Dealing with Hypomania

by Carol Campbell, MFT

Hypomania is the name given to a fairly common mood state associated with the spectrum of bipolar disorders. Hypomania is often experienced at first as not such a bad thing. After all, who wouldn't enjoy a period of time when you feel really joyful and powerful and creative? Those who are hypomanic are extremely energetic, may get by on very little sleep, have loads of ambition and competitive spirit, and a drive for success that is rewarded by our American culture. These folks are very sociable, the life of the party, and full of ideas for sharing a good time. They tend to take shortcuts, defy prohibitions, and not worry much about obeying authorities.

So what's the problem? For people diagnosed with Bipolar II disorder, an episode of hypomania usually comes along following an episode of depression. There is tremendous variability in the length and intensity of both manic and depressive mood episodes. Unfortunately, what often happens is that the person with a bipolar disorder will cycle back and forth between mania and depression, with serious consequences for both the individual and his or her family and friends.

Without medical and therapeutic intervention, a person who is hypomanic runs the risk of having the mood episode evolve into a full-blown manic episode. The fun is over at that point, because now there will be potentially dangerous or damaging changes in behavior, such as impulsively buying things, significant sleep disturbance, sexual indiscretions, reckless driving, and foolish investments. At this point there is often a loss of insight about the behavior, which creates tremendous stress for the loved ones involved.

The hypomanic individual defends against anyone showing concern by using the classic manic defense: denial, control, and contempt. He or she will ignore obvious problems caused by the mood issues, as if excessive or impulsive actions should be acceptable. They might make jokes about what has happened. They often try to regain a sense of control by acting out in such forms as running away, sexualizing relationships, provoking others, or drinking excessively. They might devalue other people's concerns about what is going disturbingly wrong.

A person in a manic episode feels compelled to keep moving, for fear he or she will fall apart if they stop. The function of all the activity and thinking and talking is to distract from unbearable emotional suffering that is threatening to emerge into consciousness. In my experience, someone who is hypomanic has a childhood history of some sort of abuse or profound criticism. The most painful aspect of their childhood involved some sort of separation or exclusion from family or peers that was traumatic. It could be about a death, divorce, relocation, or other form of being left out, for which the child had no opportunity to have a caring adult offer ways to process emotionally what happened. The feelings become overwhelmingly painful, and are kept at bay by the frenetic energy of hypomania or mania.

Particularly when untreated, hypomania can evolve into mania, which can evolve into dangerous psychosis requiring hospitalization, and cause terrible disruptions to one's career and family relationships. Mania can also evolve in the other direction to depression, with suicidal ideation a common symptom. Bipolar disorders are highly correlated with suicide. Manic behaviors can be bizarre and disturbing to see, which only adds to the stigma associated with bipolar disorders, making it sometimes difficult to get the person into treatment. While many types of emotional and mental illnesses can be treated without the need for medication, mood disorders often require life-long medication, especially when the diagnosis is Bipolar I, the more severe form.

Another common complication is that the hypomanic or manic person has a grandiose sense of his or her own abilities. To them it may seem ridiculous to think of getting professional help, because they pride themselves in being able to do what others can't. Their identity is tied up with being strong enough, big enough, important enough, creative enough to solve their own problems.

If you think that you or someone you love may be demonstrating hypomanic behaviors, I recommend these steps:

1. Read about bipolar disorders. There is excellent information available on the Internet or at your library.
    
2. Insist that the person make an appointment to see a psychiatrist. Psychiatrists are medical doctors with special training who can make very accurate diagnoses of the type of mood disorder needing treatment. Prescribing for mood disorders is a bit of an art form, because everyone responds in their own way to the various medications. It is not unusual to have to carry out several trials to find the right combination for someone, and these medications have side effects. A general practitioner is unlikely to be as well informed as a psychiatrist about the latest medications and research. The Stanford University Bipolar Clinic is a great place to get an evaluation.
    
3. Make an appointment to see a Licensed Marriage and Family Therapist or other licensed mental health practitioner. Bipolar disorders tend to affect the whole family, and a good psychotherapist can work with the patient and/or family member(s) to facilitate a good adaptation to the realities that need to be faced. Through therapy the patient can work through the troubling issues from earlier in life that may have contributed to the development of the mood disorder, thus reducing emotional pressures. A therapist can also help in noticing signs of an impending mood episode, with ideas for how to head them off.
    
4. Keep in mind that it takes tremendous courage on the part of the hypomanic patient to seek therapy. Hypomanic patients in therapy often battle the urge to leave treatment when they begin to get in touch with normal dependency needs that are linked in their minds to humiliation. To acknowledge the emotional importance of another person can feel terribly humiliating to the hypomanic patient.
    
5. If the mood-disordered person cannot be persuaded to go see a therapist, the partner or spouse would be wise to go himself or herself. Relationships involving an undiagnosed, untreated case of hypomania are difficult to manage, and unfortunately can trigger anxiety disorders, depression, or other somatic problems in the loved ones.
    
6. Do not underestimate the degree of suffering and the potential for major disorganization of the thinking processes in a person who is hypomanic. Hypomanics tend to have an unconscious belief that if someone else likes them, that is just evidence of having fooled the person. Emotions like sorrow or joy tend to be exaggerated, and there is a lot of self-contempt hidden under all the grandiosity.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.