Clearing Up Some Misconceptions About Bipolar Disorder and Mania

“You have bipolar disorder? I always thought it would be super fun to be manic!”

This was a reaction I got when I disclosed my bipolar I diagnosis to someone. Perhaps you’ve heard the term “mania” thrown around in conversation. What does mania actually mean? What about a related term: hypomania? Maybe you even think you have a firm grasp on what a manic episode means. However, if you think mania is a “super fun” experience, you are quite mistaken.

• What is Bipolar disorder?

For starters, bipolar disorder (formerly known as manic-depressive illness) is defined as “a mental health disorder where a person experiences changes in their mood, energy, activity levels, and thought patterns” (Berry). Bipolar disorder consists of mood episodes. These episodes may be hypomanic, manic, depressive or mixed (a mixture of symptoms of manic and depressive episodes). These shifts are not like the ups and downs experienced by everyone. Rather, these episodes interfere with everyday life to a significant degree.

What is mania?

Bipolar I disorder, the “classic” form of the illness, is defined by at least one manic or mixed episode. Depressive episodes are typically a part of the clinical picture as well. A single manic episode is enough to make the diagnosis of bipolar I disorder. A manic episode is a period of at least one week of persistent elevated/expansive and/or irritable mood during, in which there is a drastic change in behavior and ability to function. Even though mania may feature euphoria, it is incorrect to assume that mania is a “happy” experience. It can also include extreme irritability. The manic experience goes far beyond mood!

Defining characteristics of mania include (Berry; Daily and Saadabadi):

• Feeling very happy, elated or excited
• Feeling very irritated or agitated
• High, uncontrollable levels of energy
• Lack of social inhibitions
• Increased talkativeness and rapid speech
• Decreased need for sleep or not sleeping at all
• Racing thoughts
• Distractibility or difficulty focusing
• Increase in goal-directed activity
• Mood lability
• Impulsivity
• Psychomotor agitation
• Unrealistic, high self-esteem; grandiose
  behavior
• Risky and/or reckless activities
• Thoughts of suicide or self-harm

Other possible causes of this state (such as medical condition) are ruled out through clinical labs and exams. Situations which may resemble mania include states caused by substances such as cocaine, amphetamine, PCP and hallucinogens (Daily and Saadabadi).

Bipolar disorder may also feature psychosis (delusions and/or hallucinations). This is one of the reasons misdiagnoses may happen (such as bipolar disorder mistaken for schizophrenia). Patients may experience delusions of grandeur, characterized by an unrealistic sense of importance, power and identity (Pedersen). Another common type is delusions of persecution, ones which cause the patient to believe they are being watched, targeted and/or stalked by others (Daily and Saadabadi). For such patients, the delusions seem real, even if they are not based on any aspect of reality; you cannot simply use logic to talk someone out of their psychosis. Hallucinations may come in various forms as well, such as auditory or visual (Berry).

What does mania look like in real life?

“You may be manic if you have slept on average for two hours for the past few days without feeling tired at all. You may be manic if you find yourself impulsively buying hundreds of dollars worth of clothes, DVDs and books. You may be manic if you have become convinced that you have a novel idea that will alter the face of science forever. You may be manic if your brain feels overcrowded with all of the thoughts that are racing around in your head… Combine the wired feeling of excessive caffeine with the poor judgment of consuming too much alcohol; add a heavy dose of euphoria and grandiosity with a dash of feeling like a mad genius and you have the feeling of pure mania.(Burcak).

Although there is a wide range of “manic” behaviors, there are many common ones. Many patients engage in major shopping sprees; they may even spend their entire life savings! Other goal-directed activities with painful consequences may include poor choices regarding business investments, traveling and dating. Unfortunately, mania can lead to aggressive behavior as well, such as property damage, verbal assaults and/or physical assaults. Mania can alter one’s perspective, causing many patients to have poor insight into their own state. Therefore, friends, family, colleagues or even strangers may notice this behavior as problematic before the patient realizes it (Daily and Saadabadi). Mania often has disastrous consequences on relationships, careers, school and overall health.

How are hypomania and mania different?

Bipolar II disorder is characterized by both major depressive episodes and at least one hypomanic (less than full mania) episode. While mania is a severe episode that interferes with daily life and may even require hospitalization, hypomania is a milder form. In other words, hypomania does not cause a major deficient in occupational and social functioning. Also, hypomanic episodes are shorter, lasting a minimum of four days rather than a week. People in a hypomanic state may function well, even feeling quite productive, energetic and active during their hypomanic episodes. If the episode escalates to the point of requiring hospitalization, the label would change to mania (even if episode duration is shorter than a week).

The symptoms of hypomania are similar to those of mania, including: feeling overconfident, being more social, needing less sleep and having a happier mood than usual. However, the symptoms are much milder, since the difference between hypomania and mania is mainly a degree of severity. Although hypomania is not as severe, it can still have negative impacts on individuals and those around them. Hypomania can escalate into full-blown mania if left untreated, so it is important to recognize the signs early and seek help (Berry).

Mania is much more complex than most people realize! It isn’t being super happy nor is it just about mood. Both hypomania and mania have altered people’s lives in destructive ways, coming into their lives like a tornado. After the chaos, the manic person is often left to pick up the pieces in a depressive state.

On the bright side, the prognosis for manic patients is good. Many people can manage their mood episodes through the help of a multidisciplinary healthcare team, with treatment often comprised of medication and therapy. With proper support and treatment, a happy, fulfilling life with bipolar disorder is possible!

Sources:

• Berry, Jennifer. Mania Vs. Hypomania: Differences, Similarities, and Treatments. https://www.medicalnewstoday.com/articles/324602.php#differences
• Burcak, Anja. “In The Shoes of a Manic Girl.” The
  Calculating Mind. 20 March, 2017, https://calculatingmind.wordpress.com/2017/03/20/in-the-shoes-of-a-maniac/.
• Dailey MW, Saadabadi A. Mania. [Updated 2019 May 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:
  https://www.ncbi.nlm.nih.gov/books/NBK493168/
• Pedersen, Darlene. Psych Note: Clinical Pocket Guide. 2014.