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Types of Bipolar Disorder

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Edited & medically reviewed by THE BALANCE Team

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Previously known as manic-depressive disorder, bipolar disorder is a mental illness with rapid and extreme shifts between depressive and manic emotional states. Commonly appearing in teenage and adolescents, the condition affects approximately 2.6 percent of the U.S. adult population. Living with bipolar disorder is undoubtedly challenging, as the symptoms tend to linger for days or weeks. While it may make someone feel supercharged, sharp, and invincible at one point, these feelings of mania rapidly drain and are quickly replaced by a depressive episode to dash all the happy dreams. The constant cycling between these episodes can leave the afflicted individual feeling sad, fatigued, and defeated. Moreover, the intense mood shifts can be extremely disruptive even if long periods of calm separate them.

While there is no definitive cure for bipolar disorder, it is possible to manage it with medication, therapy, and self-education about it and its common types.

Before learning about the four types of bipolar disorder, it is imperative to familiarize yourself with the presentation of this disease. Most cases of bipolar disorder include two sets of symptoms, i.e., manic and depressive symptoms.

Manic Symptoms

Manic episodes form a key feature of bipolar I disorder. Mania refers to a condition in which an individual experiences a period of abnormally high or extremely irritable mood in addition to extreme changes in thoughts, energy, talkativeness, emotions, and activity levels. This unusually high level of physical and mental energy is easily noticeable by others.

People experiencing mania frequently take part in activities that bring them social, financial, or physical harm. For example, they may suddenly spend a huge amount of money on gambling or drive recklessly without caring for their own or others’ lives. Some of these individuals may occasionally develop symptoms of psychosis, such as hallucinations and delusions, which make it difficult for experts to distinguish bipolar disorder from other similar psychiatric issues, like schizophrenia.

A slightly less-intense version of mania, called hypomania, may also occur, especially in people with bipolar II disorder. Hypomania symptoms are less intense and may not last as long as manic episodes. This condition is also not severe enough to interfere with daily functioning.

Depressive Symptoms

The depressive symptoms of bipolar disorder are similar to those of major depression and typically include the following:

Lack of motivation
Overwhelming sadness
Irritability
Uncontrollable crying
Feelings of worthlessness and hopelessness
Fatigue
Low energy
Difficulty concentrating
Poor decision-making skills
Loss of enjoyment in things that you once loved
Appetite changes
Altered sleep habits
Thoughts of self-harm or suicide

While different experts have varying opinions about the number of bipolar disorder subtypes, most agree on the following four:

Bipolar I disorder

The diagnostic criteria for Bipolar I disorder include at least one manic episode lasting for at least seven days or a manic episode with symptoms severe enough to require urgent psychiatric hospitalization and care. This type of bipolar disorder involves depressive episodes that typically last at least two weeks. Some individuals with this disorder may experience depressive episodes with some manic features or manic episodes with few depressive features.

Bipolar II disorder

Bipolar II disorder includes alternating episodes of hypomania and depression but lacks the severe and highly impairing manic episodes that occur in bipolar I disorder. People with this subtype of bipolar disorder experience at least one episode of hypomania and major depression throughout their life. The condition generally causes the afflicted people to experience more than one episode of depression, unlike bipolar I, where depressive episodes may occur.

Between the depressive and hypomanic episodes, individuals with bipolar II disorder are capable of living everyday life.

Cyclothymic Disorder

Also known as cyclothymia, the cyclothymic disorder is a milder form of bipolar disorder comprising cyclical periods of highs and lows that persist for days or weeks. The highs and lows of this subtype are not as intense and rarely qualify as depressive or hypomanic episodes. Adolescents are typically more prone to developing this subtype.

People with cyclothymia usually appear to act and function normally, though some may call them difficult or moody. Those struggling with this problem often do not seek professional treatment as their mood swings are not severe. However, cyclothymia carries a high risk of transitioning into bipolar disorder if left untreated.

Unspecified Bipolar Disorder

Some people exhibit all symptoms of bipolar disorder, but their symptoms do not follow a specific pattern or do not fall into any of the three categories of this condition described above. However, in some ways, these symptoms still align with the criteria set for abnormal mood changes associated with bipolar disorder. For instance, an individual may go through mild hypomanic or depressive symptoms that resolve before the specified duration for cyclothymia. Alternatively, a person may have severe depressive episodes followed by experiencing mood elevation that is too brief or mild to be labeled hypomania or mania.

While experts consider these cases bipolar disorder, they do not fall under the aforementioned types.

Regardless of the type of bipolar disorder, treatment usually involves integrating medications with psychotherapy.

Medicines

You may need to try different types of medications under the supervision of a licensed doctor before finding what works best for your bipolar disorder management. Most healthcare providers prescribe the following medications to treat the symptoms of this psychiatric issue:

Mood stabilizers
Second-generation or atypical antipsychotics
Antidepressants

Some patients may benefit from a combination of the medications mentioned above for more effective management.

Psychotherapy

Psychotherapy, also known as talk therapy, can equally benefit patients suffering from different types of bipolar disorder. Some of these therapies include the following:

Psychoeducation is a type of talk therapy in which mental health professionals teach patients about their health conditions and help them learn how it can affect their lives and their loved ones.
Interpersonal and social rhythm therapy (IPSRT) is a type of therapy that focuses on techniques to help patients manage stressful situations, improve medication adherence, and reduce disruptions in social rhythms. It also teaches them skills using which patients can protect themselves from developing any depressive or manic episodes in the future.
Family-focused therapy is a type of therapy for both children and adults with bipolar disorder, along with their caregivers. Both the patient and their loved ones attend therapy together, where they learn more about bipolar disorder, seek communication improvement training, and acquire problem-solving skills.
Cognitive behavioral therapy is a goal-oriented, well-structured type of talk therapy in which the therapist helps patients take a closer look at their emotions and thoughts and learn how they affect their actions. Through this therapy, patients can unlearn negative behaviors and thoughts while adopting healthier habits and thinking patterns.

Bipolar Disorder

FAQs

What’s the difference between bipolar 1 and 2?

Understanding the differences and similarities between bipolar type 1 and 2 can be confusing for many. The core differences lie in the amount of major depressive episodes a person experiences and the intensity of their manic episodes. In bipolar one disorder, a person experiences severe mania for at least one week; however, in bipolar two, they experience a less intense form of mania (called hypomania) for at least four days. Both emotional highs of hypomania and mania include oddly high levels of energy, racing thoughts, a decreased need for sleep, impulsive behaviors, inflated self-esteem, and excessive talkativeness, among other symptoms. However, the severe form of mania that usually occurs in bipolar type 1 disorder has additional psychotic symptoms and impairments in functioning that often require hospitalization.

What is the difference between bipolar disorder and borderline personality disorder?

While bipolar disorder and borderline personality disorder (BPD) have similar symptoms, they are different from each other. BPD includes a long-term pattern of moment-to-moment and completely abrupt changes in mood, self-image, and behavior, usually triggered by conflicts in communication with others. Non-suicidal self-injury is also a common characteristic of BPD which is typically absent in people with bipolar disorder. Bipolar disorder differs from BPD as it includes longer-lasting episodes of depression and mania. Several factors may trigger these episodes, including medications, stress, substance use, and sleep changes.

Who is at risk of developing bipolar disorder?

Bipolar disorder can hit anyone. While the average age of onset is around 25 years, it may rarely start in childhood or develop as late as in the 40s or 50s. The disorder affects both males and females equally but in different ways. Women with bipolar disorder tend to switch moods more quickly and may experience more periods of depression than males.

What is rapid cycling?

Rapid cycling is a term that refers to having four or more mood swings within a one-year timeframe. These mood swings must last a few days to be labeled distinct episodes. Some people with bipolar disorder may experience changes in polarity from low to high or vice versa within the same week or even the same day. Such people may not exhibit the full symptom profile that defines separate episodes. Rapid cycling of bipolar disorder symptoms can occur at any point in life; however, some researchers believe that they are more common in the later stages of life as the individual becomes more vulnerable to illness.

What is hypomania, and what are its symptoms?

Some people with bipolar disorder experience mild forms of manic-like symptoms. The condition, hypomania, may make them feel good and capable of doing many things. Such people can typically function well at work or in social situations. While these people may not feel anything is wrong with them during an active hypomanic episode, those around them may notice changes in their activity levels and mood swings. Following an episode of hypomania, most people with bipolar disorder experience severe depression.

Manic depression vs bipolar: are they the same?

A lot of people compartmentalize manic depression and bipolar disorder as two different disorders with distinct symptoms and presentations. However, the truth is that both terms signify the same psychiatric disorders, and it is possible to use them interchangeably. Manic depression is the old name for bipolar disorder that is now obsolete since most people used to confuse manic depression with major depression, a completely different psychiatric disorder with depressive symptoms in the absence of alternating episodes of mania.

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