There Are 4 Types of Bipolar Disorder—Here’s What to Know About Each

Bipolar disorder is a complex condition that manifests in varying degrees and affects a person’s mood, energy, and behavior, according to the National Institute of Mental Health (NIMH). It is important to note that bipolar disorder cannot be generalized as a one-size-fits-all condition.

In essence, bipolar disorder is characterized by distinct mood episodes, which include manic, depressive, and hypomanic episodes. These episodes give rise to four different types of bipolar disorder: bipolar 1 disorder, bipolar 2 disorder, cyclothymic disorder, and unspecified bipolar disorder.

While all forms of bipolar disorder involve fluctuations between manic and depressive episodes, the severity and frequency of these mood episodes play a significant role in determining the specific diagnosis.

Psychiatrists can provide valuable insights into the distinctions among these four types of bipolar disorder and the symptoms associated with each mood episode. Gaining a comprehensive understanding of this mental illness is crucial as a first step towards obtaining an accurate diagnosis and devising an appropriate treatment plan in collaboration with healthcare professionals.

What Are Mood Episodes in Bipolar Disorder?

Mood episodes, often referred to as mood “swings” or mood cycling, are a common feature across all forms of bipolar disorder. This term reflects the presence of two distinct poles or periods characterized by low mood and elevated mood, as explained by James Bennett Potash, MD, MPH, a psychiatrist affiliated with The Johns Hopkins University School of Medicine.

Bipolar disorder encompasses three main types of mood episodes: manic episodes, depressive episodes, and hypomanic episodes, which are less severe versions of manic episodes. Notably, manic episodes and depressive episodes manifest in distinct ways, as outlined by the National Institute of Mental Health (NIMH).

Depressive Episodes

During depressive episodes, individuals experience the “low” phase of bipolar disorder. According to the National Alliance on Mental Illness (NAMI), the presence of one or more of the following symptoms on a near-daily basis for a minimum of two weeks is necessary, and these symptoms must significantly impact their daily functioning:

1. Persistent feelings of intense sadness, emptiness, worry, or hopelessness.
2. Restlessness or slowed movement.
3. Sleep disturbances, such as difficulty falling asleep, waking up too early, or sleeping excessively.
4. Changes in appetite or weight, including increased food intake or weight gain.
5. Slowed speech.
6. Forgetfulness or difficulty with memory.
7. Challenges with concentration, decision-making, or completing simple tasks.
8. Loss of interest in previously enjoyed activities.
9. Decreased sexual drive.
10. Inability to experience pleasure (anhedonia).
11. Thoughts of death or suicide.

These symptoms have a significant impact on an individual’s daily life, indicating the presence of a depressive episode in bipolar disorder.

Manic Episodes

What sets bipolar disorder apart from depression are the presence of manic or hypomanic episodes. According to the National Alliance on Mental Illness (NAMI), a diagnosis of bipolar disorder requires experiencing at least one episode of mania or hypomania in addition to depressive episodes. The National Institute of Mental Health (NIMH) outlines the following symptoms associated with mania:

1. Intense feelings of euphoria, extreme happiness, or an elevated mood.
2. Irritability or increased sensitivity.
3. Reduced need for sleep.
4. Loss of appetite.
5. Rapid or pressured speech.
6. Racing thoughts.
7. Engaging in risky behaviors, such as substance abuse, impulsive spending, or engaging in reckless sexual activity.
8. Grandiose or inflated self-perception of one’s abilities or importance.

These symptoms reflect the manic phase of bipolar disorder and help differentiate it from depression.

Hypomania

Hypomania exhibits similar symptoms to mania, but they are less severe and of shorter duration, as explained by Dr. Potash. For instance, an individual experiencing hypomania may have an elevated mood lasting for four days rather than an entire week.

Dr. Potash further explains that, in general, bipolar mood episodes tend to last for months before transitioning. However, some individuals may experience rapid cycling, where they rapidly alternate between high and low moods within days or even hours.

Bipolar Types

The symptoms of bipolar disorder can vary in terms of severity and duration, depending on the specific type of bipolar disorder an individual has. Consequently, the treatment approaches employed may also differ across the various forms of bipolar disorder.

1. Bipolar 1 Disorder

Bipolar 1 disorder, recognized as the most severe form of mental illness, involves distinct diagnostic criteria, according to Ashraf Elmashat, MD, a psychiatrist affiliated with Keck Medicine of USC. The diagnosis requires the presence of a major depressive episode lasting at least two weeks, along with a manic episode lasting for seven days (or fewer if hospitalization is necessary), as stated by the National Alliance on Mental Illness (NAMI).

In addition to experiencing mania, individuals with bipolar 1 disorder may also encounter psychosis, hallucinations, and delusions, as highlighted by Dr. Elmashat. Moreover, individuals with bipolar 1 disorder are more prone to hospitalization due to their symptoms compared to those with other types of bipolar disorder.

The optimal treatment approach for individuals with bipolar disorder, including bipolar 1 disorder, typically involves a combination of psychotherapy and medication, as advised by Dr. Potash. Mood stabilizers, such as lithium, are commonly prescribed to manage bipolar 1 disorder. For individuals with psychosis, an antipsychotic drug may also be recommended by healthcare professionals.

In cases where other treatment methods prove ineffective in addressing severe mood swings, Dr. Elmashat suggests that electroconvulsive therapy (ECT) may be recommended. ECT utilizes electrical stimulation of the brain to alleviate symptoms and improve the individual’s condition.

2. Bipolar 2 Disorder

Similar to bipolar 1 disorder, bipolar 2 disorder (also known as bipolar II disorder) is characterized by episodes of depression. However, instead of full-blown manic episodes, individuals with bipolar 2 experience hypomania, as explained by Dr. Elmashat. Hypomania encompasses the same symptoms as mania, but they are of less severity and duration compared to bipolar 1 disorder. Typically, individuals with bipolar 2 experience milder manic symptoms for a consecutive period of four days, and hospitalization is generally not required.

According to the Cleveland Clinic, while mania presents as an intensely elevated and irritable mood, hypomania can be described as a heightened, energized state. The elevated mood experienced during hypomania is not severe enough to significantly disrupt daily life, unlike a full manic episode that can have a more profound impact on functioning.

Dr. Potash emphasizes that individuals with bipolar 2 commonly use mood stabilizers to alleviate their symptoms. Although hypomania does not involve psychosis, some individuals with bipolar 2 may be prescribed antipsychotic drugs if their depression is accompanied by hallucinations or delusions.

3. Cyclothymic Disorder

Cyclothymic disorder, also known as cyclothymia, is characterized by the presence of hypomania and depression. However, the hypomanic episodes in cyclothymic disorder are not severe enough to meet the criteria for mania, and the depressive symptoms are not severe enough to be classified as major depression, as explained by Dr. Elmashat. If the symptoms were more severe, an individual would typically be diagnosed with bipolar 2 disorder.

In the case of cyclothymic disorder, individuals generally experience milder symptoms for an extended period. For example, they may have intermittent depression symptoms and occasional hypomanic episodes lasting for at least two full years.

Treatment for cyclothymic disorder, similar to other forms of bipolar disorder, usually involves the use of mood stabilizers, as recommended by Dr. Elmashat. These medications are commonly prescribed to help manage the mood fluctuations associated with cyclothymia.

4. Unspecified Bipolar Disorder

Unspecified bipolar disorder encompasses symptoms of both depression and mania that do not meet the specific criteria for a clinical diagnosis of any of the recognized types of bipolar disorder. According to Dr. Potash, this means that individuals may exhibit some symptoms of depression and mania, but not enough to fulfill the complete diagnostic criteria in terms of symptom duration and intensity.

For instance, in the case of unspecified bipolar disorder, hypomanic symptoms may persist for a shorter duration, such as a few days, rather than the required minimum of four days for diagnosis. People with unspecified bipolar disorder may also experience mixed episodes, which involve experiencing both the highs of mania and the lows of depression simultaneously.

Dr. Potash highlights the potentially dangerous nature of mixed episodes, as individuals may feel a combination of negativity and low mood while also having heightened energy levels. This combination can increase the risk of self-harm or other harmful behaviors.

To mitigate these risks, healthcare providers commonly prescribe mood stabilizers for individuals with unspecified bipolar disorder, aiming to stabilize their mood fluctuations and promote overall well-being.

While it is normal to experience occasional mood fluctuations, if these thoughts and feelings begin to significantly impact various aspects of life and functioning, Dr. Potash advises seeking professional help.

If you suspect you may be experiencing symptoms of bipolar disorder, it is important to reach out to a healthcare professional for diagnosis and appropriate treatment. This can involve consulting a psychologist, primary care provider, or a psychiatrist specializing in mental health conditions.