Living With Bipolar II Disorder: What Is Hypomania; How Does It Feel?

The National Institute of Mental Health (NIMH) reports that an estimated 4.4% in the U.S. experience bipolar disorder sometime in their lives. You may know bipolar disorder for its extreme highs (manic episodes) and extreme lows (depressive episodes). But the condition does not always manifest in this way. There is something known as bipolar II disorder, which is characterized by recurring hypomanic and depressive episodes. In this article, let us learn what hypomania in bipolar disorder looks like.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) says that bipolar II disorder, or BD-II, is defined by at least one hypomanic episode, one depressive episode, with no history of manic episodes.

Bipolar disorder hypomanic episodes are characterized by milder manic symptoms, in that they still impact your mood and energy levels, but without a total loss of control, as is commonly observed with mania. On the other hand, depressive episodes are characterized by persistent feelings of sadness, emptiness, and worthlessness.

Dr. Ryan Peterson, a highly experienced physician at the NuView Treatment Center, says, “While bipolar hypomania symptoms may not be like full-blown mania, it is still a challenging condition to live with. It is lifelong, and you or someone you care for will need medicines and psychotherapy to manage it effectively.”

Hypomanic episodes can begin with higher energy levels, racing and clearer thinking patterns. This can initially feel good, but it can quickly begin to look like:

• Heightened energy levels turn into recklessness and less sleep
• Risky behaviors
• Abnormally high confidence, which can lead to bad decisions.

A hypomanic episode can last for at least 4 days, after which you can feel:

• Tired
• Embarrassed
• Foggy memories of the episode
• Depressed

Depressive episodes after a hypomanic episode feel similar to depressive episodes in bipolar I disorder. You can experience:

• Frustration or guilt about the things you said and did during the hypomanic episode
• Sadness, emptiness, and worthlessness
• Fatigue and exhaustion
• Suicidal thoughts and ideation.

If anybody is experiencing suicidal thoughts or ideation, call national helplines like 9-8-8 immediately. This can be a life-saving move.

The differences between mania and hypomanic symptoms in bipolar disorder, as well as the general differences between the episodes, are as follows:

Dr. Peterson says, “Identifying bipolar II disorder requires identifying mood episodes that show a clear shift from a person’s typical functioning levels, unlike the more constant symptom patterns seen in other psychiatric conditions.”

What makes it even more difficult to diagnose is that it overlaps with other psychiatric conditions, such as:

Major Depressive Disorder (MDD) vs BD-II

MDD and BD-II share similar depressive symptoms, but only BD-II includes hypomanic episodes, which are often overlooked unless clinicians specifically ask for and gather medical history.

Significant indicators that MDD may actually be BD-II are:

• Abrupt onset and offset
• Multiple brief episodes
• Antidepressant-induced hypomania
• Atypical symptoms, like greater appetite, hypersomnia, sensitivity, and agitation
• Seasonal patterns and heightened mood reactivity

Borderline Personality Disorder (BPD) vs BD-II

While BPD is a personality disorder and BD-II is a mood disorder, both conditions share mood instability and impulsivity patterns. However, BD-II mood shifts occur in discrete, internally driven episodes, whereas BPD emotions fluctuate in the context of interpersonal stressors.

BPD also involves chronic patterns like fear of abandonment, unstable relationships, and emptiness, whereas BD-II involves less trauma history and better response to mood stabilizers.

Other Psychiatric Conditions

• Cyclothymia: Cyclothymia involves long-term patterns (minimum 2 years) of hypomanic and depressive symptoms that never meet full criteria for BD-II episodes.
• Anxiety Disorders: Anxiety conditions give rise to worry and tension, but without the heightened mood patterns commonly observed in hypomania bipolar disorder episodes.
• Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is a developmental disorder that is a lifelong condition. It is characterized by a lack of focus and impulsive behavior, but without the distinct mood episodes that define bipolar disorders.
• Complex Post-Traumatic Stress Disorder (C-PTSD): C-PTSD includes trauma-related intrusive thoughts and emotional dysregulation, but does not produce distinct hypomanic or depressive episodes.
• Substance Use Disorders (SUDs): Mood changes in SUDs are tied to intoxication or withdrawal, whereas BD-II mood episodes are discrete and internally driven, independent of substances.

To diagnose hypomania bipolar condition, your healthcare provider will collect your personal medical history, family history, and other medications/supplements you use. Then, they will conduct physical examinations like blood tests to rule out physiological conditions that may look similar to hypomania. For instance, hyperthyroidism.

Licensed and trained mental health specialists will use DSM-5-TR criteria to see if hypomania meets the criteria, such as:

• Abnormally heightened mood and energy levels.
• Three or more symptoms that deviate from your typical behavioral patterns.
• Hypomania is not severe enough to interfere with daily functions or require hospitalization.
• Hypomania is not the consequence of intoxication or withdrawal, as is found in substance misuse.
• Your hypomanic symptoms do not include psychosis - like hallucinations or delusions.

Dr. Peterson says, “Yes, bipolar II disorder can be difficult to diagnose because hypomanic symptoms are often subtle, but getting the diagnosis right is key to effective long-term management.”

Bipolar II disorder with hypomania and depressive episodes is mainly treated with a combination of medicines and psychotherapy:

• Medication: Medicines for BD-II include mood stabilizers like lithium, carbamazepine, and valproate. Even anti-psychotic medications like aripiprazole, quetiapine, and risperidone, among others, can be prescribed.
• Psychotherapy: Therapy involves both individual and group therapy, like cognitive behavioral therapy, dialectical behavior therapy, interpersonal and social rhythm therapy, family-focused therapy, and group psychoeducation.
• Lifestyle Modifications: Lifestyle modifications like a nutritious diet, consistent sleep, meditation, yoga, and other wellness practices, and peer support groups are also recommended.

Dr. Peterson says, “Bipolar II disorder is a chronic condition, which means that it has no cure and needs to be managed lifelong, like, let us say, diabetes. This may sound disheartening, but with effective treatment, we observed a 75% response rate and a 67% remission rate among our clients at NuView with just pharmacological interventions. So, when we combine medications with therapy and life skills training, the future looks bright and full of possibilities.”

If you or a loved one is struggling with hypomania or bipolar II disorder symptoms, do not delay your recovery any longer. At NuView, we provide personalized outpatient care involving medications, psychotherapy, and life skills training that meet you where you are.

Please do not hesitate to call us at (323) 307-7997 to speak with our experts today!

1. What is hypomania in bipolar disorder?

Hypomania bipolar disorder is a severe form of mania in that you experience abnormally heightened mood and energy levels, but not with the total loss of control or psychosis as is observed in mania.

2. How is bipolar II disorder different from other mental health conditions?

Bipolar II disorder is different from other mental health conditions, as it is characterized by recurring hypomanic and depressive episodes, unlike a constant symptom pattern found in other disorders.

3. Can I have both mania and hypomania?

Not really. Mania is a severe form of hypomania, but you cannot have both together, as it will not be considered bipolar II disorder anymore.

4. Does hypomania feel good?

Yes, initially, hypomania will feel good as you experience heightened mood and energy, but this will soon pave the way for impatience, recklessness, less sleep, and risky behaviors that you may feel embarrassed or guilty about later.

5. How is hypomania bipolar disorder treated?

Hypomania bipolar, or bipolar II disorder, is treated with medications and psychotherapy.

6. Can bipolar II disorder be cured?

No, bipolar II disorder is a chronic (lifelong) condition that cannot be cured. But with treatment, it can be effectively managed.

7. How much does bipolar II disorder treatment cost?

Bipolar II disorder treatment costs vary depending on the treatment center and the type of treatment program involved. However, the costs can be covered by your insurance.