Clinically reviewed by Candice Taylor, LCSW, Clinical Director
The four stages of mania are hypomania, acute mania, delusional mania, and delirious mania. They describe how intense a manic episode becomes, from a surge in energy to a break from reality. Not everyone moves through every stage, and some clinical sources count only three, folding delusional mania into acute mania.
If someone is in immediate danger, call or text 988 or call 911.
What Is Mania?
Mania is a period of unusually high mood and energy that lasts at least 7 days, or any length if symptoms are severe enough to need hospital care. Common signs include racing thoughts, little need for sleep, fast talking, and impulsive choices. Mania is the defining feature of bipolar I disorder, and trauma or other stressful events may raise the risk in people with a genetic tendency.
Bipolar I is also associated with the most intense stages of mania.
What are the four stages of mania?
The four stages of mania include hypomania, acute mania, delusional mania, and delirious mania. The stages of mania can inform professionals about how long a period of mania may last or what type of disorder the individual may be struggling with.
Stage 1: hypomania
Hypomania does not technically meet the criteria for a full manic episode. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hypomania is “[a] distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.”
SAMHSA also explains that at least 3 of 7 specific symptoms must be presentt, or 4 if the mood is mainly irritable. These symptoms are as follows:
- Inflated self-esteem or feelings of grandiosity
- A decreased need for sleep and feeling rested after only a short amount of sleep
- Talking more than usual
- Having “racing” or uncontrollable thoughts
- Being easily distracted
- An increase in goal-oriented activities
- Engaging in risk behaviors, such as risky sexual activities or excessive buying “sprees”
Hypomania differs from mania in three ways: it needs only 4 days, it does not cause marked impairment, and it has no psychotic features. An episode with psychosis is, by definition, manic.
Stage 2: acute mania
Acute mania is the presence of mania that meets the diagnostic criteria. It is when a manic episode first starts. It is also the most common type of mania to be experienced by someone who is starting to have a manic episode due to bipolar I disorder.
Someone with acute mania should be treated as soon as possible. According to Bipolar Disorder by authors Jain and Mitra, “Initial treatment [of acute mania] is aimed at stabilization of the potentially or acutely agitated patient to help de-escalate distress, mitigate potentially dangerous behavior, and facilitate the patient assessment and evaluation. When possible, a calming environment with minimal stimuli should be provided. Adjunctive benzodiazepines may be used concomitantly with mood stabilizers and antipsychotic drugs to reduce agitation and promote sleep.” Similar treatment should be initiated with delusional and delirious mania.
Stage 3: delusional mania
Delusional mania involves fixed false beliefs, often grandiose ones, such as being famous or having special powers.
Delusional mania is slightly less severe than delirious mania but still needs immediate medical attention.
Stage 4: delirious mania
Delirious mania adds confusion and disorientation, can be life-threatening, and is not a formal DSM-5 diagnosis. According to Bipolar Disorders, “Delirious mania is a syndrome of the acute onset of the excitement, grandiosity, emotional lability, delusions, and insomnia characteristic of mania, and the disorientation and altered consciousness characteristic of delirium.”
Frequently asked questions about the stages of mania
What are the stages of mania?
The stages of mania are hypomania, acute mania, delusional mania, and delirious mania, listed from least to most severe. Hypomania is a milder lift in mood and energy, while acute mania meets full diagnostic criteria. Delusional and delirious mania are the most severe forms, marked by false beliefs and confusion. Some clinical sources describe only three stages, and not everyone passes through each one.
How is hypomania different from mania?
Hypomania lasts at least 4 consecutive days, while mania lasts at least 7 days or any length if hospital care is needed. Hypomania does not cause marked impairment at work or in relationships, and it has no psychotic features. If psychosis is present, the episode counts as mania by definition. People in hypomania often feel productive and may not think anything is wrong, so family and friends tend to notice first.
How long does a manic episode last?
A manic episode lasts at least 7 days, with symptoms most of the day, nearly every day. It can be shorter if the symptoms are so severe that the person needs hospital care. Mood episodes in bipolar disorder can last a week or two, and sometimes longer. Our guide to how long manic episodes last covers what to expect in more detail.
What triggers a manic episode?
The exact cause of bipolar disorder is unknown, but genes play a large part. People with a genetic risk may be more likely to develop it after trauma or other stressful life events. Antidepressants taken without a mood stabilizer can trigger mania in some people with bipolar disorder, and some prescribed, recreational, or illicit drugs can mimic or worsen mood symptoms. Our article on the links between mania and substance use explains the connection.
How can I help someone who is having a manic episode?
Offer calm emotional support, patience, and practical help, such as a ride to an appointment or a trip to pick up a prescription (our guide to helping someone in a manic episode has more ideas). Listen to what they are experiencing without arguing with them. Remind them that getting better is possible with the right treatment, and take care of yourself too. If they may hurt themselves or someone else, call or text 988, or call 911.
How does The Phoenix Recovery Center treat mania and bipolar disorder?
The Phoenix Recovery Center builds a personalized plan for bipolar disorder that can include individual and group therapy, DBT, CBT, and medication management with our Medical Director or facility psychiatrist. Our care is trauma-informed, so it treats the whole person and the root causes behind symptoms. When substance use is also involved, our dual diagnosis program treats both together. Residential, partial hospitalization, and intensive outpatient programs let you step down in intensity as you stabilize.
When should I call for help, and what happens when I call?
Call as soon as you notice sleep loss, racing thoughts, or risky behavior that is out of character, because you do not need a diagnosis first. Tell our admissions team what you are seeing, and they will help you work out what level of care fits and verify your insurance. You can reach admissions at (801) 438-3185 any day from 6:00 a.m. to 9:00 p.m. If someone is in immediate danger, call or text 988, or call 911 instead.
Think You Are Watching a Manic Episode Start?
Watching someone you love become manic is frightening. Stay calm, listen without arguing, and offer practical help. At The Phoenix Recovery Center, our psychiatric providers and licensed clinicians look at mood symptoms and any substance use together, because some drugs can mimic or worsen mood symptoms. Our trauma-informed, personalized care plans treat the whole person: mentally, physically, socially, emotionally, and motivationally.
You do not need a diagnosis before you call. Tell us what you are seeing, and our admissions team will help you work out what level of care fits.
Call (801) 438-3185 any day from 6:00 a.m. to 9:00 p.m., or verify your insurance benefits online.
