Flow versus hypomania

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For people who work in mental health, the “flow state” sounds an awful lot like hypomania.  Feeling like you don’t need to eat or sleep, totally absorbed in what you’re doing, not wanting to stop…on the surface they can look similar.  It’s important to be able to make the distinction, especially for people who suffer from bipolar disorder.  As a person becomes manic, they may misinterpret mania and hypomania as being in flow. I recently had the unfortunate experience of having to tell someone that although they were convinced they were in flow, on a creative binge, they were in fact manic.  Being able to identify the difference between flow versus hypomania is a useful tool for clinicians and patients alike.


Since I’ve already written about flow, let’s look at the definition of mania or hypomania. Hypomania means “just under mania”, or “less severe”.  People can be hypomanic and not have bipolar or schizoaffective disorders, but people who experience mania are by definition have one of those diagnoses.  The DSM-IV (a manual which defines all of the types of mental illness) lists the following as symptoms of mania and hypomania.  In order to be considered a hypomanic state, you have to experience at least 3 of the symptoms for 4 days or less. Here they are:


-inflated self esteem or grandiosity

-decreased need for sleep

-pressured speech (being overly talkative, others can’t get a word in edgewise)

-racing thoughts

-easily distracted

-doing things that are pleasurable but can cause social harm (spending too much money on things that aren’t important or the person can’t afford, having sex without considering the consequences, making impulsive life decisions such as quitting a job)

-irritability, can be to the point of physical violence.


Mania includes everything mentioned above except that the symptoms last at least a week, cause the person to be hospitalized, or also include psychosis (the person is no longer in touch with reality).  Going through a manic state can cause financial ruin, loss of work, destruction of important relationships, and the aftermath is often traumatizing. .  


In hypomania, someone’s mood and energy levels are above normal, but not the point where it causes problems in their life.  In fact, it’s often the opposite- people who are hypomanic are frequently quite successful by Western standards - financially and socially.  They’re able to work long hours, get a lot done, and spend plenty of time with other people.  


So why isn’t hypomania like flow?


One of the hallmarks of mania and hypomania is the “ego boost”- the grandiosity.  In some types of mania the person feels like they’re on top of the world, they can do anything, and nothing can get in their way.  They may feel superior to everyone around them, and even that they can’t get hurt.  This distorted thinking can lead them to extremely risky behavior in mania, less risky behavior in hypomania, or simply show up as arrogance in either.


Inflated ego, or a sense of ego at all, is not present in the flow state.  Flow is characteristically described as not having a sense of self- as if a power is flowing through you, and you’re just the conduit or vessel.  Many people describe it as spiritual, as if the power or talent they’re accessing is coming from a divine or otherworldly source.  Even more mundane experiences of flow, such as a particularly “on” night as a restaurant server, aren’t notably ego- driven or self centered.


A second feature of hypomania and mania which is often overlooked is irritability.  In popular culture and movies, the “up” part of bipolar disorder is usually portrayed as euphoric.  In real life, there is often irritability, anger, and even violence.  The same is true for hypomania, except that again the agitation doesn’t impact or derail the person’s life as much as it does in mania.  In the flow state, people are seldom irritable or agitated (unless in response to being interrupted from their task).  The flow state is a calm and focused state, inducing a sense of wellbeing instead of pressured anxiety.  

Lastly, a major difference between flow versus hypomania is that during periods of mania or hypomania, people often start multiple projects at the same time but don’t finish them.  Attention and focus are variable. In mania, people may have a lot of “goal directed activities”- cleaning, cooking, building things, initiating conversations- however these are often rather scattershot, and the work produced is not always adequate.

Flow, however, is characterized by hyperfocus- paying attention to the one task at hand, as mentioned above, and ignoring other people and responsibilities.  There isn’t a lot of jumping around from activity to activity, or thought to thought (known as a “flight of ideas”).  Although it’s usually an extremely pleasurable state, flow is not always by definition “good”- since other people and responsibilities can’t be ignored indefinitely.  Losing yourself in an extended flow state can definitely impair relationships, especially among close family members.

It’s important to notice that hyperfocus and over-stimulation can lead to other behaviors that may trigger mania in bipolar disorder. If a person loses a whole night’s sleep because of focusing on a task, they may inadvertently induce a manic state. They may continue to hyperfocus on the desired task, switch to more interesting work, or engage in the high risk activities outlined earlier (gambling, unsafe or indiscriminate sex, spending excessively, substance abuse).  For the general population, flow is easy to navigate and can be stopped if need be, but it’s an extremely slippery slope for those with bipolar disorder.  If you are someone with bipolar, it’s helpful to track the incidences when you believe you are in flow but it becomes a manic state.  You can share this information with loved ones or mental health providers, and when you lose sight of a slide into mania, others can intervene on your behalf to prevent a full blown mania.