Hyperactivity or Hypomania? A Misdiagnosis Story

You deserve to have a say in your own story.

Jesse Meadows
Invisible Illness
Published in
9 min readMay 1, 2021

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A purple, pink, and orange digital collage of a plant with paint swirls behind it, evoking energy.
Art by Jesse Meadows

Warning: Content addresses substance abuse.

“How do you not identify with the bipolar narrative?” a friend joked, responding to a meme I’d posted about my two moods.

Of course, this was a false binary for comedic effect. I have more than two moods, I just tend to feel everything intensely. I’ve been this way since I can remember. “Stop being so dramatic” and “you’re too sensitive” were the looped tracks in the album of my childhood.

I started drinking at 15 because “I felt too much” and I “didn’t want to feel it anymore” (basically direct quotes from my journal). As an adult, my alcoholism and depression reached a fever pitch, and I was diagnosed bipolar, twice.

Neither of the psychologists so much as batted an eye at the family history of autism and the adolescent ADHD diagnosis I had previously acquired. The second psych, who threw in a “Last Episode: Manic” (despite my insistence I had never experienced mania), and an “Unspecified Personality Disorder” (I don’t even know what that means) would hear nothing of any alternate explanations for the intensity of my moods.

She did grace me with a “Highly Sensitive Person” label, though, wherein she described my many “autistic traits” and prescribed me social skills training and lessons in eye contact (jokes on her because I taught myself that stuff by watching TV).

By this time, I had grown weary of being told I was broken and needed a lifetime of heavy medication to have any hope of a future. It’s disheartening, this degeneration narrative, yet every single psychiatrist I saw had peered down at me with sympathetic eyes and told me if I did not take medication for life, I would only ever get exponentially worse.

This idea of “degeneration” has its roots in the early history of the American psychiatric institution, where it was originally used to support the lifetime institutionalization of people who were considered socially deviant. (It never really went away, it seems, just got re-purposed in service of the pharmaceutical industry.)

Eventually I discovered the neurodiversity paradigm, a framework that radically changed the way I view mental health in general and my own identity in particular. But it didn’t happen overnight — it was a painful, years-long process, a trial by fire.

Digital collage of a switchboard connected by wires on graph paper in a pink and orange gradient.
Art by Jesse Meadows

A Process of Self-Discovery

The first time someone diagnosed me bipolar, I embraced it with open, desperate arms. I was suffering so much and wanted so badly to have an easy answer, a condition with a treatment. I was ready to fling myself into the hot sea of psychiatry, expecting to be buoyed up by gentle care. Instead, I got slapped in the face by a bunch of salty waves, pummeled into a million broken shells on the shore (I told you I was dramatic.)

I will stop briefly here to say, if you are now detecting some bitterness in my tone, it’s not bipolar disorder or the medication I am bitter about. If that diagnosis was accurate and the meds helped me, I would have been a proudly medicated bipolar advocate till my dying day.

I consider bipolar disorder another neurotype deserving of respect, understanding, and accommodation, and I defend everyone’s right to personal autonomy regarding medication. If you feel the label fits and the meds help you, use it and take them!

The meds didn’t help me, though. Lamotrigine, Trileptal, Lithium, Abilify. And the label was actually making me feel more hopeless — I became convinced I had a “treatment-resistant” version of bipolar disorder. I was scared and spiraling about it.

Then, COVID lockdown hit in March 2020. I got laid off and stopped leaving the house, suddenly awash in time and space to work on the things I loved without having to socialize daily, and my moods stabilized. I dropped the meds because I needed to know why this had happened, and I needed a control state for my self-experiment.

I realized that my existence until that point had been one of chronic overload and constant damage control. I wasn’t bipolar; I was just battered by everyday life.

“Normal things” like working 40 hours per week weren’t exceedingly hard for me because I had a “broken brain”, like the doctors told me, but because I had a brain that was fundamentally incompatible with the way the world is set up, and I was fighting through it completely unaware, with no accommodations and zero rest breaks.

In the autistic community, we call this burnout. I thought it was “chronic depression,” because that’s what I found when I Googled my symptoms.

Honestly, I had been Googling for months before I submitted myself to psychological evaluation. I had read about bipolar disorder, but I didn’t relate to it. I was surprised to see it written at the bottom of that first psych evaluation, but I had shrugged, assumed the professionals knew better than me, and accepted it.

“If anyone is bipolar, it’s you,” my partner at the time had said over the phone, when I called to tell them about it. I laughed nervously and asked what they meant. “You’re just so extreme.”

I did not argue this — I knew it to be true. I had a history of benders, weird jobs in far-away countries, intense romances with strangers, and the energy of a mad scientist to prove it.

One might look at me and think: Impulsive. Reckless. Hypomanic.

But from another angle, you could see: Sensory-seeking. Distracted. Hyperactive.

Where is the line between the two?

Optical illusion of Rubin’s vase, where you can see either a vase or two faces depending how you look at it, superimposed over a swirling pink and orange textured background.
Art by Jesse Meadows

A Case of Perspective

I am fond of the idea that hyperactivity and hypomania are just two points on a spectrum of human energy states — truly there are so many similarities, it can be hard to parse them apart sometimes. It’s also pretty common to be diagnosed with both: 60–90% of children diagnosed bipolar are also labelled ADHD.

Both hypomania and hyperactivity share traits like irritability, distractibility, heightened creativity, overactive ideation, and confidence.

I talked myself into hypomania. I had days where I felt on-top-of-the-world invincible, where ideas rushed non-stop through my head like white water rapids. I partied a lot. I was sexually adventurous. Sometimes I slept less, but never stayed awake for days, a fact I conveniently ignored.

Sometimes I experience intense creative bursts and make excited plans to start niche small businesses. In these times, I buy things I don’t need, but I’ve never maxed out a credit card or bought something without obsessively researching it for days first — more facts I conveniently ignored.

In my work as a journalist, I realized you can make anything look like anything if you ignore enough data that doesn’t fit into your story. This is what I did.

Creative rushes, flights of ideas, overconfidence, and increased energy are all common experiences for people who are diagnosed with ADHD, but despite my prior adolescent diagnosis, nobody considered that.

They saw an unmarried, promiscuous, bisexual adult woman* with a substance abuse problem. ADHD is for “little boys who can’t sit still,” not “sluts who drink too much.”

They ignored the data they wanted to because it didn’t fit the story they had for me, one steeped in misogyny and years of patriarchal medicine. And I accepted it for a while, because I trusted their authority, and I had yet to find any better explanations.

But then I stumbled on some articles about masking skills and mood disorder misdiagnosis for autistic people, and I found the book Divergent Mind. The pieces clicked together. Autism and ADHD described me far more elegantly and completely than the string of other diagnoses I had collected; I just didn’t fit the medical system’s strict definitions of what those things look like.

Around the same time, I started seeing a therapist who also had ADHD, and her innate understanding was crucial for me in disentangling the bipolar narrative that had been laid over me like an ill-fitting skin. As we got to know each other, she questioned it.

“I don’t see bipolar,” she said to me. When I admitted to her that I felt like I had made it fit, she said, “We are not going to do that.”

She understood the highs and lows of hyperactivity and burnout in a way the other professionals I saw did not, because she experienced them, too. Before she changed my diagnosis in her file, she asked me if I agreed with it. It was a courtesy I had never been extended before, and it made me feel empowered to create my narrative about myself.

Three large yellow and red question marks superimposed over a graphic of bouncing circles and paint swirls in a pink and orange gradient.
Art by Jesse Meadows

Okay so, is This Hyperactivity or Hypomania?

I don’t think it’s totally possible to separate our complex neurology into discrete boxes. But if you’re wrestling with this, I will share a few things I discovered that helped me sort it out for myself — rhythm, sleep and appetite.

Bipolar disorder is cyclical — there’s a theory that it’s tied to the body’s circadian rhythms. Mood shifts can often be predicted if you track them over time (I used an app called Daylio to do this).

It takes a while to gather enough data — you’ll need at least a few months’ worth of charts to see patterns, but this is a really helpful way of understanding if there’s a cycle to your moods and what may or may not trigger them (also, doctors love charts).

Hypomania usually involves drastic and sudden changes in your sleep schedule, including a “decreased need for sleep”, meaning you feel rested after only a couple hours or no sleep at all.

When the questionnaires asked if I ever experienced this, I said yes, thinking about the periods where I partied a lot and slept less. But nobody ever asked me if I was sober when I did this (I wasn’t), and the effect of substances is a very important factor that should be considered during diagnosis.

Most people who describe hypomania talk about staying awake for several days at a time — the hypomanic experience that Bassey Ikpi describes in her memoir “I’m Telling the Truth, But I’m Lying” was really helpful for me to read, because I realized I actually did not relate to it at all outside of a substance-fueled bender.

Hypomania also involves decreased appetite, but this one is tricky, because hyperfocus can cause us to forget to eat. I do this all the time. If I’m locked into a focus spiral on a particular interest, I can go all day without eating because I don’t notice that I’m hungry, so on the questionnaires that asked if my appetite ever changed with my energy levels, I said yes.

If a provider isn’t familiar with interoception differences in ADHD or autism and doesn’t ask why you’re not eating, this can be easily mistaken for a hypomanic symptom.

Another thing I thought was proof of bipolarity was my experience with anti-depressants. Zoloft felt like I was coming up on ecstasy. When I told my psychiatrist about this, she tried to put me on a mood stabilizer.

In researching this (because the doctor never explained it to me!), I came across a common idea that anti-depressant-induced mania is a sign of “underlying” bipolar disorder, meaning, you were always bipolar, the SSRI just brought it out.

This isn’t completely accurate, though, because there have been studies that show SSRI’s can induce mania-like symptoms in anyone, regardless of their neurotype. A 2013 study found:

Manic or hypomanic episodes were 5.6 times more likely per year for people diagnosed with [Major Depressive Disorder] who were taking antidepressants than for people with the same diagnosis who were not taking these drugs.

The DSM used to preclude a bipolar diagnosis if the manic symptoms occurred after taking anti-depressants, but this was removed in the latest version. Now anti-depressant-induced mania counts toward a bipolar diagnosis, because it’s widely assumed that this is just “latent” bipolar disorder showing itself.

It’s a circular sort of reasoning though, as pointed out in this Mad in America article:

“‘Why did my son become manic after starting on antidepressant drugs?’
‘Because he had a latent bipolar disorder.’
‘How do you know he had a latent bipolar disorder?’
‘Because he became manic.’”

Not the most sound of reasoning techniques there. To me, a solid diagnostic approach is a holistic one that takes into account many aspects of your life and experience, and considers the duration and intensity of your symptoms in relation to the circumstances of your life.

It’s a process where doctors are asking why at every turn, not just taking a symptom at face value and assigning a corresponding label to it.

And, in the end, it should be a process in which you feel listened to, understood, and consulted. It’s your life and your mind; you deserve to have a say in your own story.

*I identify as non-binary but am socially read as a woman.

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Jesse Meadows
Invisible Illness

writer + digital artist doing critical adhd studies + re-politicizing mental health | they/them