Types of Bipolar Disorder

There are several kinds of bipolar disorder. Each kind is defined by the length, frequency and pattern of episodes of mania and depression.

Bipolar I Disorder

Bipolar I disorder is characterized by one or more manic episodes or mixed episodes (symptoms of both a mania and a depression occurring nearly every day for at least one week) and one or more major depressive episodes. Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes.

Bipolar II Disorder

While bipolar I disorder is characterized by one or more manic episodes or mixed episodes and one or more major depressive episodes; bipolar II disorder is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.

The highs in bipolar II, called hypomanias, are not as high as those in bipolar I (manias). Bipolar II disorder is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported. If you have recurring depressions that go away periodically and then return, ask yourself if you have also:

  • Had periods (lasting four or more days) when your mood was especially or abnormally energetic or irritable?
  • Were you:
    • Feeling abnormally self-confident or social?
    • Needing less sleep or more energetic?
    • Unusually talkative or hyper?
    • Irritable or quick to anger?
    • Thinking faster than usual?
    • More easily distracted/having trouble concentrating?
    • More goal-directed or productive at work, school or home?
    • More involved in pleasurable activities, such as spending or sex?
  • Did you feel or did others say that you were doing or saying things that were unusual, abnormal or not like your usual self?

If so, talk to your health care provider about these energetic episodes, and find out if they might be hypomania. Getting a correct diagnosis of bipolar II disorder can help you find treatment that may also help lift your depression.

Not Otherwise Specified (NOS)

Bipolar disorder that does not follow a particular pattern (for example, re-occuring hypomanic episodes without depressive symptoms, or very rapid swings between some symptoms of mania and some symptoms of depression) is called bipolar disorder Not Otherwise Specified (NOS).

Cyclothymia

Cyclothymia is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.

Rapid Cycling

Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder, and may be a temporary condition for some people.

Diagnosis

DBSA has found that nearly 7 of every 10 people with bipolar disorder are misdiagnosed at least once, and that the average length of time from a person's first bipolar symptoms to correct diagnosis and treatment is 10 years. One of the reasons for this is that many people don't report all of their symptoms. It is important for people to share all symptoms, even those not present during a health care appointment, as well as their family history to help health care providers make a correct diagnosis.

Sometimes symptoms of hypomania (a milder form of mania) are mistaken for "a really good day." Many people don't report symptoms of mania or hypomania because they feel good and it often doesn't feel like an illness.

What is the difference between bipolar disorder and ordinary mood swings?

The three main things that make bipolar disorder different from ordinary mood swings are:

Intensity: Mood swings that come with bipolar disorder are usually more severe than ordinary mood swings.

Length: A bad mood is usually gone in a few days but mania or depression can last weeks or months. With rapid cycling, moods last a short time but change quickly from one extreme to another. With rapid cycling, "level" (euthymic) moods do not last long.

Interference with life: The extremes in mood that come with bipolar disorder can severely disrupt your life. For example, depression can make a person unable to get out of bed or go to work or mania can cause a person to go for days without sleep.

For more detailed information on the types of bipolar disorder and their symptoms, read the Mood Disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which may be available at your local library.