Like many other conditions, bipolar disorder is not one-size-fits-all—though, in general, the mental illness causes unusual shifts in a person's mood, energy, and behavior, it does so to various extents, according to the National Institute of Mental Health (NIMH).
In the most general terms, bipolar disease involves "mood episodes"—manic, depressive, and hypomanic—and can be broken up into four different types: bipolar 1 disorder, bipolar 2 disorder, cyclothymic disorder, and unspecified bipolar disorder.
Though all forms of bipolar disorder are characterized by mood episodes—the "ups" and "downs" of manic episodes and depressive episodes—the the severity and frequency of these mood episodes greatly impacts a diagnosis.
Here, psychiatrists explain the differences between all four types of bipolar disorder, as well as the symptoms associated with mood episodes. Understanding the intricacies of this mental illness is an important first step in determining, with your health care practitioners, a proper diagnosis and treatment regimen.
The 4 Types of Bipolar Disorder, Explained , MD, MPH, a professor of psychiatry at The Johns Hopkins University School of Medicine and a psychiatrist with Hopkins Medicine, tells Health.
The three specific mood episodes seen in bipolar disorder include: manic episodes, depressive episodes, and hypomanic episodes (less severe manic episodes). Manic episodes and depressive episodes specifically present in very different ways, according to NIMH.
Depressive episodes are known as the "low" period of a person's bipolar disorder. According to the National Alliance on Mental Illness (NAMI), a person must exhibit one or more of the following symptoms nearly every day for at least two weeks, and those symptoms must significantly impair a their daily life.
- Feeling very sad, "down," empty, worried, or hopeless
- Feeling slow or restless
- Sleep issues (trouble falling asleep, waking up too early, or sleeping too much)
- Weight gain or increased appetite
- Talking slowly
- Difficulty concentrating, making decisions, or performing simple tasks
- Lack of interest in activities
- Decreased sex drive
- Unable to experience pleasure (anhedonia)
- Thinking about death or suicide
What distinguishes bipolar disorder from depression are episodes of mania or hypomania. According to NAMI, in order to be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania, in addition depressive episodes. Per NIMH, the following are symptoms of mania:
- Feeling elated, "up," "high," or elated
- Feeling touchy or irritable
- Decreased need for sleep
- Loss of appetite
- Talking fast or rushed
- Racing thoughts
- Risky behaviors, such as substance abuse, spending money, or reckless sex
- Feeling unusually important, talented, or powerful
Hypomania includes similar symptoms to mania, but according to Dr. Potash, the symptoms aren't as extreme and they're shorter in duration. For example, someone with hypomania might experience elevated mood for four days rather than an entire week.
In general, Dr. Potash says, bipolar mood episodes typically last for months before shifting. Some people experience rapid cycling, in which they shift from high to low mood (or vice versa) over the course of days or hours.
What are the types of bipolar disorder?
Bipolar disorder symptoms can range in severity and duration depending on the type of bipolar someone has. Treatment may also vary among the various forms of bipolar disorder.
Bipolar 1 disorder
Bipolar 1 (sometimes referred to as Bipolar I disorder) is the most severe form of the mental illness, Ashraf Elmashat, MD, a psychiatrist with Keck Medicine of USC, tells Health. To be diagnosed with bipolar I, someone has to experience a major depressive episode for at least two weeks, plus a manic episode that lasts for seven days (fewer, if the patient is hospitalized for the symptoms), per NAMI.
In addition to mania, Dr. Elmashat says people with bipolar 1 disorder may also experience psychosis, or hallucinations and delusions. People with bipolar I are also more likely to be hospitalized for their symptoms than those with other types of bipolar disorder.
According to Dr. Potash, a combination of psychotherapy and medication is the best treatment for people with bipolar disorder, including bipolar 1 disorder. Mood stabilizers, such as lithium, are one common treatment for bipolar 1; in patients with psychosis, he says a health care provider may also prescribe an antipsychotic drug.
If someone has severe mood swings that don't respond to other forms of treatment, Dr. Elmashat says a doctor may recommend electroconvulsive therapy (ECT), which can improve symptoms by using electricity to stimulate the brain.
Bipolar 2 disorder
Like bipolar 1 disorder, bipolar 2 disorder (or bipolar II disorder) involves episodes of depression. But rather than full-blown manic episodes, people with bipolar 2 experience what's known as hypomania. "It's the same symptoms as mania, but the severity and duration are less than with bipolar 1," says Dr. Elmashat. Usually, people experience milder symptoms of mania for four consecutive days, and people generally don't go to the hospital for them.
According to the Cleveland Clinic, while mania can present as an extremely elevated and irritable mood, hypomania is more an "energized" version of yourself. This kind of elevated mood is not severe enough to significantly affect your life, whereas a true manic episode can disrupt daily living.
Commonly, Dr. Potash says, people with bipolar 2 take mood stabilizers to improve their symptoms. While hypomania doesn't include psychosis, some people with bipolar 2 may take antipsychotic drugs if their depression involves hallucinations or delusions.
Cyclothymic disorder, also called cyclothymia, includes hypomania and depression. "But the hypomania is not severe enough to be mania, and the depression symptoms aren't severe enough to be major depression," says Dr. Elmashat. "Otherwise, you'd be classified as bipolar 2."
Usually, people with cyclothymic disorder experience milder symptoms for a longer duration — for example, two full years with a few depression symptoms and a bit of hypomania.
As with other forms of bipolar disorder, Dr. Elmashat says cyclothymia is usually treated with mood stabilizers.
Unspecified bipolar disorder
Unspecified bipolar disorder includes symptoms of both depression and mania that don't meet the criteria for a clinical diagnosis. "You may have a few symptoms of depression and mania, but not the full diagnostic criteria based on the duration of how many symptoms you have," he says. "So there are some bipolar symptoms there, but not enough to diagnose any of the other three types." For example, according to Dr. Potash, with unspecified bipolar, hypomania symptoms may last a few days rather than the full four days required for diagnosis.
People with unspecified bipolar disorder may experience what's called a mixed episode, which involves the highs of mania and the lows of depression at the same time. "The most common way we see it is that someone feels down and negative, but at the same time, their energy level is high," says Dr. Potash. "That mixture can be quite dangerous because people often think about self-harm." To prevent this potentially dangerous state, he says providers commonly prescribe mood stabilizers for patients with unspecified bipolar disorder.
While it's completely normal to experience fluctuations in mood from time to time, if thoughts and feelings begin interfering with your ability to function in one or more areas of your life, Dr. Potash recommends seeking help. If you think you may be experiencing bipolar disorder, reach out to a health care professional, who can diagnose and treat your symptoms. A psychologist or primary care provider can help, or you can make an appointment with a psychiatrist who specializes in treating mental health conditions.
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