By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Bipolar.
Photo courtesy of Pixabay.com
Does you temperament predispose you to mental illness?
Hyperthymia, hyperthymia personality disorder, and bipolar. Photo courtesy of pixabay.
Personality characteristics may be a risk factor for certain mental illnesses but the exact connection continues to be far from clear. Psychologists have long been interested in various personalities. Are you outgoing – let’s call that extroverted. Psychopharmacologists look for connections between meds, drugs of abuse, and temperaments or personalities.
For the mental health community, the connection becomes more problematic. We are reluctant to diagnose someone as “mentally ill” because they are introverted, extroverted or have some other “personality type.” We really want to know that your personality issue or temperament is somehow interfering with your life, job, and friendships or making you miserable before we start saying that the way you are and were born, is somehow a disorder.
We know, or think we know, that some personality characteristics might increase your risk for certain disorders. To the extent that genetics plays a role in mental illness your temperament just might be a factor in developing mental illness.
Hyperthymia is one of those possible risk factors.
Hyperthymic people are those people who have so much energy, do so many things, and get so much done they annoy others. Goel, Terman, and Terman (2002) defined Hyperthymia as equivalent to Hypomania but without the impairment. So if you lose control it is hypomania and you get diagnosed with a mental illness (Bipolar.) But Hyperthymia by this definition means you are able to hold it together.
In their discussion of Bipolar and creativity, Shapiro and Weisberg (1999) define Hyperthymia as those people who have had periods of hypomania but there had not been a period of depression. This inconsistency in definition for Hyperthymia leads to a lot of inconsistencies in our understanding of this personality dimension.
Does that mean people with Hyperthymia are mentally ill?
A Hyperthymic personality has been suggested as a possible precursor for Bipolar Disorder. Currently, the DSM-4 includes diagnoses for Bipolar I, the most severe kind, and the Bipolar II variety with less visible mania, but not necessarily less severe, as the choices. Some theoreticians have suggested that there are also some “soft bipolar disorders.” They have suggested designations of Bipolar III and Bipolar IV for the less obvious forms.
Enter Bipolar III.
Shapiro and Weisberg suggested a diagnosis of Bipolar III for people who have depressive episodes and then when given antidepressants, experience hypomania. For them, the only time Bipolar III’s are manic is when on meds. Other authors suggest or imply that most any person with Bipolar Disorder will react quickly and dramatically to antidepressants.
Could Hyperthymia be Bipolar IV?
One area of research has been the search for connections, precursors, or predictors of future mental illness. These precursors are sometimes called “premorbid” conditions. If we knew that some currently small symptoms meant you were at high risk to develop a mental illness maybe we could begin treatment early and reduce the severity and length of a mental illness. Hyperthymia just might be such a precursor.
Hyperthymia seems to be one of several personality characteristics that increase the likelihood of developing some symptoms of Bipolar Disorder. But an increase in risk does not equal you having or getting the disorder.
People with Hyperthymic personality characteristics who experience depression, even a mild depression may “overreact” to antidepressants. Doctors have been warned to look out for high energy people who have an episode of depression and when given an antidepressant are propelled into mania or hypomania. An excess reaction to antidepressants could be one way of diagnosing Bipolar Disorder. One research study (Hoaki et al. 2011 published in Psychopharmacology) suggests that doctors should consider giving these Hyperthymic type people a mood stabilizer rather than an antidepressant.
Risk factors for Hyperthymia.
These researchers also found some other risk factors for developing Hyperthymic personality and presumably a soft form of Bipolar Disorder. Now, this is my understanding from reading this and other studies but a lot more research is needed in this area. Remember this is my opinion not necessarily the researchers.
When subjects for research were first screened there seemed to be a connection between how much they exercised and how “Hyperthymic” they were. Presumably, if you exercise more you have more energy. This did not end up in the lists of the risk factors for Hyperthymia so at this point it does not seem likely that more exercise will push people with risk factors into a Bipolar Disorder. But frankly, at this point, any connection between exercise and Hyperthymia or Bipolar Disorder seems like a wild guess. If anyone out there with Bipolar Disorder has seen a connection please drop me an email or leave a comment.
More light- More Hyperthymia.
Hoaki and his colleges found the relationship between light and Hyperthymia to be fairly strong. Even people who did not exercise much, when they were in brighter surroundings, had more energy and more Hyperthymic personality traits. So being outside or around more light might improve your energy level. We know that lack of light is one reason some people suffer from SAD (Seasonal Affective Disorder) but this makes us wonder, could changes in light level provoke Hyperthymic episodes, and might this be a risk factor for a hypomanic episode?
More variation in sleep – More Hyperthymia.
One diagnostic marker for manic and hypomanic episodes is a decreased need for sleep. What Hoaki’s article seems to suggest is that it is not just that a reduced need for sleep is a problem, but fluctuations in the amount of sleep from night-to-night may be a risk factor to set off Hyperthymic characteristics. Hoaki frames this as changes in bedtime; presumably, his subjects have a constant time to get up for work or school. Studying sleep fluctuations in people who have no set time to get up might clarify this issue.
Could fluctuations in the amounts of sleep be a risk factor for inducing Mania and Hypomania?
Hoaki et al. speculate that a consistent amount of sleep might be a preventative for developing Bipolar Disorder.
People with a Hyperthymic personality or temperament also had a tendency toward Serotonin Dysregulation. So the way in which Serotonin is used in the brain may be an important marker for Hyperthymic Personality as well as for mood disorders. Hoaki notes that other authors have suggested that people with a Hyperthymic personality may also have differences in the way their brains regulate dopamine. The more we learn about the brain the more neurotransmitters seem to be involved in the way our brains work.
The conclusion of Hoaki’s study is that light, sleep, and serotonin activity are all factors in Hyperthymic personality characteristics and in Bipolar disorder, so there is likely a connection between these two conditions. How the two conditions are related we are just not so sure.
Is Hyperthymia a personality disorder?
The lists of Personality Disorders listed in the DSM-4 as diagnosable mental illness is short and specific. Hyperthymic personality is not recognized as a disorder. It would be correct to consider Hyperthymia a personality characteristic or someone’s temperament but not as a disorder.
Those very energetic people may be annoying to some but they are just not considered mentally ill at this point.
More on the recognized personality disorders to come
Hope this helped to clarify Hyperthymia, Hyperthymic Personality characteristics and why there is not a recognized Hyperthymic Personality Disorder.
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As described, hyperthymia is another person’s problem. to give it some grace some humility might be advised…just saying
I have some diagnosis of bipolar…i’ve been reflecting on self-stigma coming from my personal beliefs about my condition (which were biogenetic beliefs). These beliefs were challenged and i’ve changed my beliefs (to a traumagenic model)
this change of belief changed my self perception with a dimension of de-stigmatisation. what i valued about my hypomania was my high spiritedness, quick wit, charm which on their own can be seen as virtues or a discursive label hyperthymia perhaps
in my current state i’m ok with this non-pathological assessment of long standing personality features. having to continually self-vigilate what are usually virtues is a life’s work and existential exhaustion i’m happy to take reprieve from
happy hyperthymia, euthymia etc
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Thanks for offering that perspective and for the comment.
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Hi there – I’ve gone through many diagnosis starting with hyperthymic, then bipolar, then adjustment disorders etc etc over the last 4 years. I am 42.
I have learnt to differentiate between the two, one is just being happy with lots of creative energy but when bipolar kicks in I become agitated and often self-medicate until I realise whats happening. Normally because everyone I love rejects me, I don’t know I am falling until I hit the bottom I guess.
Also I’m an artist (painter) which also confuses people.
However I have found a morning meditation practice really helps me, 10 mins of asana followed by breathing exercises and 20mins of meditation everyday. Through this I feel clear and calm – still hyperthymic but in a positive way. Sadly I often stop meditating and then slip backwards but went two years without any issues, then 9 months after stopping my meditation I have just gone through another bipolar episode. Luckily it was brought to my attention by someone I love, and I managed to escape to a retreat before too much damage was caused.
After a week of meditation I’m back again and will try goddam hardest to keep to my ‘meditation medication’ – as I have tried nearly all the pharma without any noticeable change apart from Mirtzapine which I take for a couple of weeks to fix the imbalances during an episode that are driving the depression (when bipolar I am nearly always in mixed states until I see the damage and then fall into a deep depression).
I read with interest that hyperthymic people often move to a manic state when on anti depressants but I don’t seem to with mirtzapine. I know it’s a different class than the typical SSRIs etc – but are there any literature of case studies of hyperthymic people taking mirtzapine and if it slips into mania as to me it does not. I know you can’t offer advice on my condition over the inter webs but maybe you could suggest some links.
And if you or anyone else on this page want to know more about meditation, I would love to share what works for me.
Thank you,
Charles
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Thanks for your comment. Many artists are high energy people. That makes sense. I read somewhere the Picasso created piece of art a day. There is a fine line between creativity and lots of energy and manic behavior. In mania or hypomania, it begins to cause the person with bipolar problems. As you point out feeling good and stopping medications is a risk factor for a recurrence of symptoms. Some medications can precipitate an episode of mania or hypomania. This seems to be an individual issue so no way to predict who will take a given antidepressant and then experience an episode of mania. I do not remember reading any research about mirtazapine causing mania but that does not mean it is not out there. You might want to go to a library that has access to a large research data base and look for articles. Best wishes. David
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Great article, thank you. I have bipolar disorder in my family and was directed to Hyperthymia. I see many of these characteristics in myself.
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This characteristic seems to be helpful for people in creative endeavors. Like many personality traits it only becomes a problem when someone has an excessive amount of one characteristic but can’t keep the rest of their life in balance. Thanks for commenting and best wishes.
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Dear Mr.Miller,
My daughter was just diagnosed with Hyperthymia after being diagnosed as Bipolar for the past 5 years. She is 27 and got recently divorced. She has a 4 year old son. I was just reading about Hyperthymia and it does sound a lot like my daughter. She was under medication for about an year – Depokane Crono 500mg. This seemed to help her but she discontinued it after she read somewhere that this medication may lead to her not being able to conceive again.
The new psychiatrist she saw said that she was:
*** High on Novelty seeking (likes the thrill that comes from the chase but not quite on reaching the destination. Hence gets bored easily with activities & relationships),
*** lacks Assertiveness skills (hence ends up ‘cheating’ on partners and moves into a new relationship before closure to the previous one)
Both of the above a correct. Over the past 6-7 years she has been jumping in and out of relationships. In fact one of the reason for her getting divorced was this.
Could you please throw some light on this ….maybe a few suggestions. Also, do you need more details?
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Thanks for the comment. Some thoughts. The concepts you included here are not exactly related. For example, someone who is left handed, likes roller-coasters and plays piano may or may not have bipolar disorder. Hyperthymia is a personality description, someone high in energy who likes to do things. That is not the same thing as someone with bipolar disorder who has driven pressured behavior. Novelty seeking is a personality description also. Not automatically connected to a mental illness. Those terms, “hypothermia” and “sensation seeking” sound more like the things a psychologist could test you for. There are a great many life skills, having one or lacking one does not mean you have any particular mental illness in my book. Think of life skills as being able to read, being good at cooking and having good people skills. People with lots of life skills can adjust to life even with a mental illness. Those who lack life skills have difficulties in life regardless. Developing good life skills can help anyone regardless of their diagnosis. Not sure if that answers your question but stay tuned in the posts coming up for more on the differences between personality factors and being mentally well or mentally unhealthy. Life skills are important to everyone and there are posts on that topic also.
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While hospitilized at lakeside in Memphis, th- a bipolar specialist diagnosed me as bipolar 1with psychotic and hyperthymic tendencies. I’m trying to find out more information since my psych nurse practitioner in my town knows nothing about it and refuses to acknowledge the diagnosis.
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Keep looking for the information there is lots of it out there. There are several types some more problematic than others. Medication helps but you can also learn some non medical ways to mange symptoms.
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I was hyperthymic all of my life, then got lead poisoned and depressed, so can I now be called hypomanic (bipolar) or am I just back to my old self??? I don’t feel depressed anymore even during the toughest sh*it. I know it’s sh*t but it does not get me down (never say never). Never been on the meds. Lack of sleep is at first a trigger, and then a symptom. Loud music and dance help me achieve this state, too. Also coffee and chocolate. Being berated. Strangely, admiration makes me feel a bit ashamed. But when berated I get high:DDD Still, don’t expect me to say thank you for berating me and “just be sure to lock up all blunt instruments and throwable objects”.
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Not sure what to make of what you describe. If this is bothering you or interfering with job or relationships then you want to get it checked out by a professional. Some of what you describe like lack of sleep and the stimulants in coffee and chocolate affect most people. Thanks for reading and commenting.
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This article was exceptionally informative. Although i don’t suffer from depression, i seem to fit the profile in nearly all other measures.
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oh boy are you hyperthymic!!! Enjoy it while you can however I think you need a stable person as a friend to let you know when you are going over the top. You sound just like my brain and showing classic signs of mild mania which is fine until you do something too impulsive or zany.
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Ive been seeing a psychologists for a
few months due to anxiety which was caused by a fear of depression. Turns out im a Hyperthymic. It explains alot, especially my unique awesome ness . It explains why ive always felt better than everyone, my unwavering optimism, and that things that would bother many of.my friends i could not grasp or relate to. The only downside is the risk for depression. But honestly everyone s at risk for depression .And i.would even.say that a euthymic.persons depression is more likely.worse than a hyperthymics depression. So at the end of the day my personality is a blessing, nothing. close to a mental disorder
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Hello, thank you for this article- I find it very interesting. I am actually a physician (internist), and was diagnosed with major depression many years ago, which has been fairly well-controlled on antidepressants. I sometimes experience episodes which I had previously thought of as a mild hypomania, in which I have decreased need for sleep, feel almost excessively happy and goal-oriented beyond what is normal for me. Recently, I was off my antidepressants for a few weeks, which not surprisingly was followed by a bout of depression. Since being back on them, I have had several episodes of what seems to be hyperthermia. I am only sleeping 4 hours a night (compared to a usual need for 7-8), experiencing flight of ideas leading to taking on way too much (unusual for me, despite being a physician!), feeling much more outgoing than usual, etc. I have several family members who have depression and describe similar episodes while on medication. Certainly, these episodes are not disabling, and actually lead to enhanced productivity. Not sure if they are serotonin-mediated, based on taking SSRIs. Anyway, an interesting topic.
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I would encourage you too see a psychiatrist about your meds. As we get older there is an increased risk that depressive disorders will turn out to be some form of Bipolar Disorder. You may need a different medication. The best person to figure that out would be a psychiatrist. Take a look at the writings of Kay Redfield Jamison, another physician (Head psychiatrist) who also had Bipolar Disorder. Best wishes on managing your condition.
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Dear Councelor Miller,
I have been reading many of your articles…. Very interesting! I am researching on behalf of my mother (age 72) who I would diagnose as hyperthymic. She absolutely has all 7 of the traits you have mentioned. I actually giggled at the overconfidence one. Mom has started many projects, businesses, career changes, etc. etc. that she really had no business at all doing or thoought about it on a whim. For instance, she once gave a lecture to a group of nurses at our local college on nutrician. When I asked how that came about she said, ” Well, I was picking up information on nursing school and I overheard a woman say that the nutritionist guest speaker for the nursing students had to cancel…. So I said, oh I could do that for you! “. Mom knows the basics of healthy eating but there is no way she is qualified to give a lecture on the subject! I didn’t even ask why she was getting info on nursing school. I love my mother to death and we are very close. I do get concerned about her for several reasons. Where she has never suffered a true out of control manic stage and she has never been depressed, I don’t think that functioning at her intensity is always great. She also has a family history of mental illness. Mom is extremely positive, hits the floor running, is always on the go. That sound fine right? She has also moved about 7 times in the past 5 years ( often she buys something impulsively, once over the phone, and then decides it is not what she thought it would be. My brother and I joke that she is secretly in the wittiness protection program. . Mom is very impulsive with a lot of things, making quick decisions without thoroughly thinking of the big picture. She can be exhuberant, overly talkative, and come across that she is a know – it- all! We have said that she often lacks a filter. About a year ago she was diagnosed with breast cancer. She went through treatment just fine with her great attitude. After she seemed a little agitated/ uptight so her dr. Put her on a low dose of Zoloft. This seemed to take the edge off a bit but soon after she seemed a little too hyper again. I suggested she see someone, thought perhaps she had ADHD. She is now waiting for the results/ report from the psychologist she met with last week. Do you have any input on how she should proceed? Should she not take an antidepressant? Sorry for the rambling, I have my two little boys tugging on me to stop typing. Love your blog! Appreciate any advice.
Sincerely,
Drama-with -mama.
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Interesting case you are asking me about. Since I have not seen your mother I am in no position to really make a diagnosis. There are lots of other things that I would want to know. She sounds like one of those people who are odd but do not quite meet criteria for a diagnosable mental illness. My suggestion is that you and she need to have a talk about her symptoms. You also probably need to consult with a therapist. Hyperthymia means one thing to a psychologist and something very different to a counselor. Starting in April, I will be posting a series of articles on why these two profession may see a person in very different ways. There is a phenomenon called jumping to conclusions that is the result of fast thinking and making quick decisions. This results in some great insights and creativity, it also results in being wrong a lot. At one point in human history this had evolutionary advantages but today people who reach conclusions to rapidly may be called delusional and be told they “jump to conclusions.” If this fits your mother and the symptoms were severe enough to be diagnosable then this sounds like some form of Bipolar disorder and most of the time people with Bipolar spectrum disorders need a mood stabilizer not an antidepressant. The risk is the anti-depressant can send a Bipolar person into a near mania episode. By all means talk openly and honestly with the providers you use but be prepared to have them say she is not mentally ill and that this is just the way she is. Remember it may have been off the hook behavior, but she got the chance to talk to a group of nursing students, that sounds like a n accomplishment to me. There are lots of people on the speaker’s circuit who don’t seem to know much, but that does not stop them from earning big bucks. Best of luck on this one.
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Hi Dr. Miller, I’ve recently discovered that I am hyperthymic. I always knew I was a little “crazy” or “weird” or “different”…. I just didn’t know there were others out there like me! I’d love to chat with you more about finding other people with a hyperthymic temperament. I’m also interested in trying to dig up statistics on Americans that have this temperament as well. Great post, really helpful stuff for a topic that is rarely talked about.
I was looking around the site for your email and wasn’t able to find it. If you could shoot me an email (I think it’ll show up within this comment), that would be great! Thanks again!
TG
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Thanks so much for your comment. For the record I am not a doctor, I have a master’s degree not a PhD. I hope you don’t think that being a little “Weird, different or even crazy is a bad thing. One book about this subject is “Touched with Fire” by Kay Redfield Jamison. She wrote about people with both Bipolar and related conditions. Many very famous and productive people have/had a “Hyperthymic temperament.” It is only when it gets out of control and causes you a problem that it is an issue. See tonight’s post on “Is everyone Bipolar?” for more on the topic. I have not seen any statistics but will look and see what I can find. Thanks again for reading and for your comment.
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TG – I just found out about this recently too because I had a manic reaction to zoloft (which was prescribed due to a temporary anxiety provoking situation which is now over). I was diagnosed with bipolar NOS. This is definitely not the case. I have hyperthymia. When I read the description it screamed my name.
The only “problem” it has ever caused is that my wife (and some others) say I am way too talkative. I am a successful, creative entrepreneur professionally in the arts (music),My wife & I have been in this business together for nearly 20 years. I have good judgement and have never had problems that were not induced by pharmaceuticals. Now they want me to take lithium (started a month ago because I inadvertently took something from a vitamin shoppe that induced mania after a few weeks) but the more I read I think “why do I need to be treated ? ” The ONLY “problem” ever has been “being too talkative” – kind of a funny thing to be considered of clinical concern or intervention. Never has affected me professionally – my clients frequently refer me to their friends. I seem to know to not be overly chatty in a professional context but at home I’m “myself” To further complicate it my wife has ADD (besides being bipolar (classically, not “hyperthymic”) which could tend to create a different “take” on “how overtalkative is he ” ? since that does tend to cause impatience and distractibility !! So I’ve never had “impaired functioning” – so why pay to see a psychiatrist and a therapist. Not sure what we will talk about in the months ahead other than the weather and if my wife, in her estimation thinks that I’m no longer “talking too much”…My hyperthermic temperament has me laughing about the absurdity of the clinical intervention. Personally, I think the “treatment course” should be simply : don’t take an anti-depressant and check ingredients of anything else to see if there are any warnings on the internet about them pushing anyone into hypomania (or in my case – mania since I am already technically sort of there in “hympomania” perpetually – like you !
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Thanks for sharing your experience. As always I would suggest that you talk with your doctor before changing your meds. There can be some problems caused by suddenly stopping some meds. That this started after a temporary anxiety producing situation would suggest that as something you should explore, either with a friend or a counselor. Adjusting to temporary situations should fall under adjustment disorders which usually do not call for a prescribed med. Now that this has happened more than once maybe some prevention would help. Hyperthymia is a term from psychology and not a diagnosable condition so in practice you might also get the diagnosis of cyclothymia. Best wishes and hope you keep reading.
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My only drawback is the talking too much also- especially when I am excited, passionate about a topic, or a bit nervous… I don’t want to have people avoid me due to this. I am extremely bright and struggle waiting for my turn when many times, I already know what they are going to say….
I am on vyvance for the ADD and take On lowest dose Effexor every other day to stop my intrusive thoughts.
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Thanks for sharing that comment. I think trying to balance how much to say and how much to listen is a problem for most people. People who are active and have lots of interests often have a lot to say. Watch for situations where your contribution to the conversation will be appreciate. Best wishes.
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I have been diagnosed and treated for bipolar for about 8 years after being treated for post natal depression for 12 years. I have not had any hypomanic episodes but I realise reading this and other articles, I may have been hyperthymic for the first 28 years of my life. I lived life at a sub-hypomanic state – all the time (driving everyone up the wall) and then crashed when I had kids. So with my major depression and (What I think is) hyperthymia – I am treated for bipolar. I have mood stabilisers (Epilim) and anti-depressants (Zoloft).
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That certainly sounds difficult for you. Having hypomania first and then depression second is more unusual that depression first and hypomania second but that order is certainly possible in Bipolar Disorder. Let’s hope the treatment works for you. Even with meds, some therapy or developing a good support system would also be advisable. Thanks for the comment.
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the way I was hyperthymic for my first 28 years makes it look like a personality trait not a disorder. However when I had my children I got mixed state bipolar. Which may have been my natural personality mixed in with depression and the depression part just won’t let go so meds keep me on an even keel.
regards
Gail
PS really appreciate your site and quick reply.
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Hello sir
myself Dr. Charan Singh Jilowa from India. I am doing post graduation in Psychiatry
you said very well that any order could be possible in bipolar, sir i will be highly obliged to you if you through some light on bipolar spectrum disorder in your perspective
my email address- drcharansingh04@gmail.com
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Thanks for your comment and your question which resulted in the idea for today’s post titled “Where does the Bipolar spectrum begin and end?” I hope this post answered your question. Feel free to send in more questions, they help inspire the next post.
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