People with hypomania have activity levels off the charts
DEAR DOCTOR K:
I like to paint in my free time. Recently I've been staying up until 3 or 4 in the morning to work on my paintings. I know I should feel tired, but I don't. One of my friends said that I might be hypomanic. What is that?
Hypomania is an elevated mood or energy level -- one higher than your normal state. The decreased need for sleep that you describe is one of the hallmarks of hypomania. Some people who are hypomanic sleep only a few hours a day. But despite this, they say they feel rested from such little sleep.
On the flip side, many creative people like you are naturally energetic when working on their art. This is especially true when a creative person is in the "flow."
According to the diagnostic manual used by mental-health professionals, the "DSM-IV," a person has to have at least three of the following symptoms for at least four days to be considered hypomanic:
-- Inflated self-esteem or grandiosity;
-- Decreased need for sleep;
-- Increased talkativeness;
-- Racing thoughts or ideas;
-- Marked distractibility;
-- Agitation or increased activity;
-- Excessive participation in activities that are pleasurable but invite personal or fiscal harm (shopping sprees, sexual indiscretions, impulsive business investments and the like).
Do you have any of the symptoms described above? Some of these can be observed by others. When I'm concerned that one of my patients may be hypomanic, I ask her if I may talk to someone who knows her well, like a spouse. Does the spouse think the patient has inflated self-esteem? In your case, does your spouse say you've been comparing your art to Picasso's?
The other question I ask the spouse about each of these features of hypomania is whether it is unusual. Does the spouse say, "He's just not himself recently"? Full hypomania is rarely a constant state; it's episodic.
Someone may have always been energetic and talkative. That's still true, but now it's as if she can't ever be still. It's hard to understand what she's saying. She makes extremely risky decisions that she never would have made before. She's just not herself. If that's what others say, it's possible the person is suffering from hypomania.
Another thing I try to assess is whether a person's possible hypomania is seriously affecting his or her life at home or at work. Finally, I look for thinking that is clearly psychotic. He doesn't just think his art is the equal of Picasso's: Picasso himself said he was his equal just last week. Serious problems at home or at work due to this new behavior, or frankly psychotic thinking, indicate the person may have full-blown bipolar disorder (or manic depressive disorder).
The odds are that you're just a very energetic and creative person and don't have hypomania or full-blown mania. But if any of the features of hypomania I've described might fit, talk to your doctor.
(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)
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