Self-induced mania: An observational study of methods and motivations reported in online forums (Preprint)

Abstract

In bipolar disorder (BD), mania may be self-induced by manipulation of specific precipitants, as reported in case studies. Another potential source of information on the self-induction of mania is the online postings of users with lived experience of mania.

The primary aim of this study is to examine the range of methods used to self-induce mania/hypomania described by users of online forums with self-reported BD. Secondly, we summarise the motivations of users to engage in these behaviours.

An observational study of online forum posts that discussed self-induction of mania/hypomania by self or observed firsthand in others was conducted. Posts were identified using Google advanced search operators then extracted and coded for content in NVivo (Version 12 Mac). Forty-four online forum threads were identified discussing self-induced mania (n=25) or hypomania (n=19). These forums contained 585 posts by 405 usernames, of which 126 usernames discussed methods for self-induction across 327 posts (median = 2; range 1-11; IQR 1-4).

Thirty-nine methods were grouped by the authors, the most frequently reported were: sleep reduction (n=50), caffeine (n=37), and cessation in medication (n=27). Twenty-six usernames reported their motivation to self-induce mania/hypomania, almost three-quarters (n=19) reporting a desire to end a depressive episode. Almost a third of usernames (118 of 405) explicitly discouraged other forum users from self-inducing mania/hypomania.

Online forums provide an additional and valuable source of information about triggers for mania that may inform relapse prevention in BD. The online forum conversations were generally responsible and included cautionary advice not to pursue these methods.