Mariah Carey's Surprising Diagnosis: Here's Why Bipolar II Disorder Can Be Difficult to Diagnose


Mariah Carey is speaking out about bipolar disorder, a condition she was diagnosed with in 2001 but is just now revealing publicly for the first time. The singer-songwriter and mother of two recently told People that while she lived in “denial and isolation” for a long time, she is now receiving treatment and is “in a really good place.”

In this week’s People cover story, Carey says that she has bipolar II disorder and talks about the manic and depressive episodes that led her to eventually seek help.

To learn more about this condition, Health spoke with John Gilmore, MD, director of the University of North Carolina Center for Excellence in Community Mental Health. Here’s what Dr. Gilmore—who has not been involved with Carey’s treatment—wants people to know about bipolar disorder.

RELATED: 10 Subtle Signs of Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a psychiatric illness that is characterized by cyclical periods of depressed mood and elevated mood, also known as mania, says Dr. Gilmore. During depressive episodes, a person may feel sad, sluggish, unmotivated, or overwhelmed with life. During manic episodes, they feel unusually happy, energized, confident, or impulsive.

In order to be diagnosed with bipolar disorder, a person must have had at least one each of depressive and manic episodes. Some people with bipolar disorder experience these extreme mood swings very rarely, while others have them regularly throughout their lives.

According to the National Alliance on Mental Illness, bipolar disorder affects men and women equally, and the average age of diagnosis is about 25. Overall, about 2.6% of Americans have bipolar disorder, and nearly 83% of those cases are considered severe.

RELATED: What Is Mania in Bipolar Disorder?

What’s the difference between bipolar I and bipolar II disorder?

Both bipolar I disorder and bipolar II disorder involve highs and lows. But for bipolar II disorder, those highs aren’t quite as high. People with bipolar I disorder have full-blown mania, which may include psychotic symptoms like hallucinations or delusions. These episodes frequently involve reckless or dangerous behavior and are often serious enough that they require hospital admission.

People with bipolar II disorder, on the other hand, have episodes of hypomania—a milder form of elevated mood that doesn’t include psychotic symptoms. These episodes may not be as obvious or seem abnormal on their own, and people who have them can often still function socially and professionally. Because of that, bipolar II disorder can be harder to recognize or misdiagnosed as depression.

Episodes of hypomania often include periods of sleeplessness, intense focus and concentration, and increased productivity. That seemed to be the case for Carey: She told People that, for a long time, she thought she had a severe sleep disorder. “But it wasn’t normal insomnia, and I wasn’t lying awake counting sheep,” she said. “I was working and working and working.”

That doesn’t necessarily mean bipolar II disorder is a less severe from of illness, however, says Dr. Gilmore. “The mania is not as extreme, but you can still have very severe episodes of depression that are debilitating,” he says. “The impact of bipolar disorder on a person’s life can still be very significant, whether it’s type I or II.”

There can also be a downside to hypomania, as well, separate from the eventual depressive episodes. Carey told People that when she went through stages of intense work and not enough sleep, “I was irritable and in constant fear of letting people down … Eventually I would just hit a wall.”

RELATED: What It's Really Like to Have Bipolar II Disorder

How is bipolar disease treated?

Medications called mood stabilizers can be very helpful for most people with bipolar disorder, says Dr. Gilmore. Antipsychotic drugs or antidepressants are also sometimes prescribed to treat symptoms.

Sometimes patients are hesitant to take medication for their bipolar disorder, says Dr. Gilmore, because they like feeling productive, creative, or happy during their manic or hypomanic episodes. “Yes, those feelings are enjoyable to a certain extent, but unfortunately, they can end in a way that gets people in trouble,” he says. “Once people seek treatment, I think they realize they can be happier and more creative if they’re stable and their life is not in disarray.”

Talk therapy can also be a big part of a treatment plan for bipolar disorder. “We focus on trying to understand what the illness is and how to manage it,” says Dr. Gilmore. “A lot of the symptoms can be precipitated by periods of stress, so one of the goals is to understand the stressful things that are going on and how to cope with those better.”

Last but not least, keeping a regular schedule, getting enough sleep, and maintaining a healthy lifestyle are also important for reducing stress and keeping symptoms under control. So is avoiding alcohol and other drugs that can interfere with medications and make psychiatric conditions worse.

If people have gone without treatment for some time, Dr. Gilmore adds, therapy can also focus on strategies for “putting their lives back together.” People with untreated bipolar disorder can have difficulty holding a job or maintaining healthy relationships, for example, and many also struggle with substance abuse.

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When you (or a loved one) should get help

Everyone experiences mood swings now and then, and it’s normal to feel happy on certain occasions and sad on others. But when your moods start to get in the way of your day-to-day functioning, it’s time to talk to a doctor.

“If it’s crossed the line where it’s interfering with your work or with your ability to have good relationships, or if it’s keeping you from doing what you want to do, that’s usually the wake-up call that people need to get help,” says Dr. Gilmore.

Of course, many people don’t see their doctor—or don’t take their doctor's advice—because they worry about the social stigma of having a psychiatric condition. “But most people do quite well with treatment, and it’s important to not be ashamed,” says Dr. Gilmore. “Just learning what the illness is and how to manage it is an important part of that.”

Carey says that, now that she’s found a medication and treatment plan that works, she’s feeling good and is back to recording music. She’s hopeful that sharing her story will help remove some of the mystery and misconceptions around her condition–and keep others from feeling so alone. “It can be incredibly isolating,” she says.

But she’s also optimistic about the future and her own experience with bipolar disorder. “It does not have to define you,” she says, “and I refuse to allow it to define me or control me.”