If you’re on this page, you may worry that you, or someone you love, has bipolar disorder. That can be scary, as bipolar is a serious mental condition that short-circuits the brain’s ability to think clearly and causes states of extreme ups and extreme downs. Your first line of defense: Understanding the differences between the types of bipolar disorder, which will help you figure out what steps to take next. We’re sure you have a lot of questions…and we’ve got the answers you need.
We went to some of the nation's top bipolar disorder experts to bring you the most scientific and up-to-date information possible.
James W. Murrough, M.D., Ph.D.Director of the Depression and Anxiety Center for Discovery and Treatment and Associate Professor of Psychiatry and Neuroscience
Po Wang, M.D.Psychiatrist and Clinic Chief
Linda Hubbard, L.M.F.T.Therapist
What Does Bipolar Disorder Look Like, Generally?
Mood swings are as human as pooping and social media-ing. But when attitude shifts and irregularities in behavior become regular, intense, and noticeable, they’re no longer typical mood swings—and it's possible you could have bipolar disorder. Depending on the severity of the condition, bipolar can mess with your relationships, your job, and even your day-to-day functioning. That said: Being aware of your situation and taking medication go a long way, and when in treatment, most people with bipolar disorder can have meaningful relationships and a fulfilling life.
More specifics about what makes bipolar, well, bipolar: It involves consummate highs—called mania—and very low lows, or depression. Because depression can factor into other diagnoses, you must have had at least one manic episode to get a diagnosis of bipolar. At that point, your doctor or psychiatrist will ask additional questions to determine which type of bipolar you have.
Though many people, TV shows, and movies talk about “bipolar” as if it’s one thing, there are actually four types of the disorder:
Cyclothymic Disorder (or cyclothymia)
Other Specified and Unspecified Bipolar and Related Disorders
Details on each of those below, but they all share a few basic similarities, including significant changes in mood, activity levels, energy, and thought processes. With all, there’s a toggle between mania and depression. The biggest difference between the bipolar types is the severity of the symptoms. Depending on the type, the mood swings can last days, weeks, or months, or mania and depression can even happen at the same time.
Bipolar I vs Bipolar II: What Are the Differences?
The two most common types are bipolar I and bipolar II. What differentiates them is the intensity of the manic episodes.
The mania for a person with bipolar I is obvious to everyone around them. It’s usually so debilitating that the person is unable to function and may even need to be hospitalized.
Mania for bipolar II, called hypomania, is less severe and sometimes even mild enough that the person experiencing it may still be able to function day to day. Occasionally it can even be so subtle that nobody around them notices that anything is significantly off.
Another difference between bipolar I and II: A person with bipolar I may or may not experience a depressive state; in fact, one episode of mania is all that’s required for a diagnosis of bipolar I. But if the person does have depressive episodes—which most do—they usually last at least two weeks.
For a diagnosis of bipolar II, you must have experienced at least one major depressive episode as well as a manic episode.
What Is Bipolar I?
Bipolar I disorder is the most intense type of bipolar. Manic episodes last at least seven days or are often so severe that the person needs to be hospitalized immediately.
The key to recognizing a bipolar I manic episode: It’s so extreme that it interferes with a person’s day-to-day activities. Despite tremendous efforts, it’s difficult, if not impossible, to divert someone in a manic state into a more rational one.
The manic state of bipolar I includes any or all of the following symptoms:
Feeling high and euphoric. People in a manic state feel extreme joy and verve–far beyond what seems natural for the situation.
Heightened creativity. They begin countless activities, from starting a band to writing a novel. And while their enthusiasm is high, the follow-through is low, and they rarely finish projects.
Exaggerated sense of self-worth. Cue Ethel Merman crooning, “I can do anything better than you can.” They claim they can achieve the impossible and may say they possess supernatural abilities like invisibility or eternal life.
Pressured speech. If you're experiencing mania, you may race through your ideas, speaking hurriedly. Your conversations will sound strange because you’ll talk over other people, won’t pause in proper spots, and don’t respond to what others say.
Sleep problems. Someone in a manic state can go without sleep, or only sleep a few hours a night for days or even weeks on end. And yet, they still have abundant amounts of energy, say they feel great, and never complain of exhaustion.
Poor, impulsive, risky choices. During a manic episode, you may act recklessly without thinking through the ramifications. You might gamble away your life savings, use illicit drugs, or go on extreme shopping sprees. You may also experience excessive sexuality, having unsafe sex with multiple partners.
Irritability. People in a manic state may be fidgety, twitchy, and jittery. They simply cannot sit still.
It’s important to note that if someone is talking nonsense or acting oddly because of alcohol or drugs (or other health issues), it’s not considered a manic state. That said, someone in a manic state is more likely to use drugs and alcohol to excess, thereby worsening their level of functioning. It can be very challenging to determine which factors–the bipolar mania or the substance use–are primarily to blame for the person’s problems..
Those that have a mental illness know that these myths are exactly that: myths. Take a look for yourself.
What Is Bipolar II?
Bipolar II disorder is similar to bipolar I but the symptoms of mania are generally less severe, which is why these episodes are known as hypomanic instead of manic ("hypo" means “less than”) and do not require hospitalization.
In order for an episode to be considered hypomanic, a person needs to experience at least three of the symptoms below, lasting four days, nearly every day, for most of the day:
Decreased need for sleep. This is a hallmark of hypomania. Someone in this state may go days with very little—or even no—sleep but still function.
Good mood. They seem happier than they should be considering their circumstances.
Exaggerated self-confidence. If you’re in a hypomanic state, you’ll feel more self-assured than typical, but you won't be delusional (a.k.a. beliefs that are markedly different from reality).
Increased talkativeness. You’ll chat more and faster than usual, but people can still understand what you’re saying.
Higher activity levels. Those who are hypomanic have gobs of energy and get more done than usual.
Increased irritability. Some people in a hypomanic state seem emotionally touchier and more annoyed than before.
Flight of ideas. The sensation that thoughts are racing. Focus changes from moment to moment. During speech, a play on words may also be seen but associations are usually superficial, for example: “It’s raining. Wet rain, rainbows; bows for ribbons. Do you like red? What time is tea? I have two cats.”
People with bipolar II rarely see a doctor in a hypomanic state, because they often find it enjoyable. When you have this disorder, you typically will seek help when you’re in a depressive state.
What Are the Signs of Depression?
With both bipolar I and bipolar II, the depression is the same. Symptoms may include:
Feeling sad. Often, you don’t want to do anything—including activities you once loved. You can feel hopeless, empty, and unworthy.
Endless exhaustion. People who are depressed feel so lethargic they don’t even get out of bed, even after a full eight hours of shuteye.
Sleep issues. If you're depressed, you may have difficulty falling asleep or may wake up before morning, unable to fall back to sleep. Or you might snooze too much, because a full night’s rest doesn’t feel like enough.
Difficulty concentrating. Simple questions seem too much to think about.
Appetite changes. People in a depressed state can eat either too much or too little.
Suicidal thoughts. The depression can get so bad, people with depression may even contemplate suicide. If this is you, contact a professional immediately, or call the National Suicide Prevention Hotline at 1-800-273-8255.
To read more about the symptoms of depression (which is a separate diagnosis from bipolar disorder), click here.
There are two other types of bipolar disorder, but they are far less common than bipolar I and II.
Cyclothymic Disorder (or cyclothymia) is a milder form of bipolar. Moods fluctuate between short-but-distinct periods of hypomania and low levels of depression. In order for a diagnosis of cyclothymic disorder, symptoms must be evident for at least two years. People with cyclothymic disorder can have stable moods for long periods of time, then experience cyclical mood swings of peaks and dips.
Other Specified and Unspecified Bipolar and Related Disorders has no specific criteria for diagnosis. It’s more of a catch-all phrase of symptoms that are similar to bipolar disorder but do not meet the full criteria. People with this diagnosis experience signs of mania or hypomania and depression but the episodes are too short to be considered bipolar I or II or cyclothymic disorder.
Remember: No matter what type of bipolar you or someone you know has been diagnosed with, there is hope. With the right treatment and lifestyle adjustments, most people with bipolar can be happy and productive.
Frequently Asked QuestionsBipolar Disorder Types
What’s the main difference between bipolar I and II?
The level of intensity during the manic phase differentiates the two most common types of bipolar disorder. During manic episodes in bipolar I, mood and energy levels are so high they cause trouble with work and socializing—and can even lead to psychosis. The manic phase in bipolar II is called hypomania, in which your mood and behavior are elevated above normal but aren't as extreme as a manic period.
Does a person need to have both mania and depression to be diagnosed with bipolar I and II?
For a diagnosis of bipolar I, a person only needs to experience a manic episode, but not depression (that said, the vast majority of people who have manic episodes will also have depressive ones). For a diagnosis of bipolar II, you do need to have had at least one hypomanic episode (at least four days’ long) as well as at least one depressive episode.
Why is bipolar II often misdiagnosed?
Because the symptoms of hypomania are mild and often unrecognized, bipolar II is often misdiagnosed as major depressive disorder.
Can cyclothymic disorder turn into bipolar?
Yes, there is some chance that a person will go on to develop bipolar I or bipolar II disorder. A family history of bipolar is the strongest predictor that cyclothymic disorder will escalate into full-blown bipolar.
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