Bipolar disorder, also known as manic depressive disorder, is a mental health condition that affects about 5.7 million American adults every single year. This disorder is commonly characterized by patients’ extreme mood swings, where one may experience feelings of being emotionally ‘high’ or manic, and emotionally ‘low’ or depressed. When patients experience either type of episode, their daily life functions and social capabilities suffer. Although men and women of every age, race, social group, or ethnicity are equally likely to become diagnosed with bipolar disorder, the type and frequency of emotional episodes they experience can be different according to sex. Additionally, over 66% of individuals with bipolar disorder have at least one relative with bipolar disorder or major depression, meaning that there is a heritable influence of this mental condition. In this blog, we will hone in to discuss manic episodes, one of the two emotional extremes that individuals with bipolar disorder will face.
What is mania?
Mania is described as a period of at least 7 days in which a person will experience a drastic change in behavior that makes them feel extremely euphoric, high-spirited, upbeat, agitated, and many other ‘high’ emotions. It is a shift in mood, emotions, and energy levels that are not characteristic of the person who is experiencing it, and it is usually detectable by those who surround that individual. When someone goes through a manic episode, it will typically begin fairly abruptly and can last anywhere between 2 weeks and 4 to 5 months. However, manic individuals will stay in a manic episode for about 4 months on average. Manic episodes are not isolated conditions that affect any given person. If someone experiences a manic episode, it means that they are also experiencing a mental health condition. While Bipolar I disorder is the most commonly associated mental illness with mania, those who are suffering from postpartum psychosis, schizoaffective disorder, cyclothymia, and even seasonal affective disorder may experience a manic episode.
When it comes to experiencing these types of emotional episodes, those with bipolar disease cannot predict when they will either be in a season of mania or depression. In fact, what can make manic episodes so difficult to control is that many people with bipolar disorder do not recognize there is a drastic shift in their actions, behaviors, and decisions when they are in a manic state. Typically, friends, family, coworkers, and even law enforcement notice these very abrupt shifts in that individual and proceed to take actions to intervene. In addition, people who experience manic episodes do not have to be diagnosed with depression at any point to be diagnosed with mania, but most people will experience either one or the other condition in a cyclic fashion. For example, those with Bipolar I disorder may experience several manic episodes one after the other and very few depressive episodes.
The Symptoms of Mania
One of the main things to note about manic episodes is that they occur as individuals display very over-the-top, unusual behavior that raises concerns to the people around them. These heightened energy states occur ‘naturally’, and manic episodes are not to be confused with the feelings of euphoria or ideas of grandeur that accompany other medical conditions or substance abuse. Those who are experiencing manic episodes may experience it in very different ways, but we will go through some of the most common symptoms that characterize a manic episode.
A person experiencing a manic episode may:
- Engage in goal-directed activities or behaviors. A person in a manic state may become very absorbed or obsessed with a goal, hobby, business venture that causes them to act out in extreme ways. For example, they might spend excessive amounts of money, stay up all night long, begin business endeavors without preparation, or travel abruptly to achieve what they want. Unfortunately, this behavior can lead those in a manic state to become highly agitated and aggressive, and they may even engage in things like property damage, self-harm, or assault.
- Engage in impulsive behavior. Individuals who are manic may feel like they are invincible and have very high, untouchable self-esteems. In this state, they are more likely to engage in behaviors that are very risky or harmful. For example, an individual in a manic state might engage in binge drinking, promiscuity, drugs, or gambling to experience pleasurable emotions that may come with adverse consequences later on.
- Have unusual patterns of talking. A common symptom of a manic episode is an increase in the speed and loudness of the person’s voice. This change must be different from the normal amount of talking they typically do in their day to day life. A person in a manic episode may talk so rapidly that other people are unable to interrupt or speak at all.
- Experience racing thoughts. Manic episodes may cause individuals to experience very rapid thoughts that are out of their control. People may experience many thoughts that flood their brain all at once, or they may find that their mind cannot stop racing. This may be called a “flight of ideas”.
Other common symptoms include:
- Feeling well rested on very little to no sleep
- Become very easily distracted and are unable to focus on tasks
- Overly energetic and restless
- Unable to work off all the energy they have
- Increased irritability
- Easily annoyed with the people and environment around them
- Acting out in a hyper-sexual way
- Exhibit aimless movements such as walking around aimlessly or pacing their environment
- Feeling extremely euphoric, happy, or excited for no discernible reason
Another large component of manic episodes is related to the symptoms of delusions and hallucinations. While not every manic individual will experience these symptoms, they can be quite common. Let’s take a look at both.
- Delusions: When a manic person experiences delusions, they may begin to believe in false information or ideas. For example, a common symptom for manic episodes are grandiose delusions. About two-thirds of all bipolar patients and half of patients diagnosed with schizophrenia will experience this type of delusion. During a grandiose delusion, an individual believes that they have special powers, missions, identities or responsibilities. For example, they might believe that they are spies, government officials, or that they have specialized jobs (when they don’t really have any training in that area). Another common delusion that manic people experience are delusions of paranoia in which patients believe that they are being stalked, surveilled, or even targeted by other people. They may believe that the government or gang members are after them. Research has shown that individuals who experience grandiose delusions are at risk for physical, sexual, social, and emotional harm.
- Hallucinations: Manic episodes can cause individuals to feel like they are hearing, smelling, seeing, or experiencing things that are not real. A common hallucination for those in a state of mania is believing that someone is talking to them when there is actually nobody there. Research shows that among manic individuals who are going through psychosis, 15% of individuals may experience a visual hallucination, while 28% of individuals are likely to experience auditory hallucinations.
Diagnosing and Treating a Manic Episode
With regards to bipolar disorder, there is a term called rapid cycling which describes the experience of having 4 or more mood episodes within a year-long period. The mood episodes can either be manic, hypomanic, or depressive. The episodes must happen with at least a 2-month remission period between each episode, or the episodes must switch from one emotional extreme to another (from manic to depressive or from depressive to manic). Research shows that bipolar I women are more likely than bipolar I men to experience rapid cycling, and are also more likely to initially present with depressive and mixed episodes. On the other hand, bipolar I men are more likely to present first with a manic episode, and have an earlier onset of the disorder than women.
Diagnosing a manic episode can be tricky because there are many different psychiatric diagnoses that mimic the symptoms of mania. For example, stimulants such as cocaine, PCP, and amphetamines can produce feelings of euphoria and heightened sense of emotions in the same way that mania can make individuals feel. Hallucinogens and steroids may also lead to some of the aggressive and irritable symptoms that are characteristic of mania as well.With so much overlap, researchers and clinicians have come up with a mnemonic device to help guide providers during a patient’s intake history. The mnemonic is DIG FAST, and it stands for
- Irresponsibility or Irritability
- Flight of ideas
- increased Activity
- decreased Sleep
- excessive Talkativeness
Providers evaluate and subsequently diagnose patients with mania using DSM-V criteria, and the above mnemonic helps them ask about these common manic symptoms to see if patients are presenting with some or all of them. To be diagnosed with mania, a mental health provider must deem that a person presents with abnormal, lengthy expressions of heightened emotions and energy that lasts persistently for at least a week; patients have at least 3 or more manic symptoms (such as the ones listed above); the episode causes enough harm to disrupt normal functioning at home, work, or school; and the manic episode is caused ‘naturally’ and not by outside factors such as drugs, medications, or other illnesses.