How Do I Know What Kind of Bipolar I Have?

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There are multiple types of bipolar disorder — a disorder known as an affective or mood disorder. The three main types are: bipolar disorder type I, bipolar disorder type II and cyclothymia. Also, there are certain additional “specifiers” that denote particular types of symptoms seen in each bipolar mood.

Bipolar disorder appears evenly in men and women. Women, however, are more likely to be diagnosed with bipolar disorder type II. Women are also more likely to experience mixed episodes (see below) and a “rapid cycling” version of the illness where the person experiences more than four mood episodes per year.

Bipolar Disorder Type I

Bipolar disorder type I is what people tend to think of when they imagine bipolar disorder (previously known as manic depression). It is made of up a very elevated mood known as “mania” and a very low mood called “depression.”

A person with bipolar disorder type I experiences these moods episodically. He or she may experience a manic episode for two months followed by a three-month depression followed by a symptom-free period (known as euthymia).

Bipolar Mania

Manic episodes feature at least one week of profound mood disturbance characterized by elation, irritability, or expansiveness (euphoria with delusions of grandeur). At least three of the following symptoms must also be present:

  • Grandiosity
  • Diminished need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work or sexually
  • Excessive pleasurable activities, often with painful consequences

The mood disturbance is sufficient to cause impairment at work or endanger the person or others. The mood is not the result of substance abuse or a medical condition.

Bipolar Depression

Bipolar depression has the same criteria as major depressive disorder. Major depressive episodes are characterized as: for the same two weeks, the person experiences five or more of the following symptoms, with at least one of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia
  • Psychomotor retardation or agitation
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; the person has a plan or has attempted suicide

These symptoms cause significant impairment and distress and are not the result of substance abuse or a medical condition.

Bipolar Disorder and Psychosis

People with bipolar disorder type I also commonly experience psychosis. Psychosis is a “break with reality.” It is typically the presence of delusions and/or hallucinations. Delusions are false beliefs (such as the belief you are being followed by the police everywhere you go), and hallucinations are experiences that have not happened.

Hallucinations can happen with any sense. For example, you may see something that doesn’t exist or feel a tactile sensation for no reason. People can experience psychosis while in a mania or major depression.

Note: Experiencing psychosis has nothing to do with being a psychopath.

Bipolar Disorder Type II

Bipolar disorder type II is made up of two kinds of moods: major depression and hypomania. The criteria for the major depressive mood is identical to what it is in bipolar disorder type I. Hypomania actually has the same basic criteria as bipolar mania but it is less severe. Just like with bipolar disorder type I, this disorder is episodic.

While some characterize bipolar type II as “less severe.” this isn’t true. Bipolar type II does contain a less severe version of mania known as hypomania, but the illness itself is not less severe or impairing. This is mostly because people with bipolar type II spend significantly more time in a major depressive state than do people with bipolar disorder type I.

Bipolar Hypomania

Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least four consecutive days duration. At least three of the following symptoms are also present:

  • Grandiosity or inflated self-esteem
  • Diminished need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Engaging in activities with a high potential for painful consequences

The mood disturbance is observable to others. The mood is not the result of substance abuse or a medical condition. The episode is not severe enough to cause social or occupational impairment.

People with bipolar disorder type I can also experience hypomania, often as a precursor to full-blown mania.

Note that people with bipolar disorder type II do not experience psychosis.

Bipolar Mixed Episodes

A mixed mood is the occurrence of some of the elevated and low symptoms of bipolar disorder at the same time. Some symptoms of mania occur with symptoms of depression, or some symptoms of hypomania occur with symptoms of depression.

In the latest version of the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,” “mixed features” is now a specifier that can be applied to any mood. Any type of bipolar disorder can experience it. Mixed moods are particularly dangerous in bipolar disorder because they carry a high risk of suicide.

Cyclothymia

Cyclothymia is a diagnosis given to those who experience symptoms of both hypomania and depression episodically but do not meet the full criteria for mania, hypomania, or major depression. It is sort of like bipolar “light” but can still be debilitating depending on how a person experiences it.

Other Specifiers in Bipolar Disorder

In addition to the mixed features specifier, a mood in any type of bipolar disorder can also be specified to contain:

  • Anxious distress
  • Rapid cycling
  • Mood-congruent psychotic features
  • Catatonia (typically muscle rigidity and mental stupor)
  • Peripartum onset (occurring during the last month of pregnancy or the first few months after delivery)
  • Seasonal pattern (often known as seasonal affective disorder [SAD])

How Do You Know What Type of Bipolar You Have?

The best way to know which type of bipolar disorder you have is, of course, to get a formal diagnosis from a psychotherapist or psychiatrist. But if you’re looking at the issue on your own, keep in mind that one of the main differences is psychosis. If you experience psychosis, then you’d likely be diagnosed with bipolar disorder type I. If your elevated moods are less than a week, then you likely would be diagnosed with bipolar disorder type II. If you don’t quite fit the diagnostic criteria for major depression or hypomania/mania, then you would likely be diagnosed with cyclothymia.

No matter what version of bipolar disorder you have, it’s important to take it seriously and get treatment. The most effective way of treating bipolar disorder is with both therapy and medication combined.

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Published by

Natasha Tracy

Contributor