There are three basic types of bipolar disorder, known as bipolar I disorder, bipolar II disorder, and cyclothymic disorder, which some people casually refer to as bipolar III. The distinction among these three types is important when it comes to understanding the overall course of the disorder and the various treatments that can be used.
All that is needed to be diagnosed with bipolar I disorder is a history of at least one manic episode in the person’s lifetime. While depression is common in bipolar I disorder, it is not necessary for the diagnosis. A person with bipolar I may have had hypomanic episodes, but a single manic episode forever defines this type of the disorder.
When psychotic features of hallucinations, such as hearing voices that are not actually present, or delusional thinking are evident in bipolar disorder, only the bipolar I diagnosis applies. The seven-day minimum of a manic episode helps define the diagnosis, unless treatment interrupts the episode, as we would see in a psychiatric hospitalization.
People in a manic episode can become very excited, flush with energy and extravagance. They can exhibit rapid thoughts and become accelerated in their speech making it difficult to interrupt them. They also purposely avoid sleep due to the increased energy and need to get many things completed. They often engage in high-risk behaviors, such as spending sprees, sexual indiscretions, alcohol or drug binges, driving too fast, etc.
Not only can these behaviors lead to financial and relationship problems, but legal troubles may also eventually result. In any case, people with bipolar I disorder will often deny the consequences of mania, or justify the need to protect their manic behavior as a means to maintain creative output in their lives, despite the extensive threat bipolar I can have on their overall health and functioning.
When manic, a person with bipolar I can be mistaken as having another disorder, such as ADHD, panic disorder, or narcissistic personality disorder. If they have psychotic symptoms, they can be thought of as having schizophrenia. But the intense change in mood drives all the symptoms of this particular psychiatric disorder. When mania subsides, they often return to a more typical, or baseline, mood zone. The confusion now is about whether or not they have any psychiatric disorder at all.
Bipolar II disorder has traditionally been thought of as a lesser form of the condition compared to bipolar I. The reason for this difference is how a manic episode, which defines bipolar I, can be longer in duration and have more severe consequences within a particular episode. A hypomanic episode, which is characteristic of bipolar II, has the same symptoms but tends to be shorter in duration and generally less consequential in its effects. However, the impression that bipolar II is a lesser form of the overall condition of bipolar disorder is misleading.
First of all, simply looking at a manic episode and a hypomanic episode in a side-by-side comparison does not tell the full story of how devastating an overall bipolar II disorder can be. Unlike bipolar I, a bipolar II diagnosis fits if there is a history of one hypomanic episode and one episode of major depression. And the effects of the bipolar II condition should essentially change how that person is perceived by others around him or her.
In other words, at least one person close to that individual would agree that there is a noticeable change in their typical characteristics during hypomania. Often, because of the more objective input from family or associates around that person, the full effects of hypomania are uncovered. And in those instances, a clearer picture of hypomanic consequences can reveal impairments to occupational and social functioning.
Without a history of major depression, a person cannot be considered as having bipolar II. Someone having occasional hypomania by itself is not a bipolar disorder. But because the depressive episodes in bipolar II can be very severe—even suicidal—it’s mistaken to think of bipolar II as the lighter form of the overall condition.
To be clear, there are no comparisons in the duration or severity of depressive episodes between bipolar I and II, so it’s not unusual for bipolar II depression to be quite devastating. And the collective effects of hypomanic episodes can result in many dire consequences in the long-term.
If there is any advantage of having bipolar II over bipolar I, it can be somewhat easier to treat when it’s correctly identified. But because it’s generally more difficult to assess, people with bipolar II can, on average, go many more years undiagnosed than their bipolar I counterparts.
As a result, they may suffer consequences over a longer period of time, again making the side-by-side comparisons of bipolar I and II confusing. Like mania, hypomania is frequently misidentified as other conditions, including anxiety disorders, ADHD, personality disorders, etc., inevitably delaying effective treatment interventions.
Cyclothymia is marked by occasional episodes of hypomania and occasional periods of minor depression, known as dysthymia, that occur over a two-year period in adults and one year in children and adolescents. Sometimes, cyclothymia can be a precursor to bipolar I or II later on, especially when it starts in young people.
The genetic factor is the strongest and most consistent one in the development of bipolar disorder.1 In other words, bipolar runs in families and is passed through family genes. What is coded in the person’s DNA essentially sets the foundation for the brain’s inability to regulate moods consistently. A person generally must have this genetic predisposition for the true bipolar symptom pattern to eventually emerge during the lifespan.
Catalytic factors can bring out those symptoms. Some common catalysts involve hormonal changes, such as in puberty, or in women during or after childbirth, known as peripartum bipolar onset. Drug and alcohol abuse or certain medical disorders can also trigger underlying bipolar symptoms.
Traumatic experiences can trigger bipolar symptoms as well, but it’s important to know that trauma alone does not completely cause bipolar disorder. The average age of onset is late adolescence to early adulthood, though accurate recognition and diagnosis may not occur until several years into adult life.
It’s good to know of any family history of mental illness—especially bipolar disorder—if family historical information is available. And it’s even more important to share the family history with an appropriate mental health professional. This can improve the assessment and diagnosis, along with what the proper treatment can be for anyone who may have bipolar disorder.
Other mental health disorders