Hypomania Checklist-32 (HCL-32)

The Hypomania Checklist-32 (HCL-32) is a validated 32-item screening instrument developed to detect past hypomanic episodes, particularly in patients who…

Questions: 32
Duration: 10 min
Original title: Hypomania Checklist – 32 items (HCL-32)
Adaptation: Hypomania Checklist-32 (HCL-32)
Authors: Angst J., Adolfsson R., Benazzi F., Gamma A., Hantouche E., Meyer T.D., Skeppar P., Vieta E., Scott J.
Created: 2005

The Hypomania Checklist-32 (HCL-32) is a validated 32-item screening instrument developed to detect past hypomanic episodes, particularly in patients who present with depressive symptoms. Because individuals rarely complain about periods of elevated mood, hypomania is frequently missed, leading to lengthy delays in accurate diagnosis and inappropriate pharmacological management.

This clinician-administered tool maps the behavioral, cognitive, and emotional shifts that characterize hypomania. It asks patients to focus on their past "high" periods independently of their current mood state. When contextualized within a thorough clinical interview, the HCL-32 helps clinicians systematically spot bipolar disorder warning signs and distinguish unipolar depression from bipolar spectrum presentations. By establishing this baseline, mental health professionals can better tailor bipolar disorder interventions to the patient's actual clinical needs.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

16/ 32

The HCL-32 is a self-report screening questionnaire for lifetime hypomanic symptoms, designed in particular to identify bipolar components in patients presenting with a major depressive episode, specifically bipolar II disorder. It explores current mood state, habitual temperament, as well as the frequency, duration, and consequences of "highs" and the reactions of significant others. It consists of 32 binary (yes/no) items covering mood, energy, activity, cognition, behavior, and substance use.

généralemixed · general population · non-clinical sample (students/young adults) · Germany · n = 695 · 2007 · Meyer et al. (2007)

032

M = 16.25 ± 4.4

généralefemale · general population · non-clinical sample (students/young adults) · Germany · n = 374 · 2007 · Meyer et al. (2007)

032

M = 16.54 ± 4.16

généralemale · general population · non-clinical sample (students/young adults) · Germany · n = 321 · 2007 · Meyer et al. (2007)

032

M = 15.91 ± 4.64

généralemixed · general population · non-clinical sample (general population 35–85 years) · 35–85 years · Sweden · n = 408 · 2007 · Meyer et al. (2007)

032

M = 14.63 ± 4.82

généralefemale · general population · non-clinical sample (general population 35–85 years) · 35–85 years · Sweden · n = 196 · 2007 · Meyer et al. (2007)

032

M = 14.5 ± 4.8

généralemale · general population · non-clinical sample (general population 35–85 years) · 35–85 years · Sweden · n = 212 · 2007 · Meyer et al. (2007)

032

M = 14.76 ± 4.84

cliniquemixed · condition: Major depressive episode · patients in a major depressive episode (5 regions) · International (Iberia, Central Europe, Eastern Europe, North Africa/Middle East, Far East) · n = 5606 · 2013 · Gamma et al. (2013)

032

M = 13.7 ± 8.63

cliniquemixed · condition: Bipolar disorder · bipolar patients (DSM-IV-TR) in a depressive episode · International (Iberia, Central Europe, Eastern Europe, North Africa/Middle East, Far East) · n = 903 · 2013 · Gamma et al. (2013)

032

M = 20.2 ± 6.37

cliniquemixed · condition: Unipolar depression · unipolar depression (DSM-IV-TR) · International (Iberia, Central Europe, Eastern Europe, North Africa/Middle East, Far East) · n = 4732 · 2013 · Gamma et al. (2013)

032

M = 12.5 ± 8.45

For information

Cut-off≥ 14Cross-cultural cut-off for bipolarity (≥ 14)

Cut-off of 14 validated in 5606 patients in a depressive episode across 5 regions of the world: distinguishes between bipolar and unipolar patients (diagnostic specifier), AUC 0.86.

Gamma et al. (2013)View the study ↗

Cut-off≥ 20British cut-off for BP-I vs. recurrent depression (≥ 20)

Stricter cut-off prioritizing specificity, established between bipolar type I patients and recurrently depressed patients without a history of bipolarity.

Forty et al. (2009)View the study ↗

Scoring

Sum of positive responses, total score from 0 to 32, each item scored 0 or 1.

Factor 1 — Active / elated (elevated mood, activity, sociability)

12/ 20

Positive aspect of hypomania: energy, activity, euphoria, self-confidence, racing thoughts.

items 1, 2, 3, 4, 5, 6, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 24, 28

020

M = 10.3 ± 6.52

020

M = 14.6 ± 4.65

Factor 2 — Risk-taking / irritability

4/ 12

Negative aspect of hypomania: irritability, impulsivity, risk-taking, substance use.

items 7, 8, 9, 21, 23, 25, 26, 27, 29, 30, 31, 32

012

M = 3.5 ± 3.07

012

M = 5.6 ± 2.83

012

M = 3.1 ± 2.96

Have your patient take this test

Assign it in one click: your patient answers on their phone, you receive the score and its interpretation.

Assign this test to a patient

What the test measures

The HCL-32 systematically surveys the presence of hypomanic symptoms during a patient’s historical "high" periods. It evaluates two primary clinical facets:

Active/elated presentation: Increased goal-directed behavior, heightened sociability, subjective boosts in self-confidence, accelerated thinking, and decreased need for sleep.
Risk-taking/irritable presentation: Elevated impulsivity, substance use, distractibility, interpersonal friction, and reckless behavior that often functions as maladaptive coping.

This measure is intended for adult outpatients, specifically to uncover masked bipolarity in those presenting with recurrent mood complaints.

When and why to use it

Clinicians typically use the HCL-32 when assessing complex mood presentations or treatment-resistant depression. Its primary clinical indications include:

Intake baseline assessment: To establish a comprehensive mood history before initiating therapy, minimizing the risk of treatment-induced manic switching.
Differential support: To clarify diagnoses when historical mood shifts are subtle, ego-syntonic, or absent from the initial longitudinal case formulation.
Screening and cut-off guidance: To flag the need for a deeper exploration of the bipolar spectrum based on established clinical thresholds.

Relying solely on clinical impression can miss hypomanic traits, as patients often view these periods as times of normal or optimal functioning. A validated score provides an objective anchor to explore these states, offering a clear baseline against which clinicians can evaluate coping strategies over time.

Clinical library

750+ clinical tools

A library built with and for clinicians, ready to use in session and extend between appointments.

Access all the tools

Several resource types

Psychoeducation handouts

Understand at a glance

Interactive exercises

To do and fill in

Interactive programs

A structured path

Audios

Meditation and relaxation

Psychometric tests

Automatic scoring

The questions

At different times in their life everyone experiences changes or swings in energy, activity and mood ("highs and lows" or "ups and downs"). The aim of this questionnaire is to assess the characteristics of the "high" periods. Please try to remember a period when you were in a "high" state. How did you feel then? Please answer all these statements independently of your present condition. In such a state:
1. I need less sleep.
Probes for a decreased physiological need for sleep during elevated periods.
- Yes
- No
2. I feel more energetic and active.
Assesses subjective increases in physical energy and overall activity levels.
- Yes
- No
3. I feel more self-confident.
Evaluates the presence of inflated self-esteem or grandiosity.
- Yes
- No
4. I enjoy my work more.
Explores enhanced motivation and pleasure derived from professional or occupational tasks.
- Yes
- No
5. I'm more sociable (more phone calls, more outings).
Measures increased interpersonal engagement and extroverted behavior.
- Yes
- No
6. I want to travel and/or I travel more.
Probes for an increased urge or action to travel, reflecting heightened novelty-seeking.
- Yes
- No
7. I tend to drive faster or take risks while driving.
Assesses reckless behavior and impulsivity behind the wheel.
- Yes
- No
8. I spend more (or too much) money.
Evaluates poor financial judgment and impulsive spending habits.
- Yes
- No
9. I take more risks in my daily life (work, other activities).
Measures a generalized increase in risk-taking behaviors across daily domains.
- Yes
- No
10. I am more physically active (sports, etc.).
Checks for heightened engagement in physical exertion or sports.
- Yes
- No
11. I plan more projects or activities.
Assesses an overabundance of goal-directed planning and new initiatives.
- Yes
- No
12. I have more ideas, I am more creative.
Evaluates subjective increases in cognitive fluency and creative output.
- Yes
- No
13. I am less shy and less inhibited.
Probes for a reduction in social restraint and typical interpersonal boundaries.
- Yes
- No
14. I wear more colorful and extravagant clothes / I wear more makeup.
Measures changes in personal presentation toward the flamboyant or eccentric.
- Yes
- No
15. I want to meet more people, or I actually do meet more people.
Assesses a heightened drive for social contact and networking.
- Yes
- No
16. I am more interested in sex and/or my sexual desire is increased.
Evaluates hypersexuality and elevated libidinal drive.
- Yes
- No
17. I flirt more and/or my sexual activity is increased.
Probes for the behavioral expression of increased sexual interest.
- Yes
- No
18. I talk more.
Measures increased verbal output, potentially indicating pressured speech.
- Yes
- No
19. I think faster.
Assesses the subjective experience of racing thoughts or accelerated cognition.
- Yes
- No
20. I make more jokes or wisecracks when I talk.
Evaluates increased playfulness or facetious behavior in conversation.
- Yes
- No
21. I am more easily distracted.
Probes for heightened distractibility and difficulty sustaining focus.
- Yes
- No
22. I get involved in a lot of new things.
Measures novelty-seeking and the initiation of multiple new pursuits.
- Yes
- No
23. My thoughts jump from one topic to another.
Assesses the presence of flight of ideas and tangential thinking.
- Yes
- No
24. I do things more quickly and/or more easily.
Evaluates subjective increases in task efficiency and psychomotor speed.
- Yes
- No
25. I am more impatient and/or more easily irritable.
Probes for decreased frustration tolerance and heightened irritability.
- Yes
- No
26. I can be exhausting or irritating to others.
Assesses awareness of the negative impact one's elevated state has on relationships.
- Yes
- No
27. I argue more than usual.
Measures increased interpersonal conflict and argumentativeness.
- Yes
- No
28. My mood is elevated, more optimistic.
Evaluates the core symptom of an elevated, euphoric, or exceptionally optimistic mood.
- Yes
- No
29. I drink more coffee.
Probes for increased caffeine intake, often used to sustain heightened activity.
- Yes
- No
30. I smoke more cigarettes.
Assesses an increase in nicotine consumption during elevated states.
- Yes
- No
31. I drink more alcohol.
Evaluates increased alcohol use, potentially as self-medication or impulsive behavior.
- Yes
- No
32. I take more medication (sedatives, anxiolytics, stimulants…).
Measures an escalation in the use of prescribed or illicit substances.
- Yes
- No