Daily Archives: October 20, 2011

Finding the Threshold

In the bipolar community I feel like I’ve heard the word “hypomania” thrown around a lot and it seems that there is a bit of discrepancy about what the word means.

Hypomania is usually defined as “less severe mania”.

That’s a little broad, don’t you think? I mean really, what does that even mean? I suppose it is easy to say that there is a spectrum containing:

  • rational thought
  • hypomania
  • mania

but is there any viable definition of where hypomania ends and mania begins?

That question has been on my mind this week as I’ve attempted to get some solid footing on where my illness lands in the realm of the standard bipolar diagnosis.

I am often asked whether I have been diagnosed with bipolar type 1 or bipolar type 2.

The odd truth is that I don’t actually know. Is the issue that no doctor has ever been straightforward with me enough to tell me one way or the other, or is it possible that my swiss cheese brain doesn’t remember it happening? There are a lot of holes in my memory for some reason, I often struggle to remember pieces of years past (even more recent ones) and when dealing with long term memory my sense of time is completely warped. I feel certain though that if in the scope of my history I’d knelt on the linoleum floor and been dubbed “bipolar type 2” by some wrinkly old man wearing spectacles holding a ballpoint pen I would have remembered it.

Because that seems like an awfully important thing to forget.

Personally I feel like the diagnostic tools doctors have these days are frightfully inadequate anyway. If you knew some of the things I’ve been “diagnosed” with you’d laugh, trust me.

I have a lot more to say about that, but I think I will save it for another time.

Anyway, yes. I’d like to figure out whether I have bipolar type 1 or bipolar type 2 so, at the very least, I can answer that question when people ask it. Bipolar type 2 experiences depression and hypomania, while bipolar type 1 experiences mania as well.

So I can’t figure out which category fits me until I’ve come to some conclusion about the threshold between hypomania and mania.

I spoke with my therapist this week and out came the question:

Where does hypomania end and true mania begin?

What I want is a quantifiable answer.

  • Does it involve the moment one’s mind becomes severed with reality?
  • Or is it the instant manic symptoms slide out of one’s control?
  • Does hypomania become mania only when the effects become detrimental or self-destructive in some way to the individual? Work/school/relationships, etc?

PsychCentral.com says,

“A hypomanic episode is… not severe enough to cause serious impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.”

Ok, so one clear distinction is that paranoia, hallucinations, and delusions are symptoms only of mania; but these symptoms do not need to be present in order for a manic episode to be occurring.

This also suggests what I feared, that by having some kind of detriment is the very way by which mania is most often identified.

At this point I feel like I have a pretty good grasp on how depression feels for me and I can actively sense if I am becoming depressed. Likewise, I have taken mental notes while hypomanic to have a reference point and hopefully be able to sense when that is occuring as well. My fear really lies in mania because at this point I have no solid footing to cognitively discern whether I am experiencing mania or not, and from my past experience by the time I reach that point, I’ve already gone way beyond where I wanted to be.

But if having gone to that detrimental place is what is defining mania in the first place, how can one ever hope to catch it in time?

I also don’t know that I have ever had the capacity to recognize mania while it was happening. Most of these situations are blurred to me anyway, whether it is the swiss cheese brain or the mania itself that wipes these memories away I have no idea. Most of the resulting trauma is only recalled in mental photographs, but it might be that things are better that way.

I’m pretty unhappy with this definition. How helpful is it, really, for a very important (we’ll call it) “symptom” to be unrecognizable except in hindsight? Something that has to be reflected upon and recognized by someone who might not even remember it occurring?

Does that sound like a reliable way to make a diagnosis?

“Sexual promiscuity” is a symptom of mania. If hypomania is the same but less severe, how many random sexual partners does it take to be considered detrimental?

Yeah, still seems a little open-ended to me.

My therapist also brought up a good thought, she told me to remember that every person is different. What one person does while experiencing a manic episode might be on a totally different scale from someone else. Spending a thousand dollars on a shopping spree might be detrimental to someone, while spending two hundred dollars on a shopping spree (mind you I don’t normally shop ever if I can help it and I have a huge amount of anxiety over money) would be detrimental to me. Especially if my entire monthly income to live off of is two hundred dollars, because if you look at it that way I just spent everything I had!

For my own peace of mind I’ve concluded that the two things I plan to focus on in particular while experiencing hypomania (to try to catch things before becoming full fledged mania) are:

  • The point at which one begins losing touch with reality
  • And the instant manic symptoms slide out of control

I already found myself (two weeks ago) face to face with that first point -I realized that I was very quickly becoming detached. It felt a little bit like my consciousness began to evaporate, and as I hovered above my body (who was still walking around talking) I decided I needed to go to bed, right then, and sleep.

(Sleep helps. Forced sleep -still helps.)

Needless to say, it is hard to figure out. I still don’t feel like I have compelling evidence that I have bipolar type 1 vs 2, but I do know that in the end it doesn’t really matter to me. Putting a number on it wont change much, and I’ve always had a way of being hard to put into neat little categories.