Image: Michael Witte/NYTimes [larger view].
Have you ever met a person who seems to be on a perpetual caffeine high, without all the shaking? You know the type, those few hyperactive extroverts who are always doing things or meeting people, who have an expansive and optimistic mood yet are easily irritated, and who have an overactive libido or who enjoy really risky pastimes, like jumping out of airplanes or climbing buildings. According to some reading I’ve been doing, these are apparently those few lucky people who are “pure hypomanics”: they have emotional “highs” without experiencing the outrageous slings and arrows of extreme mood fluctuations that a typical person with bipolar disorder suffers.
Until I read this paper about pure hypomanics, I had no idea that it even existed, although I freely admit that I wish I could remain hypomanic forever instead of having to also endure my usual emotional roller coaster. I am not alone in this: apparently, pure hypomanics are poorly studied by the professionals because they rarely end up in a clinician’s office. This is probably because pure hypomanics enjoy their mood state as much as any bipolar person does, and like us, they don’t want this mood state to be “fixed.” But this led a team of researchers to ask: are pure hypomanics just happier normal people, or are they somehow different from them? Are there consequences associated with being a pure hypomanic? If so, what are they?
To begin learning more about pure hypomania, a research team based at the Zurich University Psychiatric Hospital set up a study of these individuals. First, they defined pure hypomania as a period of increased activity and decreased need for sleep — basically, this elevated mood state had to exist without the extreme emotional highs and lows that are typical of those suffering from bipolar disorder.
This team identified twenty-three young adults from the general population, and followed them from age 20 to 40 using a test, the Structured Psychopathological Interview and Rating of Social Consequences of Psychic Disturbances for Epidemiology (SPIKE). The SPIKE consists of 90 questions that assess a variety of somatic complaints, including insomnia, headache, and gastrointestinal, cardiovascular, respiratory, perimenstrual and sexual syndromes. It also assesses mental health and behavioral issues, including depression, hypomania, anxiety, phobias, obsessive-compulsive and fatigue syndromes, eating disorders, post-traumatic stress disorder, substance abuse and suicidal phenomena.
Using the SPIKE to collect information about psychiatric symptoms, the researchers found that pure hypomanics were more likely to use alcohol, drugs or sedatives, and that almost half of them were diagnosed as suffering from either substance abuse or dependence (47.8% as compared to 16.5% of normal controls). Additionally, a significant proportion of the pure hypomanics engaged in binge eating (23.8% as comapred to only 7.4% of normals) (figure 1);
Fig. 1. Psychiatric comorbidity of hypomania (N=23; left side) and controls (N=230; right side). The radial axis indicates percentages of subjects. [larger view].
The above spider-web graphics are known as radial axes or polar graphs. Each axis pertains to a particular subset of data, while the circular axes have a numeric value. In the above situation, the radial axes correspond to the percentage of study subjects (left) and controls (right) who reported a particular psychiatric syndrome.
The researchers also analyzed somatic complaints for the pure hypomanics and compared those results with normal controls and found that 70 percent of pure hypomanics reported significant sleep disturbances each week, either a decreased or — surprisingly — an increased need for sleep (figure 2);
Fig. 2. Somatic comorbidity of hypomania (N=23; left side) and controls (N=230; right side). The radial axis indicates percentages of subjects. [larger view].
Otherwise, the pure hypomanics did not differ significantly in their somatic complaints from the normal controls.
Based on these data, the researchers concluded that pure hypomanics were not normal people with an extra measure of energy, productivity and happiness. Even though pure hypomanics did not differ from normal people in their reported levels of psychic and physical well being, nor in their overall satisfaction with their health, they did differ strongly from normal people in several important ways: first, hypomanics were nearly twice as frequent among the highest income class than normal people and second, they were much more likely to be married, which is consistent with their higher-than-normal social activity and sexual interest.
However, the researchers found that hypomanics did suffer consequences of their elevated mood state as well. These negative effects included sleep abnormalities, and pure hypomanics were also much more likely to report addictive behaviors, such as binge eating and substance abuse/dependence — in fact, they had a significantly increased likelihood of being formally diagnosed with either alcohol or drug abuse or dependence in general. Additionally, when compared to normal people, pure hypomanics also displayed increased aggression, irritability and impulsivity — the same personality traits observed in hypomanics who suffer from bipolar disorder.
Based on the data collected from their small group of subjects, the researchers report that pure hypomania is not a stable mood state. I guess this is really no surprise, but it is somewhat disappointing to me to realize that a person cannot always be in a supercharged state of mind. In fact, the average number of days spent in a hypomanic state in the previous year was one month, with a maximum of just 50 days. So, just as seen in people suffering from bipolar disorder, pure hypomania is a transient, although much-welcomed mood state that appears and disappears like a warm summer breeze.
Even though this study was interesting, I caution you to remember that it had so few subjects that it is difficult to identify real characteristics of this potential mood state and to assess the validity of the data themselves. However, this project does serve as a pilot study that begins to further explore the fascinating continuum of mood disorders in humans.
A Gamma, J Angst, V Ajdacic-Gross, W Rössler (2008). Are hypomanics the happier normals? Journal of Affective Disorders, 111 (2-3), 235-243 DOI: 10.1016/j.jad.2008.02.020.