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Hypomania Symptoms: Alcoholism and Bipolar Disorder

Individuals with clinically significant mood disorders such as depressive disorder and bipolar disorder are at risk of alcohol abuse and dependence. Periodic and problematic alcohol use such as binge drinking may be an indication of an underlying type of mood instability called hypomania rather than clinically diagnosable bipolar disorder.

Bipolar Disorder and Hypomania: Similarities and Differences

Bipolar disorder is a chronic psychiatric disorder characterized by episodes of elevated mood, typically alternating with episodes of depression. The presence of mania is what differentiates the two major types of bipolar disorder from one another. In bipolar I disorder, a person typically experiences alternating episodes of depression and mania. In bipolar II disorder, which is generally considered less severe, a person alternates between depression and hypomania. During manic episodes, a person may feel exuberantly joyful or uncomfortably irritable, whereas during depressive episodes, a person may experience desperate sadness or hopelessness. It is common for episodes to be so severe that immediate hospitalization is warranted. Left untreated, bipolar disorder can have devastating consequences for individuals and those closest to them, including suicide.1

Hypomania can occur on its own, whereas mania by definition occurs only in conjunction with bipolar disorder. Hypomanic people are often unusually cheerful, have excessive energy and need little sleep. In general, hypomania is a pleasurable state that often leads to a heightened sense of creativity and power. While hypomania typically manifests in manic behaviors such as increased energy and activity, it is not severe enough to lead to the type of functional impairments associated with manic episodes seen in bipolar disorder. However, it is important to keep in mind that too much confidence may impair decision-making and blind one to associated consequences. Although hypomania is not as serious as bipolar disorder, it can lead to serious repercussions, especially if the person suffers from a co-occurring substance use disorder.2,3

Facts and Stats

  • The lifetime risk of suicide among individuals with bipolar disorder is estimated at 10% to 15%.4
  • More than 50% of people diagnosed with bipolar disorder have comorbid alcohol use disorders, which further increases the risk of suicide.5
  • Individuals with hypomania are 2.9 times more likely to meet the criteria for alcohol abuse/dependence than other people after adjusting for other factors. The relationship between hypomania and substance use outcomes does not vary by race/ethnicity.6
  • A 2004 study found that more than 25% of individuals who met the criteria for hypomania also had a substance use disorder.6

Hypomania Symptoms

A hypomanic episode is associated with a change in functioning uncharacteristic of the person’s normal behavior. An individual may be far more productive or outgoing than they usually are. The change in mood and functioning is not subtle. It is obvious to the person, family members, friends and colleagues. Hypomanic symptoms are similar to manic episodes in bipolar II, with several key differences. A hypomanic person’s mood is typically not extreme enough to cause problems at work or in social situations, does not require emergency psychiatric treatment or hospitalization and never includes signs of psychosis.7

Hypomania is characterized by episodic, persistently elevated, expansive or irritable moods, lasting at least four consecutive days and present most of the day, nearly every day. During the period of mood disturbance and increased energy and activity, three or more of the following hypomanic symptoms (four if the mood is only irritable) persist, represent a noticeable change from usual behavior and are present to a significant degree:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (e.g. feels rested after only three hours of sleep)
  • More talkative than usual or feels compelled to keep talking
  • Flight of ideas or subjectively shows thoughts are racing
  • Distractibility (e.g. attention easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal-directed activity (socially, at work/school or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities with a high potential for painful consequences (e.g. uncontrollable shopping sprees, sexual indiscretions or foolish business investments)7

Hypomania and Drinking

The etiology of substance comorbidity is not well understood, although experts think substance use may be a coping mechanism people use in an attempt to manage early symptoms of manic and depressive episodes. A study published in 2013 indicated only 0.5% of respondents met the criteria for hypomania, although this group had statistically significant higher rates of alcohol use than those without hypomania, with 95.5% having consumed alcohol at some point in their lives. Consistent with previous research on bipolar disorder and substance abuse and dependence, hypomania was positively associated with the presence of alcohol abuse/dependence. People with hypomania consumed their first alcoholic drink an average of 2.2 years earlier than those without the disorder, after adjusting for age, gender, race, education and marital status.

Researchers concluded that onset of substance use occurred before hypomania, thereby contradicting a previously published hypothesis that individuals with hypomania may use illicit substances (self-medicate) to prolong states of elation. There is relatively little research on the role of illicit substances as coping strategies for mania or hypomania. Likewise, limited studies have implied substance use can precipitate hypomanic episodes. Therefore, more in-depth research is needed to prove or refute both of these theories.6

  1. Types of Bipolar Disorder. Depression and Bipolar Support Alliance website. http://www.dbsalliance.org/site/PageServer?pagename=education_bipolar_types Accessed December 15, 2016.
  2. Ask the doctor: What is hypomania? Harvard Health Letter website. http://www.health.harvard.edu/newsletter_article/what-is-hypomania Published December 2010, Accessed December 15, 2016.
  3. Definition of Hypomania. MedicineNet website. http://www.medicinenet.com/script/main/art.asp?articlekey=30745 Updated May 13, 2016. Accessed December 15, 2016.
  4. Duarte W, Becerra R, Cruise K. The Relationship Between Neurocognitive Functioning and Occupational Functioning in Bipolar Disorder: A Literature Review. van der Stelt O, ed. Eur J Psychol. 2016;12(4):659-678. doi:10.5964/ejop.v12i4.909.
  5. Schizophrenia, Bipolar Disorder and Suicide. Treatment Advocacy Center. http://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3632-schizophrenia-bipolar-disorder-and-suicide Published September 2016. Accessed December 15, 2016.
  6. Do EK, Mezuk B. Comorbidity between hypomania and substance use disorders. J Affect Disord. 2013;150(3):974-980. doi:10.1016/j.jad.2013.05.023.
  7. Hypomanic Episode Symptoms. Psych Central website. http://psychcentral.com/disorders/hypomanic-episode-symptoms/ Updated September 2, 2016. Accessed December 15, 2016.

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