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Hey all - wondering about folks' personal experiences with diagnosis here. I know this is covered somewhat in one of the pinned posts, so I hope this post is OK.

I have a diagnosis of Bipolar II, and have been working on writing projects about it. Because of this I've been looking up sources for differentiating hypomania and mania, and I'm getting pretty confused.

For me, in terms of hypomania, I've experienced pressured speech, started a bunch of projects at once, insane compulsive risky sex, spending sprees, intense euphoria, intense irritability, distractability, blinding rage, and need for less sleep. Other things I'm sure. I have never, however, experienced delusions or psychosis, and have never had to be hospitalized. I'm primarily depressed.

I always thought that for a diagnosis of Bipolar I, you had to have delusions and/or psychosis, or that the mania had to be bad enough for hospitalization.

Most of the things I've been reading, though, don't appear to make a hard distinction between hypomania and mania. Some describe everything that I've experienced as hypomania to actually be mania, and hypomania as being vaguely "less intense."

Anyone have thoughts or experiences to share about this?

Edited by 0112358

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I tend more to hypomania in terms of upswings, though I've gotten mania where I've flown into rages (and been psychotic).  I tend heavily to psychosis though (I'm 'on the schizophrenic spectrum' and 'psychosis is more a part of my disease than most bipolar people'), so I'm potentially not a good example.  I would say a lot of what you're describing goes into mania?

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I have two different bipolar diagnoses at my gp.  My psychiatrist said something briefly about a third.  I've been diagnosed with the three before, schizoaffective, bipolar I, and bipolar II, and they tend to rotate.  I guess I feel like it's a matter of opinion at this stage.  I might not be a good example because I've moved around a ton and had to switch doctors a lot.  

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I’m schizoaffective and my manias tend to become psychotic quite quickly. For a few days though I suppose it’s hypomania. At that point I just feel energetic, colours look super intense and beautiful, and I want to talk and be around people constantly. It quickly devolves into delusions involving personal messages from the universe and hallucinations. I suppose that’s when it becomes mania, not hypomania. I can get psychosis symptoms outside of manias and depression though.  

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6 hours ago, 0112358 said:

Most of the things I've been reading, though, don't appear to make a hard distinction between hypomania and mania. Some describe everything that I've experienced as hypomania to actually be mania, and hypomania as being vaguely "less intense."

I think it is hard.  In 2018, I had about a 5-week period which I couldn't define as one or the other.  It was actually very sweet and made me wonder.  In fact, it left me thinking that it was the type of experience that causes some manics to stop taking their meds.  Typically, I become psychotic (delusional, paranoid) so that makes it easy to differentiate.

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When I was manic I became paranoid and delusional. That's how I could tell the difference.

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I used to have formal thought disorders. Clanging, loss of goal, alliteration (literally sentences sorted  out of me saliently superrepresenting .. I don't have it anymore). I had mild visual... something. Pareidolia where I thought random people looked a lot like famous people (but not that they were famous people; I just saw too many patterns and similarities no one else saw). At the height of these symptoms, written sentences seemed to have like... visual contours that were somehow meaningful in ways I can't explain. Some innocuous sentences made me sick like I wanted to vomit, I had to rewrite them. Changing fonts changed this synesthesia-like relationship with witten texts.

 

Today, I've been an asshole in various internet forums, including the bug issue board for a big project on Github. I've already requested my HN account be deleted and made my code repositories private and going under the radar for a while. I'm feeling just a little out of control in that respect. What's great about my variant is that I've always had a lot of insight, even when I was seeing geometric patterns vibrate, seeing similarities between people and finding that sentences that make me want to vomit in one font are fine in another and vice versa. Like when I've felt attractive women are suddenly obsessed with me and flirting shamelessly, I've had the good sense to know this is the madness speaking.

 

The thought disorders made it "mania". Without thought disorders and just being too fast and somewhat insensitive, it's hypomania. If I ever feel again that the fungus in my feet have something to do with a breakthrough in substructural logic, I'll chalk it to "mild mania" even if I can hold myself back from emailing prominent logicians again.My personal "philosophical" writing has actually cleared up a lot, but I knd of feel that it's at the expense of a brilliance I couldn't express well. But this is rational even with delusions of grandeur: hypomania. If my teeth start playing music: mania.

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On 4/23/2020 at 3:54 PM, 0112358 said:

For me, in terms of hypomania, I've experienced pressured speech, started a bunch of projects at once, insane compulsive risky sex, spending sprees, intense euphoria, intense irritability, distractability, blinding rage, and need for less sleep. Other things I'm sure. I have never, however, experienced delusions or psychosis, and have never had to be hospitalized. I'm primarily depressed.

I always thought that for a diagnosis of Bipolar I, you had to have delusions and/or psychosis, or that the mania had to be bad enough for hospitalization.

Most of the things I've been reading, though, don't appear to make a hard distinction between hypomania and mania. Some describe everything that I've experienced as hypomania to actually be mania, and hypomania as being vaguely "less intense."

Anyone have thoughts or experiences to share about this?

What you described partially answers your own question. There are certain hard lines that you can use to delineate. For example, some sources ambiguously describing hypomania as "less intense" is a gray line. A hard line for that same assessment would be: does the episode require hospitalization? The answer is that hypomania almost NEVER requires hospitalization. On the contrary, bipolar 2 disorder is described as a higher functioning form of the disorder. It isn't any less severe than bipolar 1 and because of the high rate of underdiagnosis for bipolar 2, it arguably carries more risk. Over HALF of bipolar 2 diagnoses start as another disorder, particularly MDD.

Next part is that having a full blown manic episode changes your diagnosis to bipolar 1. Even if you've predominantly been depressed or hypomanic in the past, a single manic episode, particularly with psychotic features, means that by DSM definition you cannot be bipolar 2. Furthermore, those with bipolar 2 DO NOT experience psychosis. Any psychosis and your diagnosis technically must be changed to either bipolar 1 or schizoaffective, bipolar type, to more accurately describe the condition. Also, those with bipolar 1 CAN experience hypomanic episodes as well. They are not exclusive to bipolar 2.

Building on the psychosis portion, during a hypomanic episode, there may be grandiose thinking, but not delusions or other indicators of a disconnect from reality like the hallucinations accompanying more classical psychosis.

So whether or not you had to hospitalize and whether or not you experienced psychosis would be the harder and more concrete variables that you can work with.

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My dx is bipolar 1, I have never been hospitalized or psychotic. That diagnosis arose out of “moderately severe” mania, for months, hyper sexual beyond question or reason and running up extreme debt, and it all seemed so reasonable. Since then I’ve had varying points on the mania continuum but not as bad.  I’m not concerned whether it’s labeled mania or hypomania, only how it affects my life. To me, I was very messed up, call it what you will, if it helps select effective meds. Now that I have the diagnosis in my record I can’t take it away and I can’t really argue the point. So I probably am no help, but that’s my experience. 

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This is interesting. Seems like there are some hard manic symptoms... psychosis, hospitalisation, etc, and some soft ones... like increased spending, heightened positive affect, etc, which could fit with either but (without the hard symptoms) could fit hypomania.  How relative this scale is could be a semi grey area. 
 

I don’t have too much trouble distinguishing between them for myself as the hard symptoms I mentioned are a key to defining my manic episodes. 

Identifying hypomania is useful as a warning sign that things are getting out of control. From a practical perspective it’s only really important in that you learn to become aware of how to recognise these symptoms to hopefully put some actions into place to prevent full blown mania.
 

 

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I rely on tdoc to tell me if I've been manic or hypomanic. But most of the times I've been manic I've also been hospitalized due to psychosis and risky behaviors.

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