Bipolar mania - or a manic episode as part of a bipolar illness - is a condition most commonly characterized by having an abnormally elevated mood, along with such other symptoms as an excess of energy, extravagant behavior, rapid speech, reckless spending and hallucinations. A person who is experiencing mania is having a manic episode, as opposed to a hypomanic or depressive episode.
The following three conditions are specific to mania or a manic episode (as opposed to hypomania or a hypomanic episode):
- Mania symptoms must last for at least one week or require hospitalization.
- There must be a "sustained and abnormally elevated, expansive or irritable mood" through the episode [emphasis mine]. In addition, there must be an abnormal increase in energy or activity. Both of these conditions have to be there most of the day, almost every day.
- Symptoms of psychosis (see below) may be present.
Everyone has times when they are exhilarated, especially talkative, generous or outgoing, or irritable (imagine a woman excitedly getting ready for her wedding). These moods can last quite some time. In mania, such a mood is exaggerated beyond what most people would experience and more than likely has no relationship to anything going on in the person's life. This is why the word "abnormally" is part of the definition of a manic episode. For more, see What Is an Episode?
Additional Diagnostic Symptoms of ManiaIn addition to having abnormal mood as given above for at least a week (if hospitalization was necessary, how long doesn't matter), at least three additional symptoms from the list below have to be present as well, or four if the abnormal mood is only irritable:
- Inflated self-esteem or grandiose thinking - for example, believing you are better than anyone else at doing something or that you can accomplish a difficult task in hours instead of the more reasonable time frame of days or weeks.
- Not needing much sleep, without feeling fatigued - for example, a person who normally sleeps eight hours now sleeps only four hours and feels fine.
- Being more talkative than usual, or pressure to keep talking (pressured speech). This could show up as talking so fast it is difficult for other people to understand.
- The disconnected speech pattern called flight of ideas or racing thoughts, where thoughts move at a rapid speed that may be uncomfortable.
- Being too easily distracted, such as being unable to focus on a task, even when there is a deadline for finishing it, because unimportant or irrelevant things easily take your attention away.
- Psychomotor agitation, a severe form of physical restlessness, and/or an increase in what's called goal-directed activity. Examples might be suddenly throwing parties every night; taking on an unusual number of home projects; volunteering to do extra jobs at work or school; or wanting more sexual activity with a partner than usual (a symptom of hypersexuality).
- Indulging excessively in high-risk behaviors. These can include compulsive gambling, risky investing, or spending without regard for one's true financial state (like buying a car when you can't possibly make the payments). Hypersexual behaviors can also be high-risk, like making inappropriate sexual advances; spending a great deal of money on phone sex, internet pornography, or prostitutes; or having affairs.
Other Requirements for a Manic EpisodeAlso, to qualify as mania, at least one of these symptoms must be present:
- Everyday functioning is seriously disrupted - for example, you aren't going to work or school, you aren't bothering to buy food for your family or you suddenly take off on a trip ignoring your responsibilities.
- Hospitalization is necessary; and/or
- There are symptoms of psychosis - hallucinations, delusions and/or paranoia (a type of delusion).
Finally, if some or all of the symptoms are caused by a drug (legal or otherwise) or another medical problem (see Ruling Out Other Physical Conditions), bipolar mania is likely to be ruled out. However, the forthcoming new edition of the Diagnostic and Statistical Manual of Mental Disorders is proposed to add, "A full manic episode emerging during antidepressant treatment (medication, ECT, etc.) and persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a manic episode."
This, then, is what constitutes mania or a manic episode. For some additional insights, see Mania - Manic - Maniac.