The article explores mania, a syndrome marked by extreme energy and varying emotions, commonly seen in bipolar I disorder. It simplifies the DSM-5 diagnostic criteria and offers fictional case studies of ‘Jack’ and ‘Jessica’ to demonstrate the disruptive effects of manic episodes on life and relationships.
What is a manic episode? In a nutshell
Mania is a syndrome where a person feels extremely high energy, overly excited, and very active. The manic syndrome is associated with bipolar I disorder.
During a manic episode, a person’s feelings and mood can change rapidly, often influenced by their environment.
While mania is usually seen as the opposite of depression, the person’s mood can be euphoric (extremely happy) or dysphoric (unpleasant and irritable).
As mania increases, irritability can become more pronounced.
Symptoms: DSM-5 criteria in plain English
Below is a simplified version of the mania criteria from the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). Manic symptoms are presented in a way that’s easier to understand for those unfamiliar with psychiatric terminology.
A manic episode is a period of heightened mood. This mood can be either elevated, irritable, or expansive. It is accompanied by increased goal-directed activity or energy. The episode lasts for at least one week and occurs most of the day, almost every day.
In some cases, hospitalization may be necessary, regardless of the episode’s duration.
If you experience a period of mood disturbance along with increased energy or activity, and you notice a significant shift from your usual behavior, then you may be experiencing symptoms of mania.
According to the DSM-5, it’s necessary to have at least three of the following symptoms present, or four of them if your mood is only irritable:
- Inflated self-esteem or grandiosity
- Decreased need for sleep, where you feel rested after only three hours of sleep
- More talkative than usual or feeling pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility, where your attention is too quickly drawn to unimportant or irrelevant external stimuli.
- Increase in goal-directed activity, either socially, at work or school, or sexually, or psychomotor agitation, which refers to purposeless, non-goal-directed activity.
- Engaging in activities with high potential for negative consequences, such as overspending, infidelity, or risky investments.
The level of disturbance in mood is severe enough to significantly affect a person’s ability to function in social or occupational settings or to require hospitalization to prevent harm to oneself or others. In addition, there may be the presence of psychotic features.
This episode is not caused by the physiological effects of a substance, such as a drug, medication, or other treatment, or by any other medical condition.
Understanding manic episodes through clinical scenarios
Some people might find the DSM-5 challenging to understand because it can be abstract.
To bridge this gap, we’ll present fictional clinical cases depicting presentations of the manic syndrome.
These scenarios aim to not only explain the syndrome but also illustrate the varied impacts of manic episodes. Each case will show how symptoms intertwine with a person’s life and relationships.
Jack: The high-flying salesman
Meet Jack, a 35-year-old high-performing salesman who has recently been experiencing dramatic shifts in his behavior and mood that have caught the attention of his friends, family, and colleagues.
Inflated self-esteem or grandiosity
Jack has always been confident, but his self-assurance has skyrocketed over the past few weeks. He asserts that he is the best salesman in the industry and is destined to become a millionaire within the year. He’s begun making lavish plans for business expansions without consulting with partners or analyzing market risks.
Decreased need for sleep
Usually one for a solid eight hours a night, Jack now claims to feel more energized than ever on just three or four hours of sleep.
He spends these extra waking hours pacing around his apartment, making calls to clients in different time zones, and drafting ambitious project proposals.
More talkative than usual or pressure to keep talking
During meetings, Jack dominates conversations and interrupts others frequently. His colleagues notice that he seems pressured to keep talking, barely pausing for breath and often not allowing others to get a word in edgewise.
Flight of ideas or subjective experience that thoughts are racing
When speaking with friends, Jack jumps from one grand idea to another without completing any particular line of thought. They describe his thoughts as "racing," making it difficult for anyone to follow along or keep up with the rapid pace of his speech.
Distractibility
At work, Jack struggles to focus on the tasks at hand. He’s easily sidetracked by minor details such as background noises or notifications popping up on his screen. This leads him to start several projects simultaneously without finishing any.
Increase in goal-directed activity or psychomotor agitation
Jack’s energy is through the roof; he’s taken on more clients than ever before and has started working weekends.
At times he can be seen pacing restlessly around the office when trying to think through his strategies.
Excessive involvement in activities with high potential for painful consequences
Despite being on a moderate salary, Jack recently purchased an expensive sports car and racked up substantial credit card debt from impulsive shopping sprees online—purchases he justifies as "investments" into his lifestyle as a future magnate.
Conclusions
Jack’s behavior exhibits several key symptoms of mania according to DSM-5 criteria: inflated self-esteem bordering on grandiosity; significantly decreased need for sleep; increased talkativeness; racing thoughts; distractibility; heightened goal-directed activity paired with psychomotor agitation; and excessive involvement in risky activities without full consideration of potential repercussions. These symptoms have led to noticeable impairment in social interactions and occupational performance—raising concerns among those close to him about not only Jack’s mental health but also his well-being due to possible financial fallout.
Riding the manic wave: Jessica’s story
Jessica, a 28-year-old graphic designer, always considered herself energetic and passionate, but over the past week, her behavior has intensified to levels that even her closest friends find unrecognizable.
Inflated self-esteem or grandiosity
Jessica recently started a project and quickly declared it would be her masterpiece.
Her colleagues noticed she’s been overly confident, dismissing any feedback. She’s been heard saying she’s destined to redefine graphic design.
Decreased need for sleep
Despite getting only 2-3 hours of sleep each night for the past week, Jessica feels more energized than ever. She spends nights drafting designs and emails colleagues at odd hours with new ideas.
More talkative than usual or pressure to keep talking
In meetings, Jessica dominates conversations, barely pausing for breath or allowing others to interject. Her friends struggle to keep up with her rapid speech and abrupt topic changes during casual chats.
Flight of ideas or subjective experience that thoughts are racing
Jessica’s mind seems like it’s on fast-forward; she jumps from one big idea to another without finishing any task at hand. Her notebook is filled with half-sketched concepts and scribbled plans for future projects.
Distractibility
Although usually very focused, lately Jessica finds herself unable to concentrate on a single task. A colleague asking a question or a phone notification easily pulls her away from what she was doing.
Increase in goal-directed activity or psychomotor agitation
At work, Jessica has taken on multiple projects simultaneously and insists on rebranding the company website overnight without approval. She paces around the office when not furiously working at her desk.
Excessive involvement in activities with a high potential for painful consequences
Recently, Jessica maxed out her credit cards purchasing top-of-the-line design software and equipment without considering the financial impact. She also started making risky bets in stock trading based on “gut feelings.”
Conclusions
Jessica’s friends and family are worried as they observe these dramatic changes in her behavior. They agree that this isn’t just Jessica being passionate; it’s something more concerning that is affecting her well-being and professional life. It’s clear that she displays many signs associated with mania as defined by DSM-5.