What’s a Mixed State?

Question: Now that you explained the difference between hypomania and mania, I’m confused about what a “mixed state” is. Can you explain it?

Answer: When we talk about Bipolar Disorder symptoms mental health professionals (and the DSM) refer to the individual experiencing “changes in mood states”. This simply means that the person’s mood is changing, which can sometimes be referred to as “mood swings”. 

The most common “mood states” associated with Bipolar Disorder are: 

1. A stable mood state;
2. A depressed mood state;
3. A hypomanic mood state; and 
4. A manic mood state. 

Each of these “mood states” has its own specific symptoms or behaviors associated with it. For example:

1. In a stable mood state the individual may be able to handle unexpected changes to their routine with ease and manage crises effectively. 
2. In a depressed mood state the individual may feel hopeless and helpless and be disinterested in things they used to enjoy doing. 
3. In a hypomanic mood state the individual may have a lot of energy and start a series of projects without any clear plan on how to follow through and complete any or all of them. 
4. In a manic mood state the individual may stop sleeping and believe they understand the complexities of the universe in a way that no one else does. 

A “mixed state” is the term we use to describe when a person is in two distinctly different “mood states” at the same time. With Bipolar Disorder this usually means being in a depressed mood state and a manic (or hypomanic) mood state simultaneously. 

“Mixed states” can actually be quite dangerous in Bipolar Disorder. The reason for this is the individual will likely be experiencing the hopeless and helpless feelings of depression while also having the burst of energy and goal directing thinking of a manic state. When these states and their symptoms occur simultaneously, a person is more likely to harm themselves or others. 

If you think you or a loved one is experiencing a mixed state, please contact your doctor and/or therapist without delay to discuss how to address it. If you are concerned that you or a loved one may harm themselves or others, contact 911 or other emergency services immediately.