What is Mania?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How is mania related to Manic Depressive Disorder?

Manic Episode or mania, as it is commonly known, is a mood episode, not a diagnosis. Mood episodes are used to decide which Mood Disorder a person has. For all practical purposes mania and its milder cousin hypomania are only associated with one of the forms of Bipolar Disorder.

Having an episode of mania or hypomania is the defining symptom that distinguishes Bipolar Disorders from Depressive Disorders. The connection is so strong that for a long time what we now know as Bipolar Disorder was known as Manic-Depressive Disorder. Changing the name has confused a lot of people. I still see clients who say they have been diagnosed with Bipolar Disorder and Manic Depressive Disorder. Sometimes they also tell me they have Depression.

Once you have Mania or Hypomania we forget the Major Depressive Disorder diagnosis and use the Bipolar label only.

A Manic Episode is marked by a period of time of at least a week, or less if you get so bad you end up in the hospital before the week is out, where you have a really high, expansive or elevated mood. This is not just a little happy or full of energy but a way “off the hook” period of time. Mania is not a good time. A little may feel like fun in the beginning. People with Bipolar Disorder may like a little mania but full-fledged mania is frightening.

Typically people who are manic have grand schemes to do things. These ideas make sense to them but they sound impossible to most other people. This is not the person who thinks they can sail around the world or invent an internet program. There have always been visionaries who plan to do great things and don’t get appreciated. These are people who try to run for president, cure cancer and beat the house in Vegas – all in one week.

They have decreased need for sleep, sometimes getting by on three hours of sleep a night and they try to do everything until they crash. This looks like a person on Methamphetamine but they don’t need drugs to be like this. Most people who get only a few hours of sleep may be able to function, but they will be tired and drag all day until they can sleep again. The person with mania can go days on little or no sleep and they feel fine. But the longer they are manic the crazier they act and sound.

Fully manic people talk a lot, pressured speech, the sort that erupts rather than is said. This is not normal conversation. They know what they are talking about by not many other people can follow them. Because their mind is racing they become angry and irritable when other people cannot keep up.

In full on mania they become very goal oriented, taking on lots of projects, rushing to do many things, but not always finishing anything. They have difficulty staying on one project, jump from task to task and sometimes get stuck on something that to others looks meaningless or insignificant.

Since they know what they have in mind they think of themselves as brilliant and important, they become full of self-importance until the manic episode ends at which point they may become depressed and regret all they have done or said. This differs from narcissism in that the episodes of grandiosity go away leaving them ashamed or embarrassed.

A common characteristic of a manic episode is getting over involved in things that are pleasurable. They may gamble, do drugs or drink to excess. There is a huge overlap between alcoholism and manic or hypomanic episodes. During manic episodes, they may have excessive, unsatisfiable urges for sex and engage in sex with partners they don’t know.

Someone who is experiencing a manic episode may become so impaired that they have hallucinations. These hallucinations will go away when the mania ends, unlike psychotic hallucinations that are more long-term. It is also possible to have a “mixed episode” where the person is both manic and depressed at the same time.

If someone has these kinds of symptoms we reserve judgment as long as they are able to work, have friends and are not upset about the episode. If it starts to affect functioning then the diagnosis is given. If someone is doing drugs or has a medical problem that is causing these symptoms then we don’t think that is mania and recommend they stop the drugs or get the medical problem treated.

If you have ever had a Manic Episode I would recommend you talk with a doctor, psychiatrist or other mental health professional. Treated early you still can have a productive life. The longer you wait to go for treatment the more the risks that while manic you will do something you can’t take back and the mania will likely get worse each time you have an episode.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Does you temperament predispose you to mental illness?

Hyperthymia person

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 play 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 symptom 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 a 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 antidepressant 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 Hyperthermia.

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 be involved in the way our brains work.

The conclusion of Hoaki’s study are 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.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.