hypomania = not impairing

Hi,

I was having a conversation with someone who thought they may be bipolar, and they brought up the DSM-IV diagnostic criteria:

Hypomanic Episode (DSM-IV, p. 338)
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Only #7 of the criteria (listed under 'B') is a destructive trait... and 'E' states that there is no marked impairment in functioning...

So my question is does hypomania always have to have destructive consequences to be diagnosed? I think it does, and moreover that the destructive quality of the euphoria is what defines hypomania (or mania).
It seems like #1-6 without (highly) destructive consequences would just be classified as hyperactivity...

Jessie

Hi,

I was having a conversation with someone who thought they may be bipolar, and they brought up the DSM-IV diagnostic criteria:

Hypomanic Episode (DSM-IV, p. 338)
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Only #7 of the criteria (listed under 'B') is a destructive trait... and 'E' states that there is no marked impairment in functioning...

So my question is does hypomania always have to have destructive consequences to be diagnosed? I think it does, and moreover that the destructive quality of the euphoria is what defines hypomania (or mania).
It seems like #1-6 without (highly) destructive consequences would just be classified as hyperactivity...

Jessie

The first one to be clear about is A. Is this clearly different from the usual? Also, does this prerson have the associated depressive episodes?

I disagree that only #7 can be considered "destrucive". I think they can all be a bit hard to handle at times. All of these things can be destrucive when taken to extremes as in hypomania. However, I believe E is intended to distinguish from a type 1 episode that is much more severe. Also, I question your use of the word always. I think it is possible there are times when hypomania is not destructive in itself but one may still be bipolar. Usually the precipitious drop into depression from a hypomanic state is what is most hurtful.

Really though, the best thing to do is refer your friend to a doctor for a proper diagnosis.

The first one to be clear about is A. Is this clearly different from the usual? Also, does this prerson have the associated depressive episodes?

I disagree that only #7 can be considered "destrucive". I think they can all be a bit hard to handle at times. All of these things can be destrucive when taken to extremes as in hypomania. However, I believe E is intended to distinguish from a type 1 episode that is much more severe. Also, I question your use of the word always. I think it is possible there are times when hypomania is not destructive in itself but one may still be bipolar. Usually the precipitious drop into depression from a hypomanic state is what is most hurtful.

Really though, the best thing to do is refer your friend to a doctor for a proper diagnosis.