Dysphoric Mania in Bipolar Disorder

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Dysphoric mania is the term that was used in the past for what we now call an episode withmixed features, though some health professionals may still use this term. Around 40 percent of people who are diagnosed with bipolar disorder experience episodes with mixed features.

Understanding Dysphoria

Simply put, dysphoria is a disconnect in emotion that has little or no relation to what is actually going on.

Dysphoria is not only associated with bipolar disorder, it’s associated with other psychiatric and nonpsychiatric conditions. These can include schizophrenia, gender dysphoria, illicit drug use, and even premenstrual cycles (premenstrual dysphoric disorder).

Diagnosis

Dysphoric mania is not a term we use often these days but it’s one that can help clarify how dysphoria applies to bipolar disorder. In this instance, a bipolar person might concurrently exhibit signs ofmaniaalong with signs of depression.Today, this is described as a mixed feature of bipolar disorder.

Symptoms of ManiaGrandiosity and exaggerated feelings of self-importanceHallucinations or delusionsRacing thoughtsRapid, frenzied speech (pressured speech)Recklessness and risk-taking behaviorAggressiveness or irritabilityNeeding less sleep or not feeling tiredPurposeless, often relentless, activity (psychomotor agitation)Symptoms of DepressionInexplicable crying or long periods of sadnessCurtailed sleep or appetiteThoughts of death or suicide (suicidal ideation)Feelings of worthlessness or guiltLethargyLosing interest in activities once enjoyedSocial isolationIndecisiveness or confusion

Symptoms of ManiaGrandiosity and exaggerated feelings of self-importanceHallucinations or delusionsRacing thoughtsRapid, frenzied speech (pressured speech)Recklessness and risk-taking behaviorAggressiveness or irritabilityNeeding less sleep or not feeling tiredPurposeless, often relentless, activity (psychomotor agitation)

Grandiosity and exaggerated feelings of self-importance

Hallucinations or delusions

Racing thoughts

Rapid, frenzied speech (pressured speech)

Recklessness and risk-taking behavior

Aggressiveness or irritability

Needing less sleep or not feeling tired

Purposeless, often relentless, activity (psychomotor agitation)

Symptoms of DepressionInexplicable crying or long periods of sadnessCurtailed sleep or appetiteThoughts of death or suicide (suicidal ideation)Feelings of worthlessness or guiltLethargyLosing interest in activities once enjoyedSocial isolationIndecisiveness or confusion

Inexplicable crying or long periods of sadness

Curtailed sleep or appetite

Thoughts of death or suicide (suicidal ideation)

Feelings of worthlessness or guilt

Lethargy

Losing interest in activities once enjoyed

Social isolation

Indecisiveness or confusion

When these ranges of symptoms co-occur, the state can then be broadly described as being dysphoric, or what we now call a manic or hypomanic episode with mixed features or a depressive episode with mixed features.

Treatment Options

It’s important to remember, first and foremost, that dysphoria is not a condition. It is a symptom in the same way that euphoria (intense feelings of happiness or well-being) is a symptom. As such, you do not “treat” dysphoria per se, but the underlying condition.

When dysphoria occurs in relation to a mixed episode, therisk ofsuicideis considered high. In people having suicidal thoughts or those whose behavior is erratic and intensifying, hospitalization may be needed.

If you or a loved one are struggling with bipolar disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with bipolar disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

Treatment Is Essential

Dysphoric mania is a serious disorder that needs immediate and ongoing treatment and support. If you or a loved one are experiencing symptoms of a mixed bipolar episode, seek help as soon as possible. Early intervention is often key to treatment success.

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fagiolini A, Coluccia A, Maina G, et al.Diagnosis, epidemiology and management of mixed states in bipolar disorder.CNS Drugs. 2015;29:725. doi:10.1007/s40263-015-0275-6Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge.Int J Bipolar Disord. 2020;8(1):1. doi:10.1186/s40345-019-0160-1Hu J, Mansur R, McIntyre RS.Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.Prim Care Companion CNS Disord. 2014;16(2):PCC.13r01599. doi:10.4088/PCC.13r01599Muneer A.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam Med J. 2017;53(1):1–13. doi:10.4068/cmj.2017.53.1.1Tundo A, Musetti L, Benedetti A, Berti B, Massimetti G, Dell’Osso L.Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states.Compr Psychiatry. 2015;63:15–21. doi:10.1016/j.comppsych.2015.07.018Vieta E, Salagre E, Grande I, et al.Early intervention in bipolar disorder.Am J Psychiatry.2018;175(5):411-426. doi:10.1176/appi.ajp.2017.17090972

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fagiolini A, Coluccia A, Maina G, et al.Diagnosis, epidemiology and management of mixed states in bipolar disorder.CNS Drugs. 2015;29:725. doi:10.1007/s40263-015-0275-6Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge.Int J Bipolar Disord. 2020;8(1):1. doi:10.1186/s40345-019-0160-1Hu J, Mansur R, McIntyre RS.Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.Prim Care Companion CNS Disord. 2014;16(2):PCC.13r01599. doi:10.4088/PCC.13r01599Muneer A.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam Med J. 2017;53(1):1–13. doi:10.4068/cmj.2017.53.1.1Tundo A, Musetti L, Benedetti A, Berti B, Massimetti G, Dell’Osso L.Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states.Compr Psychiatry. 2015;63:15–21. doi:10.1016/j.comppsych.2015.07.018Vieta E, Salagre E, Grande I, et al.Early intervention in bipolar disorder.Am J Psychiatry.2018;175(5):411-426. doi:10.1176/appi.ajp.2017.17090972

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Fagiolini A, Coluccia A, Maina G, et al.Diagnosis, epidemiology and management of mixed states in bipolar disorder.CNS Drugs. 2015;29:725. doi:10.1007/s40263-015-0275-6Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge.Int J Bipolar Disord. 2020;8(1):1. doi:10.1186/s40345-019-0160-1Hu J, Mansur R, McIntyre RS.Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.Prim Care Companion CNS Disord. 2014;16(2):PCC.13r01599. doi:10.4088/PCC.13r01599Muneer A.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam Med J. 2017;53(1):1–13. doi:10.4068/cmj.2017.53.1.1Tundo A, Musetti L, Benedetti A, Berti B, Massimetti G, Dell’Osso L.Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states.Compr Psychiatry. 2015;63:15–21. doi:10.1016/j.comppsych.2015.07.018Vieta E, Salagre E, Grande I, et al.Early intervention in bipolar disorder.Am J Psychiatry.2018;175(5):411-426. doi:10.1176/appi.ajp.2017.17090972

Fagiolini A, Coluccia A, Maina G, et al.Diagnosis, epidemiology and management of mixed states in bipolar disorder.CNS Drugs. 2015;29:725. doi:10.1007/s40263-015-0275-6

Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge.Int J Bipolar Disord. 2020;8(1):1. doi:10.1186/s40345-019-0160-1

Hu J, Mansur R, McIntyre RS.Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.Prim Care Companion CNS Disord. 2014;16(2):PCC.13r01599. doi:10.4088/PCC.13r01599

Muneer A.Mixed states in bipolar disorder: etiology, pathogenesis and treatment.Chonnam Med J. 2017;53(1):1–13. doi:10.4068/cmj.2017.53.1.1

Tundo A, Musetti L, Benedetti A, Berti B, Massimetti G, Dell’Osso L.Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states.Compr Psychiatry. 2015;63:15–21. doi:10.1016/j.comppsych.2015.07.018

Vieta E, Salagre E, Grande I, et al.Early intervention in bipolar disorder.Am J Psychiatry.2018;175(5):411-426. doi:10.1176/appi.ajp.2017.17090972

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