Bipolar Disorder: Hypomania

According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), hypomania refers to "a distinct period of persistently elevated, expansive, or irritable mood, lasting at least four days, that is clearly different from the usual nondepressed mood." A child or adult with hypomania experiences similar symptoms as in manic episodes, except that the symptoms are not as severe. How often hypomania occurs alone in children, without the additional presence of one or more extreme mood shifts, is not known. Unlike children with mania, kids with hypomania generally do not have severe impairment in school or in social functioning. Indeed, hypomanic children who do not go on to have full-blown manic episodes can function relatively well in some environments. If you think about it, this makes perfect sense. A person who is bright and creative, who thinks outside the box and needs little sleep as she pursues her goal, and who is quite charming, fun to be with, and highly persuasive has in her nature the very elements that may lead to incredible success.

Consider nine-year-old Freddie, who walked into my office one day as though he owned the place, took a long whiff of my trademark hazelnut coffee, and declared, "Ah, the sweet smell of Dr. Greenberg's office." We should all be as charming as Freddie is when he is hypomanic. How could I not smile?

Steven, the irritable boy mentioned earlier, also has hypomania from time to time. Although his main issue is depression, his parents say there are regular periods, lasting several hours, when he can be delightful. He has an intensely creative side and loves to draw comic book figures. He makes up the characters, and his plots are fascinating, with multiple twists and turns. He can dictate a story to his mother and draw for hours. He sometimes argues about going to sleep because his ideas are "so good" that he is fearful he won't remember them by the next morning. He often has a hard time sitting down and focusing on homework, but his storytelling ability comes naturally, and when he feels like it, he can write and illustrate amazing tales. During these times of prolific writing, he seems easy to get along with. He and his brother play well together, although they are silly at the kitchen table during dinner, with Steven instigating most of the antics.

If a child is in a hypomanic phase, he may exhibit times of increased energy, heightened busy-ness and creativity, grandiosity, silliness, or excessive irritability (especially when thwarted). But even though a hypomanic child can be very pleasant to be around, it's important to remember that for many bipolar youngsters, hypomania is a transient state, one that can unexpectedly shift to full-blown mania or depression.

Excerpted from:

Excerpted from Bipolar Kids: Helping Your Child Find Calm in the Mood Storm © 2007 by Rosalie Greenberg. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Perseus.

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