32-item self-test targets subtle signs of hypomania

—A 32-question checklist can help spot signs of hypomania, improving the chances of correctly identifying bipolar-spectrum disorders that often go unnoticed, researchers reports. The tool was sensitive enough to catch most cases, though it was less precise in ruling them out.

Researchers led by Zurich University Psychiatric Hospital developed the Hypomania Checklist, or HCL-32, to make it easier to pick up high period, elevated mood, extra energy and activity.

The study, published in the Journal of Affective Disorders in 2005, matters because missing bipolar features can lead to years of misdiagnosis and less effective treatment. 

The team tested the questionnaire in outpatient samples across several countries and found a stable structure with two clusters of symptoms. One cluster reflected upbeat drive and productivity; the other captured edgier, risk-prone behavior. 

What’s new is not just the number of items but the focus on everyday behaviors—sleeping less, talking more, taking on projects, spending sprees—that people recognize in themselves. The questions are brief and concrete, making the form easy to complete in waiting rooms or primary-care settings. Later open-access versions show the same 32 yes/no items, such as “I need less sleep,” “I am more sociable,” and “I take more risks in my daily life.” 

The checklist’s job is screening, not diagnosis. The authors note it cannot tell bipolar I from bipolar II, and a positive result still requires a full clinical interview. 

The authors’ early results helped launch two decades of follow-up work on how best to implement the HCL-32 and refine it for different settings. PubMedCambridge University Press & Assessment

Source: Journal of Affective Disorders, October 2005; Angst et al., “The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients.” ScienceDirect

HCL-32 – Hypomania Checklist
Answer yes or no

When you were in a “high” state (not due to alcohol or drugs), did you…

1. Need less sleep
2. Feel more energetic and more active
3. Feel more self-confident
4. Enjoy your work more
5. Become more sociable (make more calls, go out more)
6. Want to travel and/or travel more
7. Drive faster or take more risks when driving
8. Spend more money/too much money
9. Take more risks in daily life (work/other activities)
10. Become physically more active (sports, etc.)
11. Plan more activities or projects
12. Have more ideas / feel more creative
13. Feel less shy or inhibited
14. Wear more colorful or extravagant clothes/make-up
15. Want to meet—or actually meet—more people
16. Feel more interested in sex and/or have increased desire
17. Become more flirtatious and/or more sexually active
18. Talk more
19. Think faster
20. Make more jokes or puns when talking
21. Become more easily distracted
22. Start lots of new things
23. Have thoughts jump from topic to topic
24. Do things more quickly and/or more easily
25. Feel more impatient and/or get irritable more easily
26. Feel exhausting or irritating to others
27. Get into more quarrels
28. Feel your mood was higher / more optimistic
29. Drink more coffee
30. Smoke more cigarettes
31. Drink more alcohol
32. Take more drugs (sedatives, anti-anxiety pills, stimulants) 

Scoring the HCL-32:

• Score 1 point for each “Yes” answer
• Add up total points
• A score of 14 or higher. It’s often used in studies as the threshold suggesting possible bipolar II or hypomania. Some clinical contexts may use a score of 20 or more to improve specificity.

Subscale Scoring Overview

Active/Elated Subscale

• Comprised of these item numbers from the HCL‑32:
  2, 3, 4, 5, 6, 10, 11, 12, 13, 15, 16, 19, 20, 22, 24, 28 
• Scoring: Count the number of “Yes” responses within these 16 items.
• Interpretation: A sum score of 12 or higher may indicate a predominantly “active/elated” hypomanic presentation
  
  

Risk‑Taking/Irritable Subscale

• Includes the following items:
  7, 8, 9, 21, 25, 26, 27, 31, 32 
• Scoring: Sum the “Yes” responses across these 9 items.
• Interpretation: A score of 3 or more may suggest a more “irritable/risk‑taking” hypomanic tendency

Note: The HCL-32 (Hypomania Checklist) is a screening tool, not a diagnostic test, for identifying possible bipolar II or hypomanic episodes.

Comment from a person who had a period of hypomania: As someone who was diagnosed with hypomania and lived with it for a year, I feel like I experienced some of these symptoms to a minor degree. However, the hypomania proceeded into full-blown mania, I had most all of this symptoms to a much greater extent. So much so that it destroyed my life.