Bipolar disorder is a psychiatric illness that is characterized by major shifts in mood between the two extremes of depression and mania. The disorder was once referred to as manic depression. For diagnostic purposes the DSM IV (1994) delineates four types of bipolar disorder. They are distinguished from each other by the severity of depression or mania experienced and the length of time spent in a mood state or interval between moods. The four diagnosis are Bipolar I, Bipolar II, Cyclothymia and Bipolar Disorder Not Otherwise Specified.
Bipolar I Disorder
Bipolar I disorder is distinguished from the other types of bipolar disorders by the presence of true mania. Mania is characterized by an elevated mood which may consist of feelings of euphoria, intense irritability leading to possible aggressive behaviors inflicted toward others or towards self, grandiosity or an inflated sense of self, hallucinations, insomnia, intense restlessness and racing thoughts which results in pressured or rapid speech, difficulty concentrating, and extreme impulsivity.
Someone who is manic may make rash decisions such as cashing out their whole life savings and going on a spending spree or gambling, inexplicably quitting a job or school, and impulsively getting married or divorced. Other examples of types of behaviors that may be seen during a manic episode include dressing and behaving differently such as “partying” to the wee hours when previously the person was more of a “homebody” or dressing provocatively, and behaving in a sexually aggressive manner including having multiple partners or committing infidelity. In order to be diagnosed with Bipolar I disorder, the person will also have experienced at least one major depressive episode.
There are two qualifiers under bipolar I that are important to consider. Someone may experience a mixed episode which involves feeling both manic and depressed simultaneously. Also, they may experience rapid cycling between mood extremes. A person may have mood changes from mania to depression as frequently as several times in one day. This would be considered rapid cycling.
Bipolar II Disorder
The distinguishing characteristic of Bipolar II disorder from the other types of bipolar disorder is that extreme mania is not experienced. Instead, the person experiences hypomania. Hypomania can include most of the above mentioned symptoms excluding psychosis such as delusions and hallucinations and does not result in hospitalization. The impairment in the person’s life is not as severe and may even result in increased productivity and creativity. For example, instead of infidelity, a person with Bipolar II may simply be more sexual with their spouse, and instead of blowing all their savings they may spend more than they would otherwise be comfortable spending. Furthermore, these behaviors are seen as atypical in that person. Bipolar II disorder also involve periods of major depression.
Cyclothymia involves mood swings as well but instead of mania a person experiences hypomania as described above and depression instead of major depression. However, someone who has cyclothymia may develop mania later in life or major depression. At that point, they will receive a second diagnosis of either Bipolar I or Bipolar II disorder respectively.
Bipolar Disorder Not Otherwise Specified
A person may experience bipolar like symptoms but not experience them for the length of time required for a diagnosis of the previously defined conditions or types of bipolar disorder. Another possibility is they may intermittently experience hypomania without experiencing depression which would preclude a diagnosis of bipolar II or Cyclothymia.
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (1994)
National Institute of Mental Health, https://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml
This post is part of the series: Bipolar Disorder
- Defining Bipolar Disorder
- Spotlight on the Types of Bipolar Disorder
- The Facts about Bipolar Mania
- The Facts about Dysphoric Mania