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Hypomania vs. mania - is a loss of grip on reality the difference?


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Hi!

I'm new here. I'm in my 30s and was just diagnosed (for the third time, but I think I believe it this time) bipolar.

Ultimately type 1 or type 2 doesn't really matter. But my pdoc, whom I adore, did make a comment today and last week that I found interesting. He said I have a "strong inner observer".

I didn't used to, I don't think, but now I come from a background working in mental health, and I'm a mother, so perhaps I've matured.

Anyway. Here is an example. The Newtown shooting sent me into some type of dysphoric hypomania. I became obsessed with the idea that it was an inside job and that the government was going to force us into concentration camps. I'd shuttle my kids from one errand to another completely convinced that there were cameras, DNA collection receptacles, bugged helicopters, etc etc following us around. I'd cover my children's faces so that they'd be protected. I spent hours "researching" conspiracy websites. I took out a bunch of cash (it's not traceable) but spent it on crap. I pulled my children out of school. It spiraled to a demon possessing me, telling me to kill myself. It petered out into a really low energy depression. Meanwhile, during this and other similar periods, I had an inner voice telling me not to let on to others that I had these thoughts. I can somehow rein things in to be decently functional. I won't attempt suicide because my kids need me.

Is this inner observer phenomenon what separates hypomania from mania?

I'm confused on the line between the two, I guess.

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You sound as if you were delusional. That's more like the stuff that separates type 1 from type 2. So, yes, losing touch with reality is one of the factors that separates mania from hypomania. It alone is enough.

 

Your internal observer sounds like mine. I knew I was off enough to spend an awful lot of energy "acting normal" and avoiding psychiatric care. I did a pretty good job of it until BP me managed to blow up my life in my mid-30s and almost again in my early 40s when I actually sought help. Do it now. You won't regret the decision. Also, you have kids. They deserve a stable, non-crazy mom.

 

It's good to have insight. Going forward, you can use the insight to recognize early signs and work with your pdoc to adjust meds before you have real problem.

Edited by AnneMarie
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You can be psychotic (and hence type 1) whether you have insight or not. Some people have it, some don't. The diagnostic criteria are the same whether you have insight or not. View it as a gift, because it is your brain's way of protecting you even when you are very ill, which it sounds like you were. It kept you functioning and away from suicide, which is a very big deal. (And please don't blame yourself for your psychosis or feel ashamed or embarrassed - it wasn't your fault). I knew I was psychotic when I was psychotic (I heard voices and saw things that weren't there), and my insight it let me know I needed help very badly. 

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Thanks. Right now my pdoc is parsing out BP 2 vs. major anxiety. We have been treating with Seroqel and today I am going to start generic Lamictal. I need to do my official intro post, but the observer phenomenon is fascinating to me. It seems like if you don't have that third party observer "taking care" of your daily functioning, thats what will land you in the hospital. I've never been in the psych hospital; again full blown mania sends one to the hospital, whereas hypo does not. Correct? Again, ultimately the dx doesn't matter to me much. Getting stable does.

Edited by ray_of_sunshine
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I'm glad you view getting stable as a priority. That is great!

 

And insight is a gift. I'm lucky to have it too. (most of the time) It doesn't mean we suffer less, it just means we have that inner observer watching out for us. Some people don't have this and refuse treatment altogether.

 

I've been hospitalized for mania before, but I guess I never have been for hypomania. So I don't know. You may be on to something there. But I'm sure others have been hospitalized for hypomania.

 

Oh and welcome to CB!

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There is a funny thing about psychosis and Bipolar. I am bipolar 2 and I have had extreme paranoia and audial hallucenations when only hypomanic. Why? It's because I don't sleep when I'm hypomanic, that's my main problem. A doctor will tell you that anyone -- bipolar or not -- will become psychotic after 3 days without sleep. So hypomania, depending on the sleep component, can kick you in the butt pretty badly. It's not as tame as some believe.

 

 

ETA

As far as I know, the only things that separate manic from hypomanic is severity of symptoms, and whether they constitute a chance of harm to others.

Edited by goldfish
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I believe the key difference between hypomania and mania is the impact on your level of functioning during the episode. 

 

During hypomania, you can still function (usually) just fine. You can still go to work, go to school, interact with others. Other people must be able to notice your behavior change however, hypomania is not subtle. 

 

Mania on the other hand, impacts your functioning. People who are manic are often not able to go to work/school, have trouble in their relationships, get into trouble in general. My pdoc says the main difference between hypomania and mania is that manic people get themselves into trouble, while hypomanic people do not. 

 

Though, it's hard to tease out the differences sometimes. I was just hypomanic for about 2 weeks and I spent over $300 on clothes and shoes that I didn't need and found myself unable to pay my bills. I got myself into trouble. But my doc said it was still only hypomania, cause I was still able to go to work and, while people noticed the change in my behavior, it wasn't a drastic change. I just seemed far more peppy than usual. My favourite example of the difference between hypomania and mania is the difference between my bipolar 1 sister and I (I'm bipolar 2): When my sister was manic, she bought guns for some random strangers. When I was hypomanic, I bought cookies for a homeless man.  :lol:

 

As well, any psychosis during a manic episode usually automatically qualifies it as a manic episode. Also, if you need to be hospitalized, that usually automatically qualifies it as a manic episode, vs a hypomanic episode. 

 

Anyway, I also have this "inner observer", or I like to call it insight. It's a good thing to have. I often have insight even while psychotic, or I fade in and out of having insight. During my recent hypomanic episode, I strangely lost insight for the majority of it and denied I was hypomanic. That was new for me. Usually I can tell something is wrong right away and my "inner voice" tells me to act normal and go to the doctor. Keep that insight if you can! Keep reality-checking. Having insight makes treatment much easier because then you can participate in your treatment and you will most likely adhere to your medication regimen. 

 

Maybe the "inner observer" separates hypomania from mania? I don't know. I lost my "inner observer" for about a week while hypomanic, but my doc still said it was hypomania. Who knows? I think the line between mania and hypomania is blurry sometimes. 

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That makes a lot of sense, Parapluie. Going by that, I have pretty delusional/paranoid hypomanias. I too get myself into financial pickles and occasionally do not have insight into the fact that I'm hypomanic, but also don't get myself into trouble (other that mental distress).

 

I have also been paranoid to the point of delusional during hypomania. But my pdoc still calls it hypomania cause it didn't impact my functioning TOO much. It just caused me to be ultra paranoid about people looking at me, which made me get up and change locations a lot. 

 

Getting away from DSM IV/V territory, I personally believe it is possible to have delusions or borderline delusions while hypomanic. I don't think delusions automatically qualify you as manic (THIS IS JUST MY OPINION). For example you might be delusional enough while hypomanic to think that your art is going to make you lots of money and so you make tons and tons or art over the course of a few days. You'd probably be too distracted and hyper to actually attempt to sell it though, then you move onto your next project. 

 

But honestly, what does delusional mean? We have had this conversation MANY times on CB. Can you be delusional and still have insight? That's a big question. Some people say yes, some people say no. I have been delusional and maintained insight. I have thought, with every fibre of my being, that the sun in the sky is a God and needs me to sacrifice my blood. But insight held me back from actually killing myself and insight helped me get my ass to my pdoc. I knew, in a moment of clarity "whoa, this is cray" and didn't act on my delusions. Is that a true delusion? Who knows?

 

And there lies the fine line between SEVERE hypomania and mania. Really, I think it depends on the pdoc you talk to on any given day. It is essentially an argument about how many angels can dance on the head of a pin. :P

 

I have been regular ol' hypomanic (happy, giddy, silly, spent money, hyper sexual, still went to work) and I have been SEVERELY hypomanic (paranoid, delusional, unable to stop moving, not sleeping, rage, but still getting A+'s in my classes). 

 

Anyway, tl;dr, this looooong, drawn out reply was basically trying to say, there is a fine distinction between mania and hypomania, which is why my pdoc says psychiatry is just as much an art as it is a science. 

 

*whew* I'll shut up now. 

 

Edited to add: The last 5 paragraphs are my opinion, not representative of the DSM or current research in any way. Just flappin' my trap. 

Edited by Parapluie
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Interesting.  I think it's just hard to qualify and quanitfy everything, it can look so different, but generally be under the same umbrella, I guess.

 

As a for instance, I was hypomanic last week and am upping Seroquel and starting Lamictal as a way to stave it off, but I went for a run and thought I heard sirens when wearing my earphones.  Every time I took one out, I'd realize I didn't really hear them.  But I'd put it back on and hear them again.  I was absolutely positive that the sirens meant that my husband and children had been in a terrible accident.  I flipped my sh!t for a couple minutes and then my "insight" or "observer" (perhaps it's many many sessions of CBT?) took over and said that even if it *was* my family, there was nothing I could do from where I was, so I didn't need to freak out.  But.  I still had to take my earphones out so I didn't hear the sirens.  Despite knowing they didn't really, truly exist.

 

So... depending on who you ask, I guess, or what aspect of this situation you find most important, it could have presented as mania to some or anxiety for others, I guess.  Which is kind of where I was going with my other post.  I'm curious as to how anxious others' hypomanias present. 

 

Anyway now I'm flapping my trap....

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I think the inner voice is a true gift. My therapist has expressed her amazement that I have "held it together" so well, with the level of symptoms I have experienced. She said it shows a strong strength of will. We are looking for meds that will help me, help myself...so I don't have to try so hard all the time. I constantly monitor my behavior, constantly talk myself off the ledge, warn myself when my behavior gets "over the top", tell myself that I'm talking too much, not thinking rationally. This inner voice has kept me out of trouble. I feel for people who do not have it.

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I think we all have that inner voice. It's called...consciousness? Seriously.

 

I have lost that inner voice while psychotic. The reasonable, well mannered voice leaves and the crazy voice takes over. 

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I've lost the inner voice while psychotic and I've lost time while psychotic. I know when I'm getting there, but if I end up full blown manic or psychotic (or both) I'm fucked. Insight is great to have, and is something that could save you a lot of trouble.

Sometimes strong anxiety and delusions are hard to tell apart.

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Not all people with mania are hospitalized, so that isn't necessarily a requirement. I've never been hospitalized, and apparently I have been having manias for several years.

 

Agitated hypo can be pretty horrific, though.

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My point is that the inner voice is not a "true gift." It is the default inner narrative of a healthy mind. It's the touchstone when navigating rough waters. Do we sometimes lose it? Yes. But it's not a "gift," like being able to play the piano so that people weep.

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