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Personality

Rediscovering the Hypomanic Personality

Modern acceptance of a historical condition is warranted.

Key points

  • People with hypomanic personality types tend to be driven, impulsive, cocksure, intrusive, and, though often cheerful, can be moody.
  • Hypomanic personality is correlated with the risk of developing bipolar disorders.
  • Hypomanic personality can be mistaken for severe ADHD at first glance.
Timothy Dyes/Unsplash
Source: Timothy Dyes/Unsplash

Several personality disorders, like the passive-aggressive, have come and gone from the Diagnostic and Statistical Manual of Mental Disorders (DSM) for various reasons. These include what was called the cyclothymic personality in the DSM-2 in 1968 (McWilliams, 2011), or, as it was better known to history, the hypomanic (or hyperthymic) personality.

After discussion by astute figures such as Bleuler, Kraepalin, and Schneider (Millon, 2011), and the brief DSM inclusion in 1968, interest in this personality largely went underground. While of some interest to a few much later researchers (e.g., Akiskal, 1998; Jamison, 2005; Millon, 2011), and some in the psychoanalytic world (McWilliams, 2011), no spotlight ever returned on the condition.

The case of Davie (composite identity) begins to illustrate the hypomanic personality:

Davie was on a tangent in the waiting room when Dr. H opened the door. He entered the room with a levity not expected of someone starting therapy, as if they were old friends. Chattering about the beautiful painting on the wall and nice weather, he quickly changed topics to being grateful Dr. H could meet with him and “get this all behind me.”

Davie explained he understood he was referred by his employee assistance program because he’s wearing on some of his co-workers. “Look, I like to get things done,” he said, his affect turning a bit irritable. “You’d think an employer would like that. So, when I’m done marking the parts, I need other stuff to do, so I take it upon myself to work on things that could be improved, like re-organizing the tool crib.” His empoyer was also concerned about his never-ending intrusive need to get involved in others' projects and the time he spent talking, distracting others. Davie was good at the job he was hired to do, but they needed to ground him in the work environment, so thought therapy may help.

Always a bit scattered and slightly pressured in speech, Davie was tough to follow, and, at first, might strike someone as having significant ADHD. As Dr. H got to know him, his tendency for a zealous disposition, slightly more than tasteful confidence, and, at times, expansive affect, made it seem he was in a chronic hypomanicc episode.

However, Davie denied ever not having this energized disposition, though he did admit to short-lived periods of depression. These seemed to occur during periods of frustration, and generally corrollary to his temperament, like the current work situation. Though presenting with some depressive symptoms, Davie's reaction was, "I'll get over it. Life's too short to be miserable."

A challenge for even the seasoned Dr. H, Davie fit the profile of someone with what has been called a hypomanic/hyperthymic, or, as personality theorist Theodore Millon called them, exuberant personality disorder.

Defining the Condition

Parallel to how depressive personality disorder has nothing to do with an affective condition but is instead a “downer” disposition, the hypomanic personality is similar in not being an affective condition per se, but rather the antithesis of the aforementioned.

Millon (2011) noted Kraepalin’s description, for example, that these are patients who tend to “...throughout their entire lives display a ‘hypomanic personality’ pattern without severe pathogenic developments [i.e., full affective disorder episodes].” Schneider wrote, “Hyperthymic personalities are cheerful, kindly-disposed, active, equable, and great optimists. Often, however, they are shallow, uncritical, happy-go-lucky, cocksure, hasty in the decision, and not very dependable.” Brad Pitt’s character of Paul Mclean in A River Runs Through It exhibits many qualities of the condition.

Interestingly, while many diagnoses have morphed in definition since Victorian times, Akiskal et al. (1998) noted that their modern research supported the existence of this hypomanic personality as defined by the aforementioned historical figures.

More objectively, Millon (2011) explained that people with this personality exhibit a profile that is:

  • Energetic and driven.
  • Mercurial in mood. They’re often emotionally overzealous, though their exuberant and cheery mood often gives way to turbulence/dysphoria (unpleasant moods).
    AbsolutVision/Pixabay
    Source: AbsolutVision/Pixabay
  • Needlessly intrusive, vivacious, and socially buoyant.
  • Cognitively disarrayed with scrambled thoughts and minimal ability to focus.
  • See the self as a dynamic force, both tireless and enterprising.
  • Suggest their own importance through hyperbole and magnification of events.
  • Frequently unable to achieve purposeful goals due to their always-surging impulses.
AbsolutVision/Pixabay
Source: AbsolutVision/Pixabay

Relation to Other Personality Types

Millon also discussed how this condition is not unusually part of a mixed presentation, particularly with a histrionic or narcissistic personality disorder. Given the above, it is easy to see similarities and why they may occur from a psychodynamic perspective. For example, perpetual energy and zeal to the point of a level of grandiosity could indicate defense against depressive turmoil, similar to the Narcissist’s grandiose compensatory defense.

Not unlike the histrionic, a vivacious and cheery disposition forms in denial of the inner darkness. Like the histrionic, who is more interested in the thrill of the romantic chase, for being sought-after is more important for their ego than being cared for, the hypomanic/exuberant personality may feel more alive chasing rainbows than the idea of long-term success, for this would require a type of settling, and thus, stagnation in their eyes.

This is dangerous because they depend on being a moving target, lest their depressive ghosts catch up with them. Unfortunately, while an immediate salve, this perpetual motion encourages the cycle, for lack of success engenders a sense of failure, feeding depression, which the hyperthymic activity defends against.

Treatment Implications

1) It’s critical to differentiate from ADHD. While not pointedly addressed in available hypomanic/exuberant personality literature, one could see how clinicians might mistake such patients for having severe ADHD, with inappropriate intervention following. This is not a condition that would respond to stimulant medications and grounding/focus techniques.

Clearly, this could lead to the patient being seen as “untreatable” even if they remain effortful in their care. It’s easy to see how this can contribute to depressive reactions, and, quite often, depressed individuals are prescribed antidepressants. Unfortunately, as noted by Oser (2019), for those with this personality profile, antidepressants seem to trigger mixed states or frank mania.

2) There was a flurry of activity 10-15 years ago (e.g., Hensch et al., 2007; Blechert & Meyer, 2010; Giuseppe, 2010; Karam et al., 2010) that correlated hypomanic/exuberant personality as a risk factor for bipolar disorders. Given this information, it is important for providers to pay particular attention to screening for histories of true mania, mixed, and major depressive episodes in patients they suspect of having this condition.

3) If, after careful consideration, a hypomanic/exuberant personality is deemed present, while the symptomatology is similar to hypomanic episodes of bipolar disorder, treatment will be more sophisticated than pharmacological intervention and coping skills. As noted above, it is indispensable to consider the psychodynamics of such a personality and work towards a more adaptive manner of relating to the self and the world.

References

Akiskal, H., Placidi, G., Maremmani, I., Signoretta, S., Liguori, A., Gervasi, R., Mallya, G., &Puzantian V.R. (1998). TEMPS-I: Delineating the most discriminating traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. Journal of Affective Disorders (51),1, 7-19.

Blechert, J., and Meyer, T. (2010). Are measures of hypomanic personality, impulsive nonconformity and rigidity predictors of bipolar symptoms? British Journal of Clinical Psychology,44(1), 15-27. https://doi.org/10.1348/014466504X19758

Giuseppe, T. (2010). The temperaments and their role in early detection of bipolar spectrum disorders. Psychiatra Danubia, 22(1), 15-17. Retrieved from http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol22%20Supp…

Hensch, T., Herold, U., & Brocke, B. (2007). An electrophysicological endophenotype of hypomanic and hyperthymic personality. Journal of Affective Disorders, 101(1-3), 13-26. https://doi.org/10.1016/j.jad.2006.11.018

Jamison, K. (2005). Exuberance: The passion for life. Vintage.

Karam, E. G., Salamoun, M. M., Yeretzian, J. S., Mneimneh, Z. N., Karam, A. N., Fayyad, J., Hantouche, E., Akiskal, K., & Akiskal, H. S. (2010). The role of anxious and hyperthymic temperaments in mental disorders: A national epidemiologic study. World Psychiatry, 9(2), 103–110. https://doi.org/10.1002/j.2051-5545.2010.tb00287.x

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press.

Millon, T. (2011). Disorders of Personality (3rd ed). Wiley.

Oser, D. (2019) Hyperthymic temperament. Psychiatric Times, 36(9).

https://www.psychiatrictimes.com/view/hyperthymic-temperament

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