Though I have certainly experienced many many pure hypomanic, full blown manic, and depressive episodes, I have had my fair share of what most call "mixed episodes". In fact, mixed episodes were my very worst episodes of my life, and accounted for about seven of my 10 hospitalizations.

Many people are not fond of the DSM (Diagnostic and Statistical Manual of Mental Disorders), and some who liked the earlier versions of the DSM, don't like the current 5th edition. However, I think that the bipolar disorder section of the 5th edition is much improved. Though the term "mixed episode" continues today, and likely will into the future, the DSM-5 doesn't really use that term, like it's predecessor did. In fact, from my recollection, the term doesn't even appear in the 5th edition. Instead, it refers to " with mixed features" as a type of specifier to bipolar episode types. Some other specifiers include:

* with rapid cycling
* with anxious distress
* with catatonia
* with atypical features
* with seasonal pattern
...and a few more.

Why I bring up the DSM-5 is because it is the first time it has "officially" recognized mixed features with hypomania. I can tell you that many (maybe most) psychiatrists did recognize them with hypomania before the DSM-5, but often the label "mixed episode" was primarily assigned to people with bipolar type 1, and not bipolar type 2. So, according to the DSM-5, you can have the following:

- Depression with mixed features
- Hypomania with mixed features
or,
- Mania with mixed features

The choice of the above has to do with the primary episode type. That could mean the episode type with the most symptoms represented, or the episode type with the very worst symptoms represented. Given this, what we've known as "mixed episodes" can certainly look a little different for some people (or for certain episodes) than others. So if you ask me what my mixed episodes looked like, I'd say that they varied, though my very worst episodes (when I was hospitalized) happened to fit the "manic with mixed features" category more than not. I certainly feel that someone with a particularly severe "depression with mixed features" may also tend to end up in the hospital. But "hypomania with mixed features", though pretty rough, likely don't necessitate a psychiatric hospitalization. That's my understanding.

As an add-on, in terms of coding an episode for insurance purposes, there are also other specifiers relating to severity of the episode, whether psychotic features were present, or if the illness is in partial or full remission.

Maybe the above is not exactly what you were asking for, but I truly can't provide an answer other than for my worst or most common episodes that happened to have mixed features. My worst were pretty dangerous for me in terms of danger to myself or others (i.e. reckless driving), having behavior that seemed either scary bat **** crazy, psychotic, and so energized or agitated that people were stunned or severely concerned. Whether there was more clear depression represented or more clear mania (or a rapid fluctuation between extremes) varied.