Bipolar disorder is a complex condition characterized by distinct periods of abnormally elevated, expansive, or irritable moods, often alternating with depressive moods. Contrary to popular belief, there is more than one type of bipolar disorder. How these mood episodes present determines which type of bipolar disorder a person will be diagnosed with.
According to the American Psychiatric Association (APA), there are five types of bipolar and related disorders, each defined by the presence, type, frequency, and intensity of mood episodes. Understanding which type of bipolar disorder you have is important for determining your treatment options.
At a Glance
People with bipolar disorder experience mood episodes that may include manic, hypomanic, and depressive periods. How these episodes present determines which type of bipolar disorder a person has. Bipolar I and II are the most common types. Bipolar I is characterized by manic episodes, and bipolar II is characterized by hypomanic and depressive episodes. Cyclothymic disorder is another type marked by alternating hypomanic and depressive symptoms.
No matter the type, the condition is often misdiagnosed for other conditions, including ADHD, BPD, or depression. Treatments for bipolar disorder usually involve medications, therapy, and lifestyle modifications, but your doctor will make recommendations specific to the type you have.
What Are Mood Episodes, Exactly?
People with bipolar disorder may experience mood episodes—distinct periods marked by intense emotions, changes in energy and activity levels, and uncharacteristic behaviors. During these episodes, a person might feel extremely energetic or very depressed.
The three main types of mood episodes are:
- Manic: In a manic episode, you may feel extremely energized and happy or unusually angry and irritable. This state typically lasts at least one week and can require hospitalization.
- Hypomanic: Hypomania is a less severe form of mania, lasting at least four days.
- Depressive: A major depressive episode lasts at least two weeks, during which you experience five or more depressive symptoms that affect your daily functioning.
Some people may have symptoms of depression and mania at the same time, known as a mixed episode.
The 5 Types of Bipolar Disorder
The American Psychiatric Association (APA) classifies bipolar disorder based on the type, duration, and severity of mood episodes. According to the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR), doctors may diagnose you with one of these five types:
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
- Other specified bipolar and related disorder
- Unspecified bipolar and related disorder
Other specified bipolar and related disorder, together with unspecified bipolar and related disorder both used to fall under the category of bipolar disorder not otherwise specified (NOS) in the DSM-IV. However, the “not otherwise specified” category was removed and broken out into these two condition names in the DSM-5.
Bipolar I Disorder
To be diagnosed with bipolar I disorder, you must have experienced at least one manic episode that lasts at least seven days or is severe enough to require hospitalization.
Depressive episodes are common, although not necessary for the diagnosis.
Bipolar II Disorder
Bipolar II disorder involves both hypomanic and depressive episodes. To be diagnosed with bipolar II, you must not have had a full manic episode.
Bipolar II is a distinct disorder, not just a milder form of bipolar I.
Cyclothymic Disorder
Also called cyclothymia, this mood disorder consists of numerous alternating periods of hypomanic and depressive symptoms.
Unlike bipolar I and II disorders, the highs and lows of cyclothymia are not severe enough to fit the full criteria for manic, hypomanic, or major depressive episodes. However, these symptoms must be present for at least half the time for a period of at least two years, with no symptom-free period for more than two months.
Although the mood episodes are less extreme than those of bipolar disorder, it’s critical to seek help. Not only can these symptoms interfere with your daily life, but they also may develop into bipolar I or bipolar II disorder later in life.
Other Specified Bipolar and Related Disorder
This type of bipolar disorder is diagnosed when you have symptoms of bipolar disorder (such as manic or depressive episodes), but they don’t fit into other bipolar categories.
For instance, you may have cyclothymic symptoms that haven’t lasted two years, or maybe you have hypomanic episodes without depressive episodes.
Unspecified Bipolar and Related Disorder
This diagnosis is similar to specified bipolar and related disorder. It’s used when a doctor doesn’t have enough information to make a specific diagnosis, such as in an emergency room.
How Common Is Bipolar Disorder?
Studies suggest there is a lifetime prevalence rate of about 0.6% for bipolar type I and 0.4% for bipolar type II. The overall prevalence for all types of bipolar disorders is 2.4%.
Misdiagnosis Is Common
Of all the mental health disorders, bipolar is perhaps one of the most commonly misdiagnosed. Sometimes it’s not clear which one of the types of bipolar disorder a person’s symptoms align with.
Bipolar disorders can also be difficult to diagnose because they share symptoms with so many other conditions. These mental health conditions often get mistaken for bipolar disorder:
- Attention-deficit hyperactivity disorder (ADHD): Both disorders come with overlapping symptoms. However, while ADHD is a chronic condition present since childhood, bipolar disorders are episodic. Additionally, bipolar disorders primarily affect mood, whereas ADHD impacts attention and behavior.
- Borderline personality disorder (BPD): A main difference between these conditions is the length of the mood swings. Bipolar mood cycles are persistent and can last for weeks or months, whereas BPD mood swings may last a few hours or days and are generally reactive to interpersonal situations.
- Clinical depression: While bipolar disorders can include symptoms of depression, major depressive disorder is unipolar, meaning there is no mania or “high.” Doctors may initially misdiagnose bipolar disorder as clinical depression because hypomanic or manic episodes have yet to emerge or have gone unnoticed.
- Schizoaffective disorder: Psychotic symptoms can be part of manic and depressive episodes in bipolar disorder. In schizoaffective disorder, psychotic symptoms are also present independent of a clear mood episode.
Being correctly diagnosed is an important step toward getting the right treatment. The most important thing you can do to increase your chances of receiving an accurate diagnosis is to tell a doctor about all the symptoms you’ve been experiencing.
Causes and Risk Factors
The exact causes of different types of bipolar disorders are not entirely understood, but genetic factors are believed to play a significant role. Research suggests that certain risk factors can increase the likelihood that a person will develop bipolar disorder, including:
Treatment for Different Types of Bipolar Disorder
Treatment for any bipolar disorder generally involves medications and some form of psychotherapy. The specific treatment your doctor recommends may vary depending on the type of bipolar disorder you are diagnosed with.
Medications
Medication is the key to stabilizing most bipolar disorders. However, the type of medication a doctor prescribes depends on your symptoms and their severity.
Mood Stabilizers
The main treatment for mood episodes in bipolar disorder is a mood stabilizer. Examples of mood stabilizers include:
Antidepressants
Antidepressants may be prescribed for depressive episodes in bipolar disorder. Common antidepressants include selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline), Prozac (fluoxetine), or Lexapro (escitalopram).
Because antidepressants can trigger manic episodes, they tend to be avoided in bipolar I disorder and are generally prescribed along with a mood stabilizer.
Antipsychotics
If you experience psychotic symptoms during a manic or depressive episode, a doctor will likely prescribe an antipsychotic. Examples of the newer atypical antipsychotics include:
- Vraylar (cariprazine)
- Latuda (lurasidone)
- Zyprexa (olanzapine)
- Seroquel (quetiapine)
Many of the atypical antipsychotics have mood-stabilizing properties. Latuda and Seroquel are the only two antipsychotics that are officially FDA-approved to treat depression in bipolar disorder.
It can take a while to find the right bipolar medication. Most people with bipolar disorder take more than one medication.
Psychotherapy
Depending on your situation, psychotherapy might also be necessary. In fact, research shows that psychotherapy combined with medication can be more beneficial than medication alone.
Psychotherapy can help you better understand and cope with your illness. It can also help you improve your ability to manage relationships with others.
Psychotherapies that are effective for bipolar disorder include:
As with medication, there is no single therapy approach that everyone will find useful.
Takeaways
If you or someone you know is experiencing symptoms of bipolar disorder, it’s important to talk to a physician. A physician may want to rule out any potential physical health issues that may be contributing to your symptoms.
A physician may also refer you to a psychiatrist or other mental health professional for an evaluation. Be sure to speak openly about your behaviors, moods, and anything else you notice. Open, honest communication is essential to receiving a correct diagnosis and treatment plan.
