Don’t fence me in: 10 signs of hypomania you won’t find in a textbook

Whenever I tell a new doctor that I’m hypomanic they ask me to describe what I mean when I use that word. I hate the question, because it’s glaringly obvious that they’re assessing my answers against criteria they have in their heads, probably derived from the big diagnostic manuals (DSM-5 or ICD-10). Obviously when hypo I do display classic indicators like decreased sleep, increased energy, increased libido, increased productivity and so on. And of course I understand there are core set of experiences people in a hypomanic state may share which is why they they tend to appear on mood monitoring charts or apps and in self-help books.

The problem with being measured against a general checklist is that accepted symptoms are not usually what I find herald hypomania. There are a whole a range of deeply personal things that I consider much more important in making my own assessment. So the risk of giving an honest answer is that I won’t match the checklist. I will not fit in the prepared box, so the clinician will conclude is that I don’t really know what I am talking about when I explicitly state that I’m hypomanic. This causes me huge frustration; I have worked and worked to be acutely aware of my mood states and to have that expertise dismissed because it’s unorthodox is upsets me every time it happens.

So I think I’ve decided I’m giving up on truthfulness with new professionals because I’m sick of my consistent, reliable signs of hypomania being seen as irrelevant. So I think I’ll share them here instead, and if I get up enough courage I might even pop a copy in the post to the psychiatrist 😉

Funny fingers. Whenever I’m going high I get this thing where I have to scratch or rub my fingers, especially the outsides of my little fingers. I have never successfully conveyed this experience to anyone. I tried to explain to the team registrar recently that it is something that I do it because my need to feel something there. He misinterpreted that and it’s written on my discharge letter that my fingers are numb. Not a bit of it. My fingers feel and function normally, but they need more sensation. I have to do it, I have to meet that need and give them more, otherwise the agitation builds.

Swagger. I’m hardly the sort of person that swaggers around the streets of London. In fact I’m often quite timid, scared of people when I’m depressed, ashamed of my body size and dreading the next time I’m asked me if I’m pregnant (no, just a quetiapine baby). Throw a little hypomania into the mix and I couldn’t be more different. Suddenly I walk in a completely new way. I stride. I sashay. I swagger. It’s a mixture of confidence, the certainty I am sexy, a touch of arrogance and a readiness to engage in confrontation. The best I can describe it is to suggest that you walk along to the track Battle Without Honour or Humanity and see how that feels.

Necklaces. When high, I dress differently – or as the registrar recorded, with more panache. It’s not just that I think more about my clothes than I would when I am depressed. It’s not that I go out and buy new clothes. It’s that apparently great outfits I hadn’t noticed now leap out of my wardrobe. Because my self-confidence is high I am also certain of my own attractiveness so it never occurs to me that I might not be able to “work it”. Most noticeably, the necklaces come out to play. Now, I will readily admit that I am a necklace fiend, if not a hoarder. I have about 50, all of them beautiful, and yet days or weeks can go by without me wearing a single one. In comes hypomania and suddenly the biggest and boldest, the “statement” necklaces, are also leaping out at me (and the compliments I receive of course reinforce my belief that I have great taste in jewellery and should hang on to every necklace I own, so yay).

Pointy teeth. For me one of the earliest indicators of a high is having pointy teeth. Of course my teeth aren’t really any pointier than usual; a quick check in the mirror proves that, as does the knowledge that this isn’t Bon Temps. But they feel much more pointy and I can’t stop running my tongue over them. This is part of a broader package of enhanced senses; my feet are more conscious of the interior of my shoes; things sound louder; colours seem brighter. But it’s always the teeth thing that tips me off.

Asinging and adancing. Based on my Twitter connections, this is a pretty common indicator but I’ve definitely never seen it on any mood chart. On an upswing I find myself travelling from room to room via the medium of Zumba-ish dance moves. When I would normally stand still – washing up, hanging the washing out, cleaning my teeth – I am side stepping or bum kicking or scooping (sorry, that probably make much sense if you’ve never done aerobics!). I chair dance while writing. I get up and start dancing when I should be working. I’m also very into singing, loudly and confidently, loud enough for my son to complain that he can hear me through two walls and a pair of headphones. At least he says I’m good.

Comely commuters. Often I will sit on the Tube and be oblivious to my fellow passengers, buried in my phone or my Kindle. Sometimes I will plug myself into my headphones and do a little people watching. But sometimes, hypomanic times, I find that the carriage is filled with unfeasibly attractive strangers. Everywhere I look there’ll be someone hot. I know I’m staring and that some people have noticed that I am staring and look puzzled and uncomfortable but I can’t help myself. They are literally mouth-watering and my breathing gets shallow, my pupils dilating. Luckily I am never quite manic enough to proposition anyone.

Sunsets. On an upswing, sunsets become almost unbearably beautiful. On long summer evenings when the pressure is high and the sky changes from blue to lemon to streaks of intense pink, I almost cry at so much splendour and the elation spikes and pulsate.

Tweet rate. I do type pretty fast – I learned in the fast-paced chat rooms of the very early noughties – and I do tweet a lot. But hypomanic I tweet a lot more, bam, bam, bam, one tweet after another and another. Online friends sometimes (with good reason) check in with me when they see how fast I am getting my tweets out there, but of course if I feel great I’m unlikely to want to tone things down. But I will probably note what they’re saying somewhere in the back of my mind.

Head music. Head music is another one I’ve frequently heard from other with bipolar but have never seen “officially” acknowledged. It is, I guess, a pseudohallucination – something that is “heard” within the head, but not as an actual sound as someone might experience if they hear voices. For me, it’s usually a loop of a particular song or piece, a particular musical phrase, a snatch of melody or, at its most annoying, a single word over and over again. It can easily be linked with a switch to mixed mood as I become very agitated by being unable to stop the music.

In the loop. Strangely the head music often has no connection at all to what I have been listening to. Which is a good thing, as despite the fact that I have 219 Spotify starred songs when I’m high I will play just one over and over, all day long (hoping the neighbours are at work). When Tom gets home and opens the door there is sometimes a very audible “Uh-oh!” as he clocks what I’m listening to. Again.

I’m not asking anyone to change any diagnostic criteria or mood apps on my account. In fact, I’m asking clinicians to do less work. I want them to sit back and trust that I know something about my condition and remember that I’m monitoring myself for the 23.5 hours a day while they get a 30-minute window. Now, I’m willing to bet that pretty much anyone who experiences hypomania has something weird and quirky that they know they need to watch that’s outside the diagnostic box. This is the stuff that professionals should value; they should be learning from our quirks. Don’t fence us in.

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
This entry was posted in Bipolar, Hypomania, Mania, Self-management and tagged , , , , , , , , , , , . Bookmark the permalink.

31 Responses to Don’t fence me in: 10 signs of hypomania you won’t find in a textbook

  1. AnonOne says:

    I agree with the singing and dancing more (mostly Michael Jackson). Also with the commuters and the dressing to impress, for me the two are mutual.

    I have been having depressive episodes since I was 13 and “hypomanic-like” episodes since I was 18 after stoping my antidepressants. I am finding my GPs infuriating because I have been taking various bipolar tests since I was 18, about various ones once every 3 months, and every time it is ‘80% more extremely likely’. I’ve sat in my university library’s psychiatric section so I know I am on to something rather than exaggerating a little once in a blue moon niggle. I always get ignored so I just have to try to ride out my depressive episodes. It makes me want to cry but your blog cheers me up since I found it so thank you.

  2. davesoapbox says:

    Reblogged this on davesoapbox and commented:
    I could read this blog all day and am glad to have Charlotte on Twitter, She is a truely amazing person who has so much passion

  3. Teresa says:

    Oh my goodness. Thank you so much for sharing. I’m sitting here at 5am having been up for several hours unable to sleep. I’ve tried sooo hard for so long to get a proper diagnosis. I do suffer from bad depression but my doctor said my over-sensitivity to sound and seeing brighter colours and hearing music (as in your pointy teeth section) is a form of synesthesia and I’m not hyper/high in any way so can’t possibly be bi-polar. God, I tried to explain how much energy it takes and for how many years I’ve struggled to keep these feelings in check to appear some kind of normal but they’ve told me I don’t fit into any of their boxes so they don’t know what to do with me. They also tell me time and time again that I’m very self-aware!!!. I;m struggling with suicidal thoughts at the moment as I’m under a lot of pressure (for me) and have an appointment with my dr on Tues to try to convey my feelings again. Thank you Charlotte, I truly thought i must be going slowly mad.

    • That’s really a shame, the person who made me realise that my heightened senses were a symptom of bipolar – I’d no idea! Yes, we’re “self aware” but that’s no good if that awareness isn’t listened to! Wishing you the very best for you appointment. Some people print out my posts to help others understand, if you think that would be helpful then please do share the post with your care team x

    • gravbeast says:

      So sorry to hear about the struggles you’ve been having 😦
      I sympathize with the feeling of “having to keep feelings in check” – people don’t always seem to understand that hypomania doesn’t mean you necessarily *act* on every impulse – but it does take constant conscious effort to make sure you’re not being, well, too obviously odd or obnoxious.

  4. Gareth John says:

    I find the lack of ‘respect’ for my hypomanic symptoms frustrating. I’m practically told to ‘enjoy’ it by mental health professionals due to my depressive episodes being so bad. Bear in mind that although I am being treated for bipolar (and have been for some years) I have no formal diagnosis. I have all the classic symptoms mentioned above, mainly pacing around the house talking to myself as one idea flies after another and hand-wringing. And, like you Charlotte, despite having many ‘happy’ songs I will listen to the same one over and over. I tend not to tweet personal stuff as I usually stuff, but frantically search the internet to post interesting (to me anyway) finds. I also get extremely impatient and irritable. In fact, it’s usually noticing this aspect that leads to me going off work sick, as I work with vulnerable adults and as I speed up, they slow down even more than they usually would. The point at which I find my patience levels dropping, I know it’s time to get out. Unfortunately this hypomania is always followed by depression, so my sick leave can be quite protracted (I’m off work sick now). And, of course, the higher you go, the deeper the fall. So from my experience, hypomania just isn’t acknowledged or acted upon or taken at all seriously and I’ve given up trying to change this – as with so much else. Just my two-penneth. Thanks for highlighting our similarities and differences – if only mental health services were so enlightened.

  5. Gareth John says:

    TW: OD
    Sorry – just to add: despite what many say I KNOW you can experience mixed episodes with hypomania and depression and for me they have been the cause for many OD attempts. I had to email Prof Nick Craddock at Cardiff University (an expert in the field of bipolar studies) just to get my psychiatrist to admit it was even possible. For the record here’s my email to him and his reply:

    Dear Prof. Craddock,
    Please excuse my impertinence in writing to you directly, I am hoping that you will be able to help me with a query I have related to my own diagnosis of bipolar disorder, or rather the difficulties I am having confirming one. The question I have is a general one, i.e. not personal to me and I will keep it brief.
    Can a mixed state be characterised as one in which depression and hypomania are experienced simultaneously? Or must they be experienced separately, say for example, hypomania in the morning and depression in the afternoon? I believe I have experienced a mixed state or episode this year (for the first time) and my experience was that the hypomania and depression were literally ‘mixed up together’ in that I experienced the two simultaneously. A psychiatrist I saw this morning has said that a mixed state can only be defined as an episode where the two moods are experienced one after the other.
    My experience led to me very nearly killing myself and I am keen to establish what it was and how best to deal with it if it comes around again. I feel that by postulating the above the psychiatrist is dismissing my version of events without taking the time to explore my experience. Is he right or is it possible to experience a mixed state in both ‘forms’.
    My apologies again for bothering you and I fully understand if you do not wish to involve yourself. Having said that, I would really appreciate your help.
    Sincerely,
    Gareth John

    Here’s his reply: ‘The simple answer is: It is possible, and not uncommon, that a person with bipolar disorder can experience both mania and depression symptoms at the same time. It is a dangerous state because the negative thoughts which may lead to suicidal thinking are combined with an energized, agitated state making it likely that the person will act.’

    It didn’t make much of an impression on my psychiatrist, but that was to be expected. My hypomania remains unacknowledged and I know that is not because they haven’t seen me the ‘magic three times’ in that state to make the diagnosis, it is simply that they do not believe it to be a problem.

    • Hi Gareth 🙂 I’m finding it hard to get my head around this, because mixed states are in both diagnostic manuals, in fact they are more clearly defined in the new DSM-5! And yes, they are also known from outcome data to be the riskiest time for a bipolar to attempt suicide (the only overdose I have ever taken was in a mixed mood state). I just feel baffled reading thos. It is there in any textbook, I just can’t understand how your psychiatrist could simply refuse to accept the clinical evidence and the criteria in the manuals. For me, a mixed state at its worst means feeling all the despair of deep depression with al the agitation of a nasty high, though sometimes when less intense I will be aware of feeling unwell but not be able to identify what mood state I am in, and it usually turns out to be mixed. It’s really important to be able to try and recognise them!

  6. Gareth John says:

    I think it’s precisely because the psych doesn’t ‘rate’ hypomania that the idea of mixed states is a no-goer from the get go. I sometimes feel they are humouring me with all the talk of bipolar, but then as someone on lamotrigine, quetiapine, diazepam and duloxetine they do seem to be treating me for it. That after the lithium failed to work after a couple of years. It’s taken two suicide attempts in the past three months – serious enough to put me on life support for a week – to even get a CPN assigned. So-called Welsh measures also guarantee a Care Plan, but that’s nowhere to be seen. Actually I haven’t heard from my CPN despite him supposedly calling me at the beginning of the week. I no longer even care, I resign myself to them always getting it wrong.

    • Hi Gareth. I’m really sorry to hear how unhelpful your psychiatrist has been. I’ve seen two psychiatrists since being diagnosed with Bipolar last year. The first didn’t seem to think my hypomania and mixed mood were too worrisome & left me under the care of my GP after prescribing antipsychotics and antidepressants and benzos. However he has since left the service and I now have a new psychiatrist, who has a completely different attitude. Psychiatrist number two stresses to me that mixed affective bipolar states are extremely risky especially in terms of suicide risk. He explained that the anger and depression I experience combined with uncontrollable energy are serious bipolar symptoms & advised me to contact their team immediately if this happens. Psychiatrist number two also seems to think hypomania is a serious issue (to the extent that i am currently advised against both driving & working until more stable). He thinks that the more times people with bipolar ‘cycle’ between moods, the worse our prognosis is over time and therefore any marked changes in mood/energy in bipolar are serious (depressing news to me given that I’ve been rapid cycling for years). I know it’s a long shot but would it be worth asking if you could see a different psych? Wishing you a speedy recovery from the current episode you are experiencing. X

      • Gareth John says:

        Unfortunately I live in the middle of nowhere (well, Wales) where we have only two psychiatrists. I’ve seen them both and have had little joy with either of them. In all fairness, they have vigorously pursued the medications angle, but that’s about it. Until my last OD they kept flinging me back to my GP too (she’s been excellent) but I’m afraid I’m stuck with them now for better or worse. I think I’m winning them over gradually, but it’s bloody hard work 🙂

  7. RuthyToothy says:

    New health professionals not trusting my own judgement of my mental state has been a massive problem for me in the past. The worst was the days after giving birth to my son, where I tried repeatedly to convince midwives and psych liaison nurses that I was becoming seriously unwell, and nothing was done until day 5, by which point I was in the full grip of a psychotic mania that necessitated a month of inpatient treatment! It was my regular Consultant who saw me on day 5, and he has always told me that the patient is the expert on their own condition because they are the only person experiencing it from the inside, 24/7. I didn’t fit most of the “usual” symptoms of puerperal psychosis, and the previous hospital staff had refused to accept the non-typical symptoms I was describing were anything serious – funny fingers, head music and sunsets were amongst them actually!

    Finding beauty in all sorts of unusual places is a major warning sign for me, as well as an exaggerated beauty in things like sunsets. My head music will often be several different pieces of music layered over each other, which I simultaneously find amazingly pleasing and utterly infuriating because I can’t decide which piece of music is the most beautiful or most important. Your description of funny fingers is very accurate to my own experiences, too, and often results in me picking my fingers until they bleed. I also get a similar issue with my jaw / teeth / gums, where I feel the need to bite down hard or grind my teeth to get a feeling of deep pressure in my jaw, and will also floss aggressively to satisfy the need for strong sensations. These finger/jaw/teeth/gum symptoms seem to be highly indicative of a mixed state episode for me, though, rather than “pure” hypomania, and seem to encompass the twitchy restlessness and sensory seeking aspects of hypomania and the high anxiety and agitation of depression. Yuck!

    I, too, have recently resolved to save descriptions of these less “typical” symptoms for those who know me well and trust my assessment of my mental state, so basically a few close friends and my consultant, and when speaking to my husband or to healthcare professionals other than my consultant I will try to stick to describing the things they want to hear in order to come to the same conclusion I have already reached. I feel like that is the only way I will get the treatment I know I need at times of crisis. It is very frustrating though, not least because it feeds into those people’s perception that we all have the exact same set of experiences when unwell. Sometimes the priority has to be your current crisis rather than facilitating a wider understanding of Bipolar, unfortunately.

    • RuthyToothy says:

      And looking at that reply, I realise that I am exhibiting my other major sign too… extreme verbosity! Sorry!!

      • No need to be sorry ((Hugs)) one of my big indicators too! xx

      • Els says:

        I educated my psychiatrist that in my case the extreme verbosity would transfer to sending emails too. I told him: if you want to know how I am, ask how many emails I send per day. It’s a fail proof diagnostic test! He DID take that in; we need to keep educating them!

    • Hi! Lovely to see you 🙂 VERY frustrating, because if these early warning symptoms were taken seriously in the first place maybe we wouldn’t have to get to crisis point. IDK how it’s supposed to help any of us to lie (on our part) or ignore (on their’s). I want to change it! I feel full of evangelical zeal! But know that’s probably just hypomania again 😦

      • RuthyToothy says:

        Yeah, I have to consciously steer my thought away from considering how different things could have been if I had been taken seriously and given anti-psychotics etc 4.5 days earlier. I am certain that my inpatient stay could have been far shorter, and I suspect the catatonic depression I fell into 3 months after my son was born would have been less severe. If I had been able to bond with my child from the start instead of being stuck on a psychiatric ward unable to even see him some days, then maybe I could have avoided the first year of my son’s life being dominated by my ill health, and perhaps ECT would not have been necessary. For a long time I was extremely determined to have things in the system “put right” in order that no other family would have to go through what happened to us, but I have had to accept that I simply do not have the emotional energy to spare to fight the system. Except when hypomanic, of course, when I have plenty of energy to spare, and believe that I could single handedly “fix” the entire NHS if only everyone would recognise my brilliance…

  8. Els says:

    Sorry to hear you are feeling like this, Gareth. I applaud you for contacting the prof. Did he, apart from validating your experience, give any advice on how to deal with it? I have experienced it several times over the last 10 years, and although I have a good psychiatrist whom I like, I don’t really think he gets it on how dangerous these states are or can be.
    Take care,

    • Gareth John says:

      Sorry – what you see there is all I got. I didn’t feel comfortable pumping him for info as I had no connection with him and I simply wanted validation from him that mixed states existed so I could present it to my psychiatrist. I too have come to like him, but it did take a couple of ODs on my part to get him to open up! His exact words were: ‘You’re in the system now.’ At first I was pleased as I thought this would change everything re: my care. Subsequent experience has shown this not to be the case. C’est la vie. Regardless, I still think it’s important to seek help if these states become dangerous for you, so don’t let my experience put you off. Stay safe.

  9. Reblogged this on ohandalsothis and commented:
    Wow, recognise a lot of these in myself!

  10. Oh yes, I see myself in a lot of that.

    Although it does strike me that any psych refusing to acknowledge those experiences are indicative of a textbook hypomanic state are failing to think about those symptoms in relation to real lives. For example comely strangers > increased libido. Pointy teeth > heightened sensitivity. Tweeting > increased sociability and exaggerated sense of own importance (I always think I’m tweeting the most life altering-ly brilliant stuff when hypomanic!) etc etc etc. It underlines, for me, the reluctance of psychiatrists to accommodate patient-led treatment/therapeutic interventions etc etc. Knobs.

  11. LucyG says:

    I am totally relieved that I am not the only one experiencing these symptoms that you all are reflecting on. I don’t have a psychiatrist as I live in an area where we only seem to have locums who stay for 6 months at a time. I became so very tired of the lack of continuity. I decided with my last visit to a psychiatrist in 2010 was enough as I wasn’t being listened to or helped in any way. It is an awful experience when you know how you feel and you keep describing your feelings and they fall on deaf ears.
    However I am so extremely grateful to the one locum psychiatrist who correctly diagnosed that I was indeed suffering from bipolar in 2005. He gave me the help and support I needed at an extremely difficult time. I am still on the same medication today as what he suggested then. However I think it does need changing but I am very reluctant to talk to anyone in the medical profession because I have totally lost faith in them. Changes in medication can be a trial and error process which has been so cruel in the past to changes in how I feel and my family have had to cope with the consequences.
    I cannot describe fully enough how different I feel since finding your blog Charlotte. I truly bless the day I stumbled upon it after reading an article about you. You have made a profound difference to my approach to my illness and your blog is more helpful to me than five minutes with a psychiatrist. Thank you so much for being there for all fellow sufferers who feel the same way about your existence and how you try to reach us all. Love and hugs.

  12. Wow, 4 of them is mine I think
    Hahahahahaha

  13. Pola says:

    Oh yes, the jewellery. For me, it is earrings as well as necklaces. I have two, completely different, collections. When I’m down, I usually can’t be bothered with any jewellery. When I’m OK, I have some nice stuff, not too showy, simple. But oh boy, when I’m a bit ‘up’ then out comes the stuff I wouldn’t be seen dead in any other time, huge, chunky, glittery, OTT statement pieces.
    And I totally get the rubbing-your-little-fingers too, though for me, it is massaging my cuticles. So these really are things that should be documented and listened too.
    Thank you so much for your blog – it resonates with my own experiences so very much, and I can’t always bring myself to read, when I’m afraid of stumbling across triggers,but other times, it is so reassuring to be reminded that other folk are dealing with this shit too. Stay strong.

    • I notice that in these past weeks when I have been mostly feeling better I haven’t really worn jewellery at all! Trying not to think of exactly nom many unworn items are in my necklace basket…

  14. RP says:

    OMG. I get the singing and dancing, the “everyone is sexy”, the interminable head music (once had a single line – “I’m walking on sunshine, whoa-oh, I’m walking on sunshine, whoa-oh, I’m walking on sunshine, whoa-oh, I’m walking on sunshine, whoa-oh, I’m walking on sunshine, whoa-oh…” – for a FORTNIGHT), the quickfire repeated excessive posting online, the “I need to play this song forty times in a row”, and the “that sunset is so beautiful I FEEL GOD’S PRESENCE” (I’m an atheist).

    My musical tastes also change. When I’m high I listen solely to cheesy 80s music and disco. Except for that one time I stayed up all night listening to as many different versions of Rachmaninov’s 3rd piano concerto as I could, because I needed to find the perfect one.

  15. Holy Moly, you are my hypo twin. Right down to the jewelry obsession. I feel so validated!!

  16. Pingback: A life in the day of bipolar mixed mood | purplepersuasion

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