The Difference Between Bipolar Disorder 1 and 2

Many people think of rapid mood changes when they think of Bipolar Disorder. But there are several different categories of mood disorders depending on a person’s symptoms, and not all of these categories include the highs of mania and lows of depression. Only a doctor or mental health professional can provide a diagnosis for a mood disorder, and it may take years of observation to get an accurate diagnosis.

Understanding bipolar disorder

Most people have emotional ups and downs from time to time. But if you have a brain condition called bipolar disorder, your feelings can reach abnormally high or low levels.

Sometimes you may feel immensely excited or energetic. Other times, you may find yourself sinking into a deep depression. Some of these emotional peaks and valleys can last for weeks or months.

There are four basic types of bipolar disorder:

• bipolar 1 disorder
• bipolar 2 disorder
• cyclothymic disorder (cyclothymia)
• other specified and unspecified bipolar and related disorders

Bipolar 1 and 2 disorders are more common than the other types of bipolar disorder. Read on to learn how these two types are alike and different.

Bipolar 1 vs. bipolar 2

All types of bipolar disorder are characterized by episodes of extreme mood. The highs are known as manic episodes. The lows are known as depressive episodes.

The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type.

A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode (a period that’s less severe than a full manic episode).

A person with bipolar 1 may or may not experience a major depressive episode, while a person with bipolar 2 will experience a major depressive episode.

Bipolar Disorder I

Bipolar I disorder requires symptoms to meet the full criteria for what is known as a manic episode. You do not have to experience depression to be diagnosed with Bipolar I, but many people with the diagnosis experience both kinds of mood episodes.

A manic episode must include at least three of the following symptoms:

• increased talkativeness
• increased self-esteem or grandiosity
• decreased need for sleep
• increase in goal-direct activity, energy level, or irritability
• racing thoughts
• poor attention
• increased risk-taking (spending money, risky sexual behaviors, etc.)

Mania is much more extreme than a sudden burst in energy or motivation or a happy mood. It often results in problems in work, school, and relationships, and it some cases it may require hospitalization. A manic episode is also just as frequently characterized by an irritable mood as an elevated one for people with Bipolar I, so never assume a manic episode is not present because a person doesn’t not appear happy or enthusiastic.

Bipolar Disorder II

To qualify for a diagnosis of Bipolar II Disorder, a person has to have experienced a depressive episode and a less severe form of mania which is known as hypomania. A person experiencing mania will exhibit manic symptoms but is able to continue with day-to-day responsibilities and may even see an increase in job performance or other goal-directed activity. The elevated mood, however, is not so severe that the person requires hospitalization or experiences significant disruption at home or work.

To meet the criteria for a depressive episode, a person must experience 5 or more of the following symptoms:

• depressed mood
• changes in sleep
• changes in eating
• fatigue or lack of energy
• loss of pleasure in activities once enjoyed
• restlessness or slowing down
• feelings of guilt or worthlessness
• indecision or difficulty concentrating
• thoughts of suicide

Many people with Bipolar II Disorder are diagnosed with depression because they fail to report the elevated mood symptoms of hypomania to their doctor. People with Bipolar II also may be at higher risk for substance use and eating disorders. They are also more likely to have a relative in their immediate family with a psychiatric illness. To summarize, a Bipolar I diagnosis requires a manic episode but also can include depression. A Bipolar II diagnosis requires both a depressive episode and a hypomanic episode.

What are the symptoms of bipolar disorder?

As mentioned above, bipolar 1 disorder causes mania and may cause depression, while bipolar 2 disorder causes hypomania and depression. Let’s learn more about what these symptoms mean.

Mania

A manic episode is more than just a feeling of elation, high energy, or being distracted. During a manic episode, the mania is so intense that it can interfere with your daily activities. It’s difficult to redirect someone in a manic episode toward a calmer, more reasonable state.

People who are in the manic phase of bipolar disorder can make some very irrational decisions, such as spending large amounts of money that they can’t afford to spend. They may also engage in high-risk behaviors, such as sexual indiscretions despite being in a committed relationship.

An episode can’t be officially deemed manic if it’s caused by outside influences such as alcohol, drugs, or another health condition.

Hypomania

A hypomanic episode is a period of mania that’s less severe than a full-blown manic episode. Though less severe than a manic episode, a hypomanic phase is still an event in which your behavior differs from your normal state. The differences will be extreme enough that people around you may notice that something is wrong.

Officially, a hypomanic episode isn’t considered hypomania if it’s influenced by drugs or alcohol.

Depression

Depressive symptoms in someone with bipolar disorder are like those of someone with clinical depression. They may include extended periods of sadness and hopelessness. You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like. Other symptoms include:

• tiredness
• irritability
• trouble concentrating
• changes in sleeping habits
• changes in eating habits
• thoughts of suicide

What causes bipolar disorder?

Scientists don’t know what causes bipolar disorder. Abnormal physical characteristics of the brain or an imbalance in certain brain chemicals may be among the main causes.

As with many medical conditions, bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, your risk of developing it is higher. The search continues for the genes which may be responsible for bipolar disorder.

Researchers also believe that severe stress, drug or alcohol abuse, or severely upsetting experiences may trigger bipolar disorder. These experiences can include childhood abuse or the death of a loved one.

How is bipolar disorder diagnosed?

A psychiatrist or other mental health professional typically diagnoses bipolar disorder. The diagnosis will include a review of both your medical history and any symptoms you have that are related to mania and depression. A trained professional will know what questions to ask.

It can be very helpful to bring a spouse or close friend with you during the doctor’s visit. They may be able to answer questions about your behavior that you may not be able to answer easily or accurately.

If you have symptoms that seem like bipolar 1 or bipolar 2, you can always start by telling your doctor. Your doctor may refer you to a mental health specialist if your symptoms appear serious enough.

A blood test may also be part of the diagnostic process. There are no markers for bipolar disorder in the blood, but a blood test and a comprehensive physical exam may help rule out other possible causes for your behavior.

How is bipolar disorder treated?

Doctors usually treat bipolar disorder with a combination of medications and psychotherapy.

Mood stabilizers are often the first drugs used in treatment. You may take these for a long time.

Lithium has been a widely used mood stabilizer for many years. It does have several potential side effects. These include low thyroid function, joint pain, and indigestion. It also requires blood tests to monitor therapeutic levels of the drug as well as kidney function. Antipsychotics can be used to treat manic episodes.

Your doctor may start you on a low dose of whichever medication you both decide to use in order to see how you respond. You may need a stronger dose than what they initially prescribe. You may also need a combination of medications or even different medications to control your symptoms.

All medications have potential side effects and interactions with other drugs. If you’re pregnant or you take other medications, be sure to tell your doctor before taking any new medications.

Writing in a diary can be an especially helpful part of your treatment. Keeping track of your moods, sleeping and eating patterns, and significant life events can help you and your doctor understand how therapy and medications are working.

If your symptoms don’t improve or get worse, your doctor may order a change in your medications or a different type of psychotherapy.

What is the outlook?

Bipolar disorder isn’t curable. But with proper treatment and support from family and friends, you can manage your symptoms and maintain your quality of life.

It’s important that you follow your doctor’s instructions regarding medications and other lifestyle choices. This includes:

• alcohol use
• drug use
• exercise
• diet
• sleep
• stress reduction

Including your friends and family members in your care can be especially helpful.

It’s also helpful to learn as much as you can about bipolar disorder. The more you know about the condition, the more in control you may feel as you adjust to life after diagnosis.

You may be able to repair strained relationships. Educating others about bipolar disorder may make them more understanding of hurtful events from the past.

Coping With Bipolar Disorder

Typically, individuals with bipolar disorder will experience one to two episodes per year, but those who experience “rapid cycling” will have four or more episodes in a twelve-month period.

Being in tune with your feelings and recognizing if symptoms are increasing is an important part of living with bipolar disorder. Noticing that an episode might be coming, managing stress levels, and identifying and avoiding things that trigger episodes can help manage symptoms and maintain stability.

Having a treatment team made up of professionals that you trust is important for managing symptoms. Open, honest communication about your symptoms and stressors is an essential part of treatment.

There are many stigmas that people with bipolar I and bipolar II disorder face. But stigmas are often the result of a lack of knowledge on a particular subject. Both bipolar I and bipolar II are highly treatable.Individuals with these disorders can receive effective treatment, stabilize, and lead fulfilling lives.