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Not everyone who becomes manic experiences the full-blown syndrome of a manic episode. Hypomanic individuals show an expansive, energized and sometimes elated mood, with rapid thinking and pressured speaking in evidence. At a minimum (for the label hypomania to be appropriately applied), this expanded mood state must persist for at least four straight days.

As is the case with manic episodes, hypomanic episodes are also characterized by the presence of characteristic symptoms. At least three of the following must be present (for at least four days) before the diagnosis of hypomanic episode is appropriate:

• an inflated or expansive and even grandiose (but not delusional; not completely out of touch with reality) sense of self
• reduced sleep needs compared to normal
• talks more than usual
• subjective sensation of racing thoughts (often called a “flight of ideas”)
• distraction or derailment of thought occurring significantly more often than normal
• an increase in goal-directed activity, or physical agitation
• a marked increase in participation in risky but pleasurable behavior (such as unprotected sex, gambling, unrestrained shopping, etc.)

You’ll notice that these are essentially the same criteria that are applied to manic episodes. What is suggested (and what is intended) by this duplication of criteria is that what separates a hypomanic episode from a manic episode is mostly the degree of intensity (or energy) present in the behaviors the manic person emits (and not in their variety). When the observed energy level is above average but still within normal limits, you have a hypomanic state on your hands. When the energy level goes off the normal scale entirely, you have a manic episode.

People experiencing a hypomanic state are not necessarily unrelentingly sunny in disposition; they may experience irritable mood states too, as is also the case with full manic episodes. However, whatever level of irritability may be present during a hypomanic episode is by definition nowhere near as severe as what might occur during a fully manic episode.

Since hypomania is less severe than mania, people experiencing a hypomanic episode may retain sound judgment and not engage in self-destructive behavior. In fact, their sharpened intellect and ability to function with little sleep contributes to hypomanic individuals’ increased productivity compared to non-manic people. This is to say, hypomania can create a distinct advantage in the workplace, because it helps people to be maximally productive and get more things done than their peers. This positive aspect of hypomania is often seen as a benefit by people who have bipolar disorder. Hypomanic individuals are likely to be creative risk-takers, who can bring creative ideas to fruition. Numerous historical and contemporary figures, including composer Ludwig van Beethoven, pioneering physicist Issac Newton, authors Charles Dickens and Edgar Allen Poe, artist Vincent van Gogh, statesmen Abraham Lincoln, Winston Churchill and Theodore Roosevelt, and media mogul Ted Turner have been documented to have experienced severe and debilitating recurrent mood swings. Some authors (e.g., John Gartner, MD [Hypomanic Edge] have even suggested that America’s unique entrepreneurial character and spectacular economic achievements achieved over the last century are due in large part to a high incidence of hypomania among American entrepreneurs. While we can neither confirm or discard this interesting speculation, we can say that there is more to hypomania than a simple business advantage. When you are hypomanic on a regular basis, you have a mild form of what can be a disabling illness. There is no guarantee that your hypomania will stay stable as hypomania. When left untreated, the underlying causes that produce hypomania can and do sometimes worsen until full manic episodes occur.

Although popular culture tends to equate mania with happiness and depression with sadness this isn’t really the best way to think about what is happening in bipolar disorder. Bipolar Disorder involves not so much a swing between happy and sad states, as it does a swing between high and low energy states. When in a high-energy state, people appear happy because they are motivated and excitable, whereas in a low energy state, people feel sad, and lack motivation and enthusiasm. As the energy level of a manic episode increases, the early happy mood tends to degenerate into a more agitated and psychotic state which may be experienced more as terrifying than happy, but which is nevertheless very energizing. Similarly, as a depressive mood state increases, people may go from merely feeling badly about themselves to literally not being able to leave their bed. Thus, the happy and sad moods that are thought to characterize mania and depression respectively are results of different energy states and not necessarily primary features of the disorder.

The high and low energy states characteristic of bipolar disordered moods are often thought of as places that exist upon a continuum of energy levels. Manic moods are characterized by high energy states, while depressive moods are characterized by low energy states. As bipolar moods shift from depressed to manic and back to depressed again, part of what is happening, according to this way of seeing things, is that there is a smooth shifting of the bipolar person’s energy state moving up and down the energy continuum. Each end of this energy continuum can be considered to be a pole, or end point (in the same way that the North and South Poles are the end points of the earth), hence the origin of the term “Bipolar” (meaning, involving movement between two poles).

Mania and Manic Episodes

Because high-energy manic states exist on a continuum, it is possible for someone to be a little manic or very manic. People who are very manic are said to be experiencing a manic episode. People who are only a little manic are said to be experiencing a Hypomanic Episode. The term ‘hypo’ means “under”, so the term “hypomanic” translates to “less than fully manic”.

There are defined criteria (in the DSM) that must be met in order to say that someone is experiencing a full manic episode. For example, manic episodes must be present for at least one week’s duration before they can be diagnosed (although they may last far longer than that). Up to several months duration are possible.

A variety of symptoms are possible during a manic episode. At least three of the following symptoms need to be present before the diagnosis can be made:

• an inflated, expansive, grandiose (and possibly delusional) sense of self
• reduced sleep needs compared to normal
• pressured speech (talking so fast the words don’t have time to get out the mouth)
• subjective sensation of racing thoughts (often called a “flight of ideas”)
• distraction or derailment of thought occurring significantly more often than normal
• an increase in goal-directed activity (purposeful behavior), or physical agitation
• a marked increase in participation in risky but pleasurable behavior (such as unprotected sex, gambling, unrestrained shopping, etc.)

Manic episodes typically do not come on all at once. Rather, there is a progression of manic symptoms that occurs over a period of time. During an early manic phase of a bipolar condition, a person may become highly energetic, have a million ideas, become very talkative, stay up all night, feel sexually and generally potent, and become very productive. As the manic episode progresses and gains in strength, manic individuals tend to lose their inhibitions and whatever judgment they might normally have, and pursue one or more ill-advised and risky, but immediately pleasurable courses of behavior. Severely manic people may become sexually promiscuous, for instance, leading their becoming pregnant (or impregnating someone else) or becoming infected with a sexually transmitted disease. They may spend impulsively on shopping, travel, gambling, or drugs, causing massive credit card debts, and leaving a trail of bounced checks and large cash withdrawals from the ATM in their wake. In their enthusiasm to socialize, manic people may chatter on and on about things that are inappropriate to share with strangers, (e.g. personal beliefs, sexual experiences, etc.) They may also display inappropriate anger, or agitation, and even lash out and become violent in some cases. For example, a manic individual in a bar might pick a fight with little provocation. In the most severe cases of mania, hallucinations, delusions, and outright psychosis occur, further complicating the situation. The inappropriate and out-of-control behavior characteristic of people experiencing a manic episode makes the costs associated with mania sometimes devastatingly high.

The above-mentioned symptom of “significant distress” is an important diagnostic indicator for all mental disorders. Ordinarily, when someone has a mental disorder they are able to recognize their difficulties and can identify their symptoms of discomfort. Their symptoms cause them a significant amount distress and dissatisfaction, and they are deeply troubled by their difficulties. This is usually true of people with personality disorders. However, an interesting peculiarity of personality disorders is that some people with personality disorders will routinely experience difficulties in their relationships, and difficulties at work or school, but they do not believe that there is anything wrong. In fact, they may not appear to be bothered much at all. In other words, their personality traits do not appear to be causing them any distress; meanwhile, they are causing distress to everyone around them. When that is the case, it is often the other people in their lives who notice the person is frequently hard to get along with, and difficult to relate to.  Such people often seem blissfully unaware of any problem. Meanwhile, it is readily apparent to others that they have great difficulty adapting to life’s ordinary challenges, and often seem to steer directly into storms.

There are several reasons for this lack of awareness. First, a person may simply not know any differently. They may not know there is a better, alternative way of thinking, feeling, or behaving so they have nothing to compare to their way of being in the world. Consider that if you lived in complete darkness you would have no knowledge of this unless you also had light. Let’s use a more clinical example: Suppose you’ve only experienced relationships in which you were abused and treated with hostility. You lack experience with the alternative experience of being treated with kindness and respect. In this case, you simply wouldn’t know it is preferable to be treated kindly and therefore you blithely accept mistreatment from others with little concern. If someone expressed to you their shock or alarm about the way you “allow” other people to mistreat you, you simply wouldn’t understand what they were talking about. You could not utilize their feedback because you have no alternative experience with which to compare.  Thus, to other people you will appear to be unbothered or unaware of any problem.

Similarly, someone may have grown up with poor role models and may not know how to behave any differently.  For example, if a young girl only ever heard her parents yell and scream to get what they wanted, she would not know that people can just as easily ask politely and respectfully for what they want.  As a result, she would grow up lacking these critical skills and may not know how to behave differently.  Thus, any feedback she might receive later in life about her unpleasant method of getting what she wants would be met with a puzzled gaze. She simply has no idea how she could get what she wants without throwing a temper tantrum.

Another reason for this apparent lack of distress is that for some people, it may simply be too painful, overwhelming, or embarrassing to admit to themselves, and to others, that they are at least partially responsible for some of the problems they experience. So instead, they retreat to a position of thinking the problems they experience are everyone else’s fault. This is perhaps a more comfortable, less painful position to adopt, but not a particularly helpful one.

Let’s further illustrate these concepts with some characteristic patterns that are commonly observed in certain personality disorders.  Take the example of someone who does not have any friends.  They do not desire any friends, and do not get any pleasure or enjoyment from being with other people.  Thus, they see nothing wrong with this and so they are completely unconcerned about their lack of friendship, because having no friends doesn’t cause them any emotional distress. However, to other people they seem aloof, odd, and strange.  This would make it difficult for their co-workers or family members, to form a positive relationship with them. This person may never have experienced positive, pleasant interactions with others. Therefore, they simply do not know that friendships can be rewarding and enjoyable. They may not have had role models who enjoyed close relationships, so they are unaware of what they’re missing.  Because of this, they will also be missing important social skills that are needed to form comfortable and enjoyable relationships with others.  Their lack of social skills makes them seem odder still. This lack of social skills makes any attempt to form friendships awkward and uncomfortable.   The result is a personality pattern of social awkwardness and isolation.

Another example is someone who has developed a pattern of behavioral extremes. For instance, any time they feel the least bit ignored by a friend, they wind up cutting that friend out of their life entirely, deciding never to speak to them again. This complete severance of the relationship is less distressing to them than the alternative (such as openly discussing their hurt feelings) so they may see no problem with their response.

There are several reasons for this inability to choose a more comfortable and gentle response. A person may lack the interpersonal skills needed to address conflict in a constructive manner.  Lacking these skills, it may be difficult to express themselves in a confident and effective manner. Furthermore, they may be too upset to think clearly about what has happened.  They may not be able to “mentalize.” This means they cannot empathize with their friend.  Furthermore, it is difficult for them to consider the various reasons their friend ignored them, some of which may have nothing to do with them. It may also be too shameful for them to think about their own contribution to the problem they are having with their friend.

Now that we have a better understanding of what is meant by “personality,” let’s return to the original question. What is a personality disorder? Many psychologists and mental health professionals have struggled with how to define a “disordered” personality, as distinguished from a healthy one.  For our purposes, it may be most helpful to think about someone with a healthy personality as a person who accurately interprets their environment.  Thus, their subsequent thoughts, feelings, and behaviors reasonably correspond to the reality of their environment.  As a result, they can accurately appraise their own strengths, weaknesses, and motivations. Likewise, they can accurately identify the strengths, weaknesses, and motivations of others.  Therefore, a person with a healthy personality is someone who can navigate the world effectively, with a minimum of unproductive detours, and who usually manages to steer clear of major storms.

If we were sailors navigating the world on the open seas, we would need to have a set of precisely tuned, highly sophisticated instruments in order to navigate effectively. Our navigational tools would need to be capable of swiftly adjusting to changing conditions (weather conditions, cargo weight, etc.).  The same is true of our personalities.  In other words, we must be able to adjust our reactions to the specific circumstances of each situation. This means our perceptions and interpretations of the world must not only be accurate, but also nuanced.  This requires of our personalities a high degree of flexibility in order to take into account the special needs and circumstances of every unique situation we encounter.  Each situation may need to be interpreted differently. Our reactions must be finely tuned and properly adjusted to precisely correspond with the unique demands of each individual situation. Unfortunately, people with personality disorders lack this essential flexibility, and respond to situations and events with a characteristically rigid constellation of thoughts, feelings, and behaviors. This inflexibility, and difficulty forming nuanced responses, represents the primary difference between healthy and disordered personalities.

The question remains, how do we account for this fundamental difference between healthy and unhealthy personalities? The answer seems to lie in the “navigational instruments.” It appears that people with personality disorders are missing an important tool. Research by Fonagy and his colleagues (1996) found that people with personality disorders seem to lack a highly necessary skill called “mentalization.”Mentalization refers to the ability to reflect upon the behaviors, internal states, and motivations of both ourselves and other people. The ability to mentalize may enable people with healthy personalities to adjust their behaviors to the differing demands of each unique situation. In other words, what permits this flexibility may be the capacity to reflect upon one’s own behaviors and motivations, and to reflect upon the behaviors and motivations of others. Thus, the ability to mentalize permits an accurate assessment of each unique situation that renders an appropriate response for that situation.

This concept of flexibility further suggests that what may be a healthy and adaptive response in one circumstance or situation, might be maladaptive in another. Typically, healthy personalities are flexible enough to account for these differences and respond accordingly. Let’s use an example to illustrate this concept. Suppose I work as a receptionist within a prison. It is healthy and advantageous for me to adopt a vigilant approach in this kind of workplace. Thus, it is adaptive for me to be cautious and somewhat suspicious of others because these thoughts, feelings, and behaviors properly match that particular situation and circumstance. Now, imagine what might happen if I attempted to use this same approach in a different workplace setting; say for example, a clothing store. If I am constantly vigilant and distrustful of others, and suspect my co-workers or customers might try to harm me at any moment, I will likely behave in a manner that is overly-guarded, hostile, suspicious, or withholding. This approach would certainly interfere with my performance at the clothing store, and would negatively affect my interactions with co-workers, supervisors, and customers.

This example illustrates what can happen when people attempt to navigate the world with a rigid, inflexible approach. People with healthy personalities would account for the differing demands of each workplace, and would select behaviors appropriate to each one. This flexible approach increases the likelihood they will experience workplace satisfaction and success. In contrast, people with personality disorders, who cannot so easily adjust their approach, will eventually experience dissatisfaction and a lack of success.

While we may intuitively recognize that it is not sensible to use the same approach for every situation, it doesn’t answer, why is this considered adaptive and healthy? The flexibility that is characteristic of people with healthy personalities is considered “adaptive” because their patterns of thoughts, feelings, and behaviors do not usually lead to any significant distress, and ensure a reasonable degree of success and satisfaction. Or, to continue with our metaphor, they navigate their world with few unproductive detours and typically steer clear of major storms. Conversely, the inflexibility that is characteristic of “disordered” personalities is considered maladaptive because it leads to distress, dissatisfaction, and failure. These unfortunate folks frequently experience stormy relationships and repeatedly find themselves in situations that lead to their unhappiness and lack of success. When personality traits consistently cause distressand impair interpersonal relationships, or impair one’s ability to function successfully at work, we then begin to consider the possibility of a personality disorder.

Of course, we all have our issues, conflicts, and hardships that certainly can cause us distress.  We don’t behave well all the time. Sometimes we annoy other people.  In other words, some storms are inevitable and some detours are difficult to resist.  As we mentioned earlier, a personality disorder is a variant form of a normal, healthy personality. Therefore, it is quite reasonable to expect that healthy personalities will experience some difficulty some of the time.  In order for a personality disorder to be diagnosed, an enduring pattern needs to be present.  This pattern consists of problematic behaviors and traits, starting early in life, observed across many different situations, over a long period of time, that cause significant distress. 

In psychological parlance, “personality” refers to a person’s unique and enduring pattern of thinking, feeling, and behaving.  When viewed in this manner it becomes evident that “personality” encompasses nearly every aspect of human experience.  Subsequently, our personalities have the potential to greatly impact our well-being.  In particular, the quality of our relationships is significantly affected by our personalities.  Moreover, because human beings are social creatures, this means our personalities greatly influence our overall success and satisfaction with life.  These are pretty bold assertions, so let’s examine why this is so:

Let’s begin by examining the relationship between our personalities and our thoughts, feelings, and behavior.  In each and every moment, we receive enormous amounts of information from everything going on around us in the world.  Psychologists use the term “environment” to refer to these external events going on around us.  As we receive this information from our environment, it undergoes a subjective, internal process of evaluation and interpretation.  We begin with a subjective evaluation of the information detected by our senses (what we see, hear, etc.) Then, an interpretive thought forms about what we thinkis going on.  In addition, the information is assigned some kind of meaning and importance.  As this occurs, we will experience an array of feelings, in a varying degrees of intensity, about what we think is going on around us.  The intensity of the feelings that arise in us is usually determined by the importance we assign to a particular thought.  We tend to have very strong feelings about things that are highly important to us, and less intense feelings about things that are less important.  This process of interpretation (our thoughts) and assigning meaning and importance (our feelings about those thoughts) will then determine our behavioral response to these external events in our environment. In other words, what I think and feel determines how I will behave.

Not only does the environment impact our behavior but our behavior will subsequently impact the environment. Therefore, there is a dynamic, interactive exchange between the environment and our personalities (what we think and feel, and how we behave). This interactive exchange creates a circular feedback loop that leads to the development and maintenance of habitual patterns of exchange between a person and their environment. These habitual patterns form the foundation of “personality.” Therefore, the environment influences the development of our personalities, and our personalities’ influence how we respond to the environment.

Before we continue, let’s use an example to illustrate how this circular pattern forms between our personalities (how we think, feel, and behave) and the environment:

Suppose a woman has smiled at me with sincere and genuine kindness, and I have observed this event (the smiling woman being an event occurring in my external environment).  However, as I subjectively evaluate what I observed, I incorrectly interpret her smile as a menacing smirk.  My interpretation of her smile as a menacing smirk then causes me to become somewhat suspicious about her motivations and I begin to feel worried.  I don’t like people smirking at me like that. Maybe she plans to hurt me!  Because I suspect malicious intent from this smirking woman, I’m likely to behave in a negative manner.  Maybe I’ll make some unkind comment to this “smirking” woman- I’ll show her!  Now, because I’ve said something unkind to her, this formerly happy, smiling woman becomes upset with me.  She returns the favor and shouts at me, “You’re a jerk!”  You see?  I was right!  I knew she meant to cause me harm.

The above example demonstrates how a circular pattern is formed between the environment and our personalities. It also illustrates that once formed, these patterns are reinforced and maintained over time to create an enduring pattern.  Notice that my unique, subjective, internal interpretation of the environment and subsequent thoughts about the environment (the woman is smirking, not smiling), led to my suspicious, wary feelings.  These suspicious feelings then led to by my unkind behavior, causing the environment (the smiling woman) to change accordingly (the formerly smiling woman is now upset, and calls me a “jerk”).  Since she called me a “jerk” her comment verified my initial (incorrect) interpretation this event (that she was smirking, not smiling), and the feedback loop is thus completed.

Over time, this circular pattern of interactions between people and their environments will cause enduring patterns of internal experience and behavior to develop.  In other words, people eventually develop habits of interpreting and responding to the environment that influence the way they experience and interpret their world.  These enduring patterns of internal experience and behavior are called “personality traits” and the specific combinations of those traits comprise our personalities.  Because of the circular nature of the feedback loop, once these patterns have formed, they are maintained and become fairly stable.  So generally, personality traits will not radically change across time or situations. For instance, if someone is typically generous, we don’t expect them to suddenly become miserly.