220 CHAPTER 6
A mixed episode may last weeks to months, at which point all or some of the
symptoms may disappear. Alternatively, a mixed episode may evolve into an MDE
or, less often, into a manic episode. Mixed episodes are more common in young
people and those over 60 years old, and they are more common among males than
females (American Psychiatric Association, 2000).Hypomanic Episode
The last building block for diagnosing bipolar disorders is a hypomanic episode,
which is a distinct period of persistent and pervasive elated, irritable, or euphoric
mood that is less distressing than mania and doesn’t impair functioning, but it
is clearly different from the individual’s nondepressed state. Hypomania does not
have psychotic features, nor does it require hospitalization; hypomania rarely in-
cludes the fl ight of ideas that bedevils someone in the grips of mania (American
Psychiatric Association, 2000). In contrast to the grandiose thoughts people have
about themselves during manic episodes, during hypomanic episodes people are
uncritically self-confident but not grandiose. When hypomanic, some people
may be more effi cient and creative than they typically are (American Psychiatric
Association, 2000). During a hypomanic episode, people may tend to talk loudly
and rapidly, but, unlike what happens when people are manic, it is possible to
interrupt them.
Two key features distinguish manic and hypomanic episodes:- Hypomania does not impair functioning; mania does.
- Symptoms of a hypomanic episode must last for a minimum of 4 days, com-
pared to 1 week for a manic episode.
Some research suggests that the 4-day minimum duration for a hypomanic episode
specifi ed in DSM-IV-TR may be too restrictive and that 2 days may be a more ap-
propriate criterion for duration (Akiskal, 2003; Angst et al., 2003). Like a manic
episode, a hypomanic episode begins suddenly; symptoms rapidly escalate during
the fi rst day or two but can last several weeks to months.
Kay Jamison remembered her episodes of hypomania fondly, which made
it all the harder for her to continue to take the medication that evened out
her moods:
I tend to compare my current [medicated] self with the best I have been, which is when
I have been mildly manic... most productive, most intense, most outgoing and effer-
vescent. In short, for myself, I am a hard act to follow.
(1995, p. 92)The Two Types of Bipolar Disorder
The presence of different types of mood episodes—different building blocks—leads
to different diagnoses. According to DSM-IV-TR, there are two types of bipolar
disorder: bipolar I disorder and bipolar II disorder. Another disorder—cyclothymia
(to be discussed later)—is characterized by symptoms of hypomania and depres-
sion that do not meet the criteria for the two types of bipolar disorder we are
about to discuss.Bipolar I Versus Bipolar II Disorder
The presence of manic symptoms—but not a manic episode—is the common
element of the two types of bipolar disorder. The types differ in the severity
of the manic symptoms. To receive the diagnosis of the more severe bipolar I
disorder, a person must have a manic or mixed episode; an MDE may also occur
with bipolar I. Thus, just as an MDE automatically leads to a diagnosis of MDD,
having a mixed or manic episode automatically leads to a diagnosis of bipolar I.
In contrast, to be diagnosed with bipolar II disorder, a person must alternateDuring a hypomanic episode, which is less
intense than a manic episode, an individual
may go on spending sprees or make foolish
investments.David Woolley/Getty Images