Bipolar disorder is a complex mental health condition characterized by fluctuations in mood and energy. It can be a debilitating, even disabling, disease for many. There are three currently recognized types of bipolar disorder: bipolar type 1, bipolar type 2, and cyclothymic disorder (cyclothymia).
Understanding the difference between these types of bipolar disorder is an important step toward understanding your diagnosis.
Bipolar disorder is characterized by alternating periods of manic highs and depressive lows. The types of bipolar disorder are defined by the intensity of the symptoms they present during these manic or depressive episodes.
There are three broad categories of symptoms of bipolar disorder: mania, hypomania, and depression. Each category has different symptoms.
Mania (or manic episodes) refers to the highs of bipolar disorder. The symptoms of mania can include increased energy, decreased need for sleep, feeling jumpy or wired, racing thought patterns, risky behavior, delusions, and hallucinations.
Hypomania is a less severe form of mania. Symptoms of psychosis, such as hallucinations and delusions, are not seen during hypomanic episodes.
Depression refers to the lows of bipolar disorder. Depression seen in bipolar disorder is very similar to the depression observed in major depressive disorder (or clinical depression). Symptoms include decreased energy, feeling lethargic, having little interest in activities that were once pleasurable, feeling hopeless, and thinking about or planning suicide.
The National Institute of Mental Health (NIMH) currently describes three types of bipolar disorder: bipolar I disorder (bipolar type 1), bipolar II disorder (bipolar type 2), and cyclothymic disorder. The most recent (released in 2013) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association describes two additional types: substance/medication-induced bipolar disorder and bipolar disorder due to another medical condition. Some examples of these last two types would be bipolar disorder due to amphetamine use or bipolar disorder due to hyperthyroidism.
This discrepancy between the NIMH and DSM-5 categories may be due, at least in part, to new NIMH frameworks for thinking about mental health in a way that does not rely solely on the symptom-based classifications of the DSM. In other words, NIMH no longer uses the DSM-5 as the “gold standard” for guiding diagnostics. While the DSM-5 is still a useful tool for practicing physicians, this article will concentrate on the categories defined by the NIMH.
Bipolar disorder type 1 is an extreme form of bipolar disorder characterized by the presence of at least one episode of manic symptoms. According to the NIMH, a manic episode must either last at least seven days or include symptoms of mania so severe that the person requires hospitalization. Depressive symptoms are also present as a person’s mood swings from one extreme to the other. It is also possible for depression and mania symptoms to be present at the same time in what is called a mixed state.
The peak age of onset of bipolar disorder type 1 is usually between ages 15 and 25, although it can begin earlier or even later in adulthood.
The frequency at which a person’s mood swings from mania to depression varies from person to person. Some people experience rapid cycles between mania and depression. Rapid cyclers experience four or more episodes of mania or depression in one year. But people can cycle even faster than that in what has been termed ultrarapid cycling (mood swings over the course of weeks to several days) and ultradian rapid cycling (mood swings with a period of 24 hours). Rapid cycling is associated with poorer responses to medications, and antidepressants may even worsen symptoms.
Unlike type 1, bipolar disorder type 2 does not feature manic episodes. Instead, moods swing back and forth between depressive symptoms and hypomanic symptoms. Although mania-related symptoms are more intense in bipolar disorder type 1, research suggests that bipolar disorder type 2 is more severe in terms of episode frequency. However, bipolar type 2 can also be more difficult to diagnose than bipolar type 1 because it can look so similar to unipolar depression. People can also rapid cycle if they have bipolar disorder type 2. The difference is that people with bipolar type 2 cycle (rapidly) between hypomanic states to depressed ones.
The age of onset of bipolar disorder type 2 tends to be a little older than bipolar disorder type 1. One study found that the age of onset of individuals with bipolar type 2 (about 30 years) was 5.8 years older than those with bipolar type 1 (about 24 years).
Cyclothymic disorder (cyclothymia) is a type of bipolar disorder where the individual experiences hypomanic highs, but their depressive lows are not severe enough to reach diagnostic criteria for a true episode of depression for bipolar type 2.
Some researchers believe that the field of pediatric psychiatry has largely ignored cyclothymia in youth, which has led to an underdiagnosis of what could be the most common form of bipolar disorder. Some experts theorize that cyclothymia is a risk factor for other types of bipolar disorder, while other researchers disagree.
The age of onset in cyclothymia tends to be in early adulthood.
Bipolar disorders type 1 and type 2 are usually treated with a combination of medications, including mood stabilizers, antidepressants, or antipsychotics. Treatment can differ by type, but it also varies greatly from person to person. In other words, what works best for one person may not work for another, even if they have the same type of bipolar disorder. Psychotherapy is also recommended in cases of bipolar disorder. Additionally, cyclothymic individuals can benefit from a treatment plan that includes medications and psychotherapy.
Read more about treatments for bipolar disorder.
A person can only have one bipolar diagnosis at a time. However, some people are diagnosed with one type of bipolar disorder and later progress to a more severe type.
One long-term study of people with either cyclothymia or bipolar disorder not otherwise specified (BiNOS) found that, after 4.5 years:
In the same study, 17 percent of participants who began with diagnoses of bipolar type 2 progressed to bipolar type 1.
Read more about prevalence, risk factors, and diagnosis for bipolar disorder.
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