expansive mood. Unfortunately, Hypomanic Episodes are almost always followed by Depressive Episodes, if not managed by medication and psychotherapy.
Criteria for Hypomanic Episode (DSM-IV, p. 338)1
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
1 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (American Psychiatric Association, 1400 K Street NW, Suite 1101, Washington, DC 20005-2403 USA)
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