Bipolar II: What Is It And How Is It Different?
Perhaps due to the stigmas often surrounding bipolar disorder, some may not understand the difference between bipolar I and bipolar II disorder. Understanding bipolar II disorder and what makes it different can be valuable in understanding the symptoms and taking a bipolar test to see how they may present.
What is bipolar disorder?
Bipolar disorder statistics show that bipolar disorder affects approximately 5.7 million U.S. adults yearly. It is a spectrum disorder with various subtypes, each with its own diagnostic criteria. Having a family history of bipolar disorder is one of the risk factors for developing it. Often, the condition is marked by periods of mania, hypomania, or depression. Understanding each type of mania and how bipolar depression can appear may be valuable in understanding bipolar II disorder.
Mania definition
Mania is often marked by an elevated mood, increased energy, euphoria, and irritability. Other manic symptoms could include:
Insomnia, sometimes going days without sleep
Hallucinations or psychosis
Believing you are invincible or otherwise experiencing delusions of grandeur
Talking fast, sometimes not making sense
A heightened ability to complete tasks
Risky or impulsive behaviors
Distractibility
In the DSM-V, a manic episode involves a distinct period of "abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week or any duration if hospitalization is necessary." Manic episodes are only a symptom of bipolar I disorder and not bipolar II, and they may cause consequences in a person's life.
Hypomania definition
In the DSM-V, a hypomanic episode includes a distinct period of persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four days and present for most of the day. It may include symptoms of inflated self-esteem, a decreased need for sleep, fast talking, distractibility, and involvement in risky activities.
However, unlike a manic episode, a hypomanic period is marked by hypomanic symptoms that are not severe enough to cause social or occupational impairment. It also does not involve psychotic features, which are unique to mania. Any type of bipolar disorder can experience hypomania, but it is the only type of mania experienced by those with bipolar II disorder.
Depression definition
Some individuals experience depression as a symptom of bipolar disorder, with symptoms similar to major depressive disorder. For an episode to be considered a bipolar depression episode, it may last two weeks or more. Common symptoms of depression can include:
A persistent low or depressed mood
A loss of interest in previously enjoyed activities
Difficulty sleeping or sleeping more than usual
Changes in appetite
Difficulty completing tasks or caring for oneself
Excessive or inappropriate guilt
Suicidal thoughts*
*If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support.
According to the Substance Abuse and Mental Health Services Administration, bipolar II disorder is a “lifelong condition that doesn’t go away on its own.” Because individuals with bipolar disorder typically experience recurrent episodes, ongoing, enduring treatment is suggested. With proper care, the disorder’s symptoms can be managed, and its negative effects can be limited.
Types of bipolar disorder
Bipolar disorder is a mood disorder with four subtypes. The phases of mania, hypomania, and depression can differ for each. The severity and frequency of manic and major depressive episodes may vary depending on a diagnosis of bipolar I disorder, bipolar II disorder, or another subtype. Specific symptoms within each phase may vary.
Additionally, several specifiers may be provided alongside a bipolar diagnosis to further describe the symptoms an individual is experiencing. These include anxious distress, in which irritability, trouble focusing, and other symptoms of anxiety are present; mixed features, in which symptoms of mania and depression occur simultaneously; and rapid cycling in which an individual experiences at least four or more manic, hypomanic, or depressive episodes in a one-year period.
Bipolar I disorder
Bipolar I disorder is a bipolar spectrum subtype that includes at least one manic episode lasting at least one week or requiring hospitalization. People with this subtype may also experience hypomania and depressive symptoms, although they are not a requirement.
Bipolar II disorder
Bipolar II disorder is a subtype of bipolar spectrum disorder characterized by periods of hypomania and at least one depressive episode. Although people with bipolar II disorder do not experience mania, they may benefit from treatment for symptoms of hypomania and major depression.
Cyclothymia
Cyclothymic disorder is a mood disorder within the DSM-V that has features of hypomania and depression but does not meet the full criteria for bipolar disorder. Cyclothymic disorder may be marked by more rapidly cycling mood swings and mood symptoms, sometimes within the same day or week. It does not include the signs and symptoms of mania.
Bipolar disorder, not otherwise specified (NOS)
Bipolar disorder NOS is diagnosed that may be made if an individual has bipolar disorder symptoms that don't fit one of the above three categories.
Bipolar I vs. Bipolar II: What's the difference?
Since bipolar I and bipolar II disorder have bipolar symptoms in common, many individuals may wonder how the distinction is made. Below are a few differences.
Manic symptoms
Bipolar type I disorder is the only subtype of bipolar disorder marked by manic episodes, as described above. Along with the elevated mood episodes accompanying mania, people with bipolar I disorder may experience symptoms of psychosis such as delusions or hallucinations. Those diagnosed with bipolar II disorder do not experience these symptoms.
Hypomanic symptoms
Both bipolar I and bipolar II disorder may feature hypomanic phases. In bipolar I disorder, a hypomanic episode may be followed by mania. A person with bipolar II disorder may experience hypomania without symptoms of mania. Hypomanic episodes are often shorter than manic episodes.
Mixed features
All subtypes of bipolar disorder may include mixed features, which are rapid cycling symptoms of hypomania or mania and depression within a short period.
Depressive symptoms
Many individuals living with bipolar disorder have periods of mild to severe depression. However, depression is not required for bipolar I disorder, meaning those with the condition may only experience manic episodes. People with bipolar II disorder experience episodes of depression, which may be mild to severe.
Level of impairment
People with bipolar I disorder may struggle with daily functioning during manic phases. Their work, relationships, and hygiene might become challenging, leading to potential job losses or dysfunctional relationships. Symptoms of bipolar disorder can lead to physical health complications—such as heart disease, sleep disruptions, and significant weight loss or gain—that can make self-care difficult.
In individuals with bipolar II, depression and hypomania symptoms can significantly impact daily functioning. Although bipolar II may be seen as a “milder form” or "less severe” version of bipolar I, it can have marked impacts on the individual diagnosed. Similarly, hypomania is not a "fun" or "lighthearted" form of mania; it can still cause impairment on a lesser level.
Suicide risk
Bipolar disorders with elements of bipolar depression may be one of the risk factors of suicide. Studies have found that the risk may be upward of 20% higher than in the general population. A 2010 overall review of the literature by the National Institute of Mental Health shows that there is no significant difference between the rates of suicide attempts in people with bipolar I and bipolar II disorder. However, those who experience bipolar I disorder without depression may have less of a suicide risk.
If you are experiencing suicidal thoughts, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to a crisis counselor. They are available 24/7 to offer support.
Summary of differences
In the final analysis, the differences between bipolar I disorder and bipolar II disorders include the following:
Manic episodes of at least one week or requiring hospitalization are present in bipolar I disorder but not bipolar II disorder
Significant impairments are often present in bipolar I disorder, whereas lesser impairments may be present in bipolar II disorder
In bipolar I disorder, hypomania may escalate to mania, serving as one of the warning signs that mania may be coming, whereas in bipolar II disorder, it does not escalate or act as warning signs for potential mood swings.
People with bipolar I disorder may not experience depression
Diagnosing bipolar disorder
The DSM-V is used to diagnose mental health conditions. It is formally known as the Diagnostic and Statistical Manual of Mental Disorders, and its fifth edition has been in use since 2013. Psychiatrists and psychologists might use this manual to identify psychiatric disorders and anxiety disorders and distinguish symptoms of subtypes like bipolar I, bipolar II disorder, and related disorders.
Is there a bipolar disorder test?
No lab test or brain scan can diagnose bipolar disorder. Instead, professionals may conduct psychological interviews or self-reported testing to understand an individual's symptoms. They may also observe the person's symptoms or behavior at the appointment.
If a person has been admitted to a psychiatric hospital in the past for maniclike or suicidal episodes, they may use this information to make an informed diagnosis. You can also take a free screening quiz for bipolar disorder online through Mental Health America. However, note that online screening tests do not provide a diagnosis. Bring your results to your mental health provider to further discuss your symptoms and learn about ongoing treatment options.
Recording treatment for bipolar disorder
Psychiatrists and other mental health professionals record symptoms, diagnoses, and treatments using the ICD-10 bipolar disorder codes. The ICD-10 is the International Classification of Diseases, edition 10, a cataloging system used in the U.S. for diagnosis and insurance purposes.
Recording these codes allows insurance companies to process claims. Additionally, providers might use bipolar disorder ICD-10 notations to help them track your symptoms over time. However, if you meet with a new provider, they won't be able to view your past codes unless they work for the same agency or mental health provider.
How is bipolar II disorder treated?
Most clinical practice guidelines for bipolar II disorder state that medication is the first-line treatment. Commonly utilized medications for bipolar disorder are mood stabilizers, antidepressants, and antipsychotic drugs. Always consult with a healthcare professional prior to starting or stopping any medication.
Through psychotherapy, people with bipolar II can receive emotional support, develop coping strategies, and address symptoms of common comorbid health conditions like attention-deficit/hyperactivity disorder and eating disorders. Additionally, many individuals with bipolar and related disorders benefit from family interventions, in which family members learn how their interactions may influence the development and treatment of symptoms. According to the American Psychiatric Association, electroconvulsive therapy—a brain stimulation technique—can also be used for bipolar disorder.
Counseling options for bipolar II and related mental disorders
Does bipolar make you crazy? Labeling people with bipolar as "crazy" can be stigmatizing. Bipolar disorder is a serious condition that can be managed with proper medication, like mood stabilizers, and therapy. If you think you may be experiencing symptoms of bipolar I disorder, bipolar II disorder, or another subtype of bipolar disorder, consider reaching out to a counselor. Millions of people experience this condition yearly, and you're not alone. If you struggle to find a provider in your area due to barriers like cost, availability, or schedule, you can also find a bipolar disorder therapist online.
While an online therapist may not be able to provide a formal diagnosis, they can offer personalized treatment for your symptoms and provide you with coping mechanisms to use at home, as well as suggestions for other areas of support. You can also attend sessions from home via phone calls, video chats, or in-app messaging as long as you have a stable internet connection. One study on internet-based mindfulness therapy found that 95% of clients with bipolar disorder had an increased quality of life after treatment.
If you're interested in reaching out to a provider to develop a treatment plan, consider signing up for an online platform like BetterHelp, which offers a network of trained and licensed mental health providers specializing in various areas of mental health.
Takeaway
What is a bipolar II person like?
A person experiencing bipolar II disorder may act in a different manner depending on whether or not they are experiencing a hypomanic or depressive episode. While those with bipolar II disorder tend to have less intense episodes than those with bipolar I disorder, they may still have a number of symptoms that cause them to act abnormally. Acute symptoms of bipolar II disorder will largely depend on what type of episode they are experiencing. Here are several examples of hypomanic and depressive symptoms.
Hypomanic Bipolar II Symptoms
Hypomanic episodes often include the following symptoms:
- Impulsive behavior
- Hypersexuality
- Excessive talking
- High energy levels
- Substance misuse
Depressive Bipolar II Symptoms
Depressive episodes often include the following symptoms:
- Low energy
- Sense of worthlessness
- Loss of interest in previously pleasurable activities
- Persistent sadness
What is the difference between bipolar I and II?
While bipolar I and bipolar II disorder (sometimes referred to as bipolar 1 and bipolar 2) have similarities, there are distinct components that set them apart. For example, while those with bipolar I disorder can have a manic or depressive episode, those experiencing bipolar II disorder may have hypomanic (a less severe form of mania) or depressive episodes. Individuals with bipolar II disorder will also typically exhibit no psychotic symptoms, while those with bipolar I can.
Managing bipolar II disorder may be easier than managing bipolar I disorder due to differences in symptom severity. As a result, individuals affected by bipolar II are less likely to require hospitalization. In addition, those diagnosed with bipolar I disorder need to have had at least one manic episode in their lifetime to meet diagnostic criteria, while those with bipolar II need to have had at least one depressive episode.
How does bipolar II affect you?
Bipolar II disorder is characterized by periods of hypomania and depression, each of which has its own set of symptoms. During a hypomanic episode, a person may experience higher levels of energy and hyperactivity while believing they require less sleep. These individuals may also have an inflated sense of self-confidence, which may cause them to create grandiose plans that they are unlikely to follow through with.
During depressive episodes, which may follow a period of hypomania, individuals may experience noticeably different symptoms. The depressive symptoms of bipolar II disorder typically involve lower energy levels and a loss of interest in activities that previously brought joy. Individuals may have an inappropriate sense of guilt or persistent thoughts of worthlessness in addition to insomnia or hypersomnia.
Is bipolar II mostly depression?
While each person’s experience with bipolar II disorder will differ, depressive episodes have the potential to last much longer than hypomanic episodes. These depressive episodes may follow shortly after periods of hypomania, potentially lasting for days, months, or even years.
How long an episode lasts may change depending on a person’s family history of mental illness and whether they are being treated for their bipolar II disorder. In addition, there can be long periods where people experience no symptoms. According to the American Psychiatric Association, some individuals experience significant instances of usual functioning and “normal mood” in between hypomanic and depressive episodes, while others may cycle consistently.
Should I marry someone with bipolar II?
It is possible to have a healthy relationship or marry someone experiencing bipolar II disorder. While the disorder may create challenges, there are ways to address concerns and manage the symptoms associated with bipolar II disorder. Disorder management may be completed through a combination of talk therapy and psychiatry, during which a person can be placed on a type of medication known as a mood stabilizer.
Couples may also engage in family-focused therapy to address interpersonal concerns. With the right treatment and a healthy amount of communication, it's possible to manage bipolar II disorder in a way that makes romantic relationships more sustainable.
Can people with bipolar II love?
People experiencing bipolar II disorder can experience the same sense of love as neurotypical individuals and are capable of having healthy relationships. However, bipolar II disorder can create challenges that may affect the stability of a relationship, which may create the need for an individual to seek treatment. Here are a few problems that may be influenced by the presence of bipolar II disorder.
- Emotional Outbursts: Bipolar disorders have the potential to create mood swings and irritability in those experiencing them, which may be directed toward someone’s partner. Other emotions may also pop up and cause an outburst, which could be a strain on a relationship.
- Compassion Fatigue: Because a person with bipolar II disorder may require consistent care during their hypomanic or depressive episodes, their partner may become burned out. Partners may also believe that they are being neglected due to the overwhelming needs of their significant other. As a result, their own needs may not be met, which could create problems over time.
- Infidelity: Hypomania may cause unusual shifts in sexual urges or a state of hypersexuality, where a person may struggle to control their sexual impulses and pursue risky sexual encounters. If this is directed outside a relationship, a person may cheat on their spouse, which could potentially end their relationship.
Can bipolar II turn into I?
In some cases, it may be possible for someone with bipolar II disorder to develop bipolar I disorder. One 2006 study that assessed 263 children and adolescents with bipolar disorders found that 20% of bipolar II participants converted to bipolar I, while 25% of those with bipolar not otherwise specified (BP-NOS) converted to either bipolar I or II disorder.
It can also be possible for someone with bipolar I disorder to be initially misdiagnosed as bipolar II. While this wouldn’t technically involve someone with bipolar II developing bipolar I disorder, it may lead to confusion or inadequate treatment protocols. In addition, rare forms of bipolar disorder like cyclothymia may develop into bipolar I or II disorder.
What triggers bipolar type II?
Bipolar II can be triggered by a number of different situations, with episodes occurring more often based on exposure to specific risk factors. Here are several potential triggers for a bipolar type II disorder episode.
- Stress: High levels of stress have been known to trigger bipolar episodes. Poor sleep; significant weight gain, loss, or cycling; relationship struggles; pressure at work; or academic problems are all possible sources of stress that may exacerbate bipolar disorder symptoms.
- Substance Misuse: While the use of prescription or recreational drugs isn’t likely to cause bipolar disorder, it may increase the occurrence of hypomanic or major depressive episodes. According to one scientific review, the misuse of certain substances like amphetamines may cause more rapid cycling or induction of bipolar disorder episodes.
- Prescription Medications: Certain prescription medications like antidepressants may also trigger episodes of hypomania. Medical guidelines regarding the administration of antidepressants dictate that patients need to be monitored for signs of hypomania and may be instructed to cease their medication if a bipolar disorder episode is triggered or other side effects are incurred.
Is bipolar II a mental illness?
According to the (DSM-V), bipolar II is a mental illness that is categorized under mood disorders. In order to treat bipolar disorder, a person will first need to get diagnosed by a medical team. There are several aspects of an individual’s mental health history that the DSM-V identifies as necessary for a diagnosis. These points include the following.
- A person must have had at least one hypomanic episode and at least one major depressive episode.
- A person must never have had a manic episode.
- The occurrence of hypomanic and major depressive episodes is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and psychotic disorders.
- The symptoms or unpredictability of depression and hypomania causes clinically significant distress or impairment in occupational, social, or other important areas of functioning (i.e. day-to-day tasks, responsibilities, etc.)
Can stress trigger bipolar II?
One of the most common triggers for bipolar II disorder is stress. There are numerous stressful events that may trigger symptoms, including the following.
- A Lack of Sleep: Failing to get adequate sleep can cause an increase in a stress hormone known as cortisol. As a result, a person may become easily overwhelmed, angry, or low-energy. In those living with bipolar II disorder, these effects can worsen to the point where a hypomanic or depressive episode is triggered.
- Relationship Struggles: Trouble in one’s relationship or marriage can also create overwhelming amounts of stress. Episodes of bipolar II disorder may be triggered by significant strife or change in one’s relationship, including a long-distance relationship, a large fight, or a breakup.
- The Loss of a Loved One: The passing of someone close to someone can cause them to grieve, which is typically a healthy response to loss. However, for those experiencing bipolar II disorder, grief may cause an episode of hypomania, sometimes referred to as “funeral mania.”
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