Calculators / Bipolar spectrum
HCL-32
Hypomania Checklist, 32 items. Self-report screen for hypomanic symptoms.
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The HCL-32 calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Looking for hypomanic symptoms in a person with depression, especially when the first question is whether an antidepressant is the right choice.
- Giving the person words for a high they may not have described, and a page to bring to the visit.
- Following a conversation about the length, cost and visibility of the highs.
Do not use it for
- Diagnosing bipolar disorder or hypomania. It never was a diagnosis.
- Ruling bipolar disorder out. A score under 14 makes hypomania less likely, and does not exclude it.
- Telling hypomania from mania, or from ADHD, borderline personality disorder or substance effects, which can also produce a high count.
The person answers for how they are in general, not just today. For the 32 statements, ask them to remember a high period when they were not using drugs or alcohol, and to say yes to each statement that was true of them in that state.
The first two questions give context and are not added to the score. The total is the number of yes answers among the 32 statements.
HCL-32
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More about the HCL-32
About the HCL-32What it is and what it is for
The HCL-32 is a checklist of 32 statements about hypomania. Jules Angst and colleagues published it in 2005 to find bipolar II disorder in people who come for depression and have never reported their highs. The person remembers a high period when not using drugs or alcohol and marks each statement that was true of them. The total is the number checked, from 0 to 32.
A total of 14 or more is the threshold from the original study. It is a fine-tooth comb for the manic side of the mood spectrum, not a yes or no test for bipolar disorder.
How to use itGiving it and scoring it
Ask the person to answer for how they are in general. Q1 and Q2 give context and are not scored. For the 32 statements they recall a high period when not using drugs or alcohol, and say yes to each that was true. The total is the number of yeses, from 0 to 32. This page does the counting.
The sheet that goes with the visit has four prompts that matter just as much as the count: how long the highs usually last, when the most recent one was, what people close to the person say, and how much of the past year was spent in one.
Interpreting the scoreScore ranges and what they suggest
| Statements checked | What it suggests | Usual response |
|---|---|---|
| 0 to 13 | Below the thresholdFewer than 14 statements checked. Hypomania is less likely, not ruled out. | Stay alert to a family history of bipolar disorder, or depressions that began young. |
| 14 to 32 | At or above the thresholdThe threshold from the original study. Worth a careful conversation about hypomania. | Ask how long the highs last, what they cost and what others noticed. This is not a diagnosis. |
Fourteen or more was the threshold in the original study. At that threshold the checklist caught about 4 of every 5 people with bipolar II, but flagged about half of those with ordinary unipolar depression too. It over-calls on purpose.
Pearls and pitfallsTips and common mistakes
- Ask the four follow-up questions every time. Length, cost and what others noticed tell you more than the count.
- Write down the person's own words for the highs. It makes the next conversation easier.
- A person who answers yes to the sleep, energy and talking statements and to the risk statements deserves a closer look, but the page does not weigh them. Read the answers, not only the total.
- A person on an antidepressant may have a high that is a drug effect. Ask about each drug.
- For a short screen in a person who is depressed, use the Modified RMS.
EvidenceAccuracy and reliability
- Angst and colleagues (2005) developed the HCL-32 to find hypomanic symptoms in outpatients with depression, to improve the detection of bipolar II.
- At the original threshold of 14 it caught about 4 of every 5 people with bipolar II and flagged about half of those with unipolar depression. Studies in other countries and settings have reported sensitivity and specificity in the range of about 70% to 90% at the same threshold.
- Factor analyses of the checklist describe two groups of statements, one of active and elated symptoms and one of risk-taking and irritable ones.
- The checklist is a self-report screen. It does not stand in for the interview, family history or course.
Source, license and referencesWhere it comes from
The HCL-32 was developed by Jules Angst and colleagues and published in the Journal of Affective Disorders in 2005. Statement wording follows the published checklist as it appears on the Psychofarm HCL-32 one-page sheet.
- Angst J, Adolfsson R, Benazzi F, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord. 2005;88(2):217-233.
- Phelps J. Spectrum framing and the Bipolarity Index. psycheducation.org.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. 2022.