7. Excessive involvement in activities that have a high potential for painful conse- quences (e.g., the individual engages in unrestrained buying sprees, sexual indis- cretions, or foolish business investments).
. The episode is associated with an unequivocal change in functioning that is uncharac- teristic of the individual when not symptomatic.
. The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupa- tional functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
Individuals with short-duration hypomania have experienced at least one major depres- sive episode as well as at least two episodes of 2—3 days’ duration in which criteria for a hy- pomanic episode were met (except for symptom duration). These episodes are of sufficient intensity to be categorized as a hypomanic episode but do not meet the 4-day duration re- quirement. Symptoms are present to a significant degree, such that they represent a no— ticeable change from the individual’s normal behavior.
An individual with a history of a syndromal hypomanic episode and a major depres- sive episode by definition has bipolar II disorder, regardless of current duration of hypo- manic symptoms.
sive episode, with their increased comorbidity with substance use disorders and a greater family history of bipolar disorder, more closely resemble individuals with bipolar disor- der than those with major depressive disorder.
Differences have also been found between individuals with short-duration hypomania and those with syndromal bipolar disorder. Work impairment was greater for individuals with syndromal bipolar disorder, as was the estimated average number of episodes. Indi- viduals with short-duration hypomania may exhibit less severity than individuals with syndromal hypomanic episodes, including less mood lability.
The prevalence of short-duration hypomania is unclear, since the criteria are new as of this edition of the manual. Using somewhat different criteria, however, it has been estimated that short-duration hypomania occurs in 2.8% of the population (compared with hypoma- nia or mania in 5.5% of the population). Short-duration hypomania may be more common in females, who may present with more features of atypical depression.
Genetic and physiological. A family history of mania is two to three times more common in individuals with short-duration hypomania compared with the general population, but less than half as common as in individuals with a history of syndromal mania'or hypomania.
Individuals with short-duration hypomania have higher rates of suicide attempts than healthy individuals, although not as high as the rates in individuals with syndromal bipo- lar disorder.
Functional Consequences of Short-Duration Hypomania
Functional impairments associated specifically with short-duration hypomania are as yet not fully determined. However, research suggests that individuals with this disorder have less work impairment than individuals with syndromal bipolar disorder but more comor- bid substance use disorders, particularly alcohol use disorder, than individuals with major depressive disorder.
Bipolar II disorder. Bipolar II disorder is characterized by a period of at least 4 days of hypomanic symptoms, whereas short—duration hypomania is characterized by periods of 2—3 days of hypomanic symptoms. Once an individual has experienced a hypomanic ep- isode (4 days or; more), the diagnosis becomes and remains bipolar II disorder regardless of future duration of hypomanic symptom periods.
Major depressive disorder. Major depressive disorder is also Characterized by at least one lifetime major depressive episode. However, the additional presence of at least two life— time periods of 2—3 days of hypomanic symptoms leads to a diagnosis of short-duration hy- pomania rather than to major depressive disorder.