How High Are Your “Ups?”

“Individuals do not always perceive hypomania as pathological, and as such do not spontaneously report it to clinicians (Lee, et al.).” In other words, it’s just your “normal” in contrast to the bouts of depression you suffer. So you only seek treatment when you’re down and you seek it from your family doctor. He’s not trained to look for hypomania and you don’t mention it because you don’t think it’s an issue. You don’t even know that’s what you’re experiencing. Tragically, this means that “the recognition of hypomania is frequently delayed, distorting the accurate identification of diagnosis (Lee, et al.).” Thus, you go years and maybe even decades thinking you’re just really depressed from time to time, getting treatment that is not effective and, tragically, even worsens some of your symptoms. Which is to say, “Failure to diagnose or misdiagnosis in BD … brings about delayed intervention and an unfavorable treatment outcome (Lee, et al.).” There is one simple tool, though, that you can check out to see if it gives you and your doctor food for thought. We’ll take a look at that tool after exploring the nature of hypomania. Knowing what we’re dealing is crucial because making the distinction between depression and a mood disorder is not a luxury after all, it’s a matter of life and death.

You know what “hypertension” means. It mean high blood pressure. Well, “hypotension” is just the opposite – low blood pressure. In similar fashion, “hypomania” means a period of abnormally elevated mood that doesn’t quite escalate into full-blown mania. Hypomania is an insidious part of Bipolar Disorder Type II because it’s so hard to recognize on your own and even the people around you won’t think there’s anything truly serious going on with you. This contrasts with a manic episode, in which it will be obvious to family and friends that you’re not well, you’ll probably do a lot of damage to your life, and you stand a good chance of being hospitalized for a fair amount of time. So what exactly does hypomania look like? Here are some examples of behavior that may characterize this state:

  • You find a song, just one song, and fixate on it to the extent that you play that song, and that song only, for your entire forty-five minute commute to work at a volume that is probably damaging your hearing. Maybe you bounce around with the tune a little. You probably can’t help singing along at points.
  • Get in touch with friends you haven’t spoken to for weeks or months and act as though everything is great and whatever closeness was between you at one point has not dimmed one bit since last you spoke. In retrospect, this will look to you like “drunk dialing,” but you were completely sober.
  • Go to the library and check out a dozen books on some topic that’s recently fascinated you, with every intention of becoming an expert on same and possibly making a career move. You may read some of these books, perhaps even all of them, but most likely you’ll read the first ten pages of each, and resignedly return them in a week or two, shaking your head and wondering “what I was thinking, wanting to know everything there is to know about the seminal naval battles of World War I?”

One tool for helping you see if you’re “normal” is actually too high is the HCL-32 Questionnaire. It’s a short screening checklist you can complete on your own that may indicate whether you should consider talking with your doctor about where your “highs” fit into the overall picture of your mental health. As with any self-screener, the HCL-32 is not a diagnostic tool, so you shouldn’t rely on it for any definitive conclusions. Rather, it can serve as a catalyst for an exploration of problems you might be having in treating a mental health condition. You can take the test here and score it here. It’s recommended you do the checklist before you look at the scoring sheet so you don’t bias your answers. If you’re struggling with depression, and suspect you’re a little too “up” when you’re not down, it’s well worth the few minutes it takes to go through the HCL-32. In fact, it just might save your life.

For more on this topic, and to check out another great resource, see my review of the new book Bipolar, Not So Much.

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