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 RÃ¶ssler (2008). Are hypomanics the happier normals? Journal of Affective Disorders, 111 (2-3), 235-243 DOI: 10.1016/j.jad.2008.02.020.
"Are there "consequences" associated with being a pure hypomanic? If so, what are they? ... First, they defined pure hypomania as a period of increased activity and decreased need for sleep with consequences such as legal trouble or overspending."
It sounds like they define the state as having "consequences", and then find that it does have them. Would the same results apply if the definition didn't require consequences in the first place?
It's hard to take the entire discipline of psychiatry seriously when its practitioners look at high-achieving, unfailing happy, perpetually energetic people and say, "There HAS to be something wrong with them! Let's label 'em 'pure hypomanics' and root out the horrors!"
This was interesting. The range of bipolar-type mood disorders is very broad and defining and labeling them is challenging.
I went to a lecture put on by the MDSG this week. It focused on medication, but the speaker also spoke about the identification and classification of mood disorders. Its surprising how much of this is in its infancy.
Grrlscientist you should get to the MDSG lectures, they are very informative. Coming up next month: Myths and Realities about Antidepressant Use in the Treatment of Bipolar Disorder http://www.mdsg.org/lectures.html
So there's a name for those happy, cheerful annoying sods :o)
Anon at #1 seems to be misquoting - making stuff up even. There is nothing in the definition of hypomania given in the main post about legal consequences, or overspending, or any other consequences come to that: "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." The consequences were empirical findings, not built into the definition.
Hey grrl... Thanks for the polite private response. It was much appreciated. Not always the case with online 'stuff'.
I just wanted to say that publicly.
Nigel - that text comes from the abstract.
Thanks for that wonderful graphic on top of your piece. Thanks too for the information about a condition I think I might be. I must read the full article.
I'll put a link to your piece on my blog.
Highly productive, energetic, happy lives, whats wrong with that? Us hypomanics are just going on and not complaining, if we have the odd night with less sleep, we know what sleeping pills are for. You guys can make up for it with your 9 hours a night! Go on and study us. Sound to me like you are just jealous. Drone on.
hyperactive extroverts who are always doing things or meeting people, who have an expansive and optimistic mood yet are easily irritated . . . enjoy really risky pastimes
Yipes, this sounds like someone I work with. While there's no question that she is smart, funny, and highly productive, she is very hard to deal with. Her mood can turn on a dime. The least annoyance triggers a burst of verbal rage, including threats of retaliation ("I won't do my job if others don't do things the way I want"). Since the job involves lots of contact with people, and people are notoriously unreliable, this can happen several times a day.
Ann, you may be happy and productive, but my coworker is just plain nuts. A difference in degree of hypomania, perhaps?
I'm diagnosed Bipolar One / hypomanic, and I think what characterizes a true hypomanic as having a health condition worth attending to is that, while the hypomanic may not crash into deep depression, s(he) is also prone to bouts of irritability and impulse control issues, as the article suggests. So even though one is generally happy, productive, etc., there is still a down side; and as Rugosa points out, her hypomanic co-worker is difficult to be around. Even at my "happiest," people in my midst were annoyed by me, although of course I was too happy to care. Then, I would snap at them, and the results were not good for my social life. The medications I take for this condition definitely help, as I find myself no less productive, but much less inclined to snap at people or experience periods of restlessness, irritability, extreme frustration, etc. Anyhoo, my ten cents, fwiw.
Yeah, it's not normal to ALWAYS be "on the go."
These people are repressing something. The irritability, outbursts and social difficulties are indicative of something inside themselves they don't want to face.
I'll take my 6-8hrs of sleep plus a power nap. I find I'm much more focused and effective that way, and able to be around people easily and undistracted.
Anyway you shake it, sleep deprivation and hyperactivity are not normal. Sorry. I don't buy the manic insistence that they are happier. Doesn't ring true.
it's odd, you know, because for me i find that i need to have at least 6 hours of sleep most nights, however, i do sleep in when i can. after i wake up it takes a bit of time to get the engines going. but once they are on, they are on full force.
life is way intense and exilirating for me. i typically have an incredibly resilient attitude accompanied by a rush of deep and complicated thoughts. sometimes my friends and family, even myself at times, are shocked at the profoundness of what i say. my level of confidence is absolutely through the roof.
for a long time i rejected it because i felt like i was out of control. i became very good at dealings with people and able to handle loss and rejection extremely well. but at the same time i knew the "rules of the game."
yogi-one may be on to something about the repression aspect in connection with irritability, etc. humans, in my opinion, need to experience the gamut of emotions to function "normally." people that don't are depressive or abusive, etc. perhaps people with hypomania have extremely violent episodes of anger because they rarely, if ever, become sad and most of the time are in a good or great mood. unbalanced.
the key component here being unable to get sad. being able to feel sadness is quite important when it comes to human relationships in terms of being empathetic and understanding. thus, those not being functionally able to feel sadness can have a very different attitude when it comes to relating to other people. hence the classic cold-hearted ego maniacal jerk label hypo maniacs are know for.
even while hypo maniacs full well know there condition and enjoy it, it can also be difficult to cope with at times. there are moments where i know i should be feeling fear or sadness but don't. when i do it's generally intense and subsides very quickly.
all this being said, i still love it to death. outside of the punctuated moments of anger, it's the greatest gift in the world.