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Types of Bipolar Disorder: Understanding the Difference

Posted on July 01, 2021
Medically reviewed by
Paul Ballas, D.O.
Article written by
Brooke Dulka, Ph.D.

  • Three types of bipolar disorder are currently recognized: bipolar type 1, bipolar type 2, and cyclothymic disorder.
  • Bipolar disorder types are distinguished by the intensity of manic and depressive episodes.
  • Bipolar disorder can progress over time to a more severe type.

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.

Types of Bipolar Symptoms

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

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

Hypomania is a less severe form of mania. Symptoms of psychosis, such as hallucinations and delusions, are not seen during hypomanic episodes.

Depression

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.

Where Do Bipolar Classifications Come From?

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

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.

Bipolar Disorder Type 2

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

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.

Treating Bipolar Disorders: Does Treatment Differ by Type?

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.

Can You Have More Than One Type of 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:

  • Cyclothymia or BiNOS had progressed to bipolar type 2 in 42 percent of cases.
  • Cyclothymia or BiNOS had progressed to bipolar type 1 in 10.5 percent of cases.

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.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 13,000 members diagnosed with bipolar disorder come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Do you know what type of bipolar disorder you have? Has that diagnosis changed over time? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Bipolar Disorder — The Lancet
  2. The Prevalence and Burden of Bipolar Depression — Journal of Affective Disorders
  3. Bipolar Disorder — National Institute of Mental Health
  4. Bipolar Disorder — Symptoms and Causes — Mayo Clinic
  5. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — American Psychiatric Association
  6. Post by Former NIMH Director Thomas Insel: Transforming Diagnosis — National Institute of Mental Health
  7. Age at Onset Versus Family History and Clinical Outcomes in 1,665 International Bipolar-I Disorder Patients — World Psychiatry
  8. Rapid Cycling in Bipolar Disorder: A Systematic Review — Journal of Clinical Psychiatry
  9. Ultra-Rapid and Ultradian Cycling in Bipolar Affective Illness — The British Journal of Psychiatry
  10. Treatment of Rapid-Cycling Bipolar Disorder — Journal of Clinical Psychiatry
  11. Differential Features Between Bipolar I and Bipolar II Disorder — Comprehensive Psychiatry
  12. Bipolar Disorder Diagnosis: Challenges and Future Directions — The Lancet
  13. Onset-Age of Bipolar Disorders at Six International Sites — Journal of Affective Disorders
  14. Cyclothymia (Cyclothymic Disorder) — Mayo Clinic
  15. Cyclothymic Disorder in Youth: Why Is it Overlooked, What Do We Know and Where Is the Field Headed? — Neuropsychiatry
  16. Staging Bipolar Disorder — Neurotoxicity Research
  17. Parsing Cyclothymic Disorder and Other Specified Bipolar Spectrum Disorders in Youth — Journal of Affective Disorders
  18. Cyclothymic Temperament and Major Depressive Disorder: A Study on Italian Patients — Journal of Affective Disorders
  19. Treatment of Bipolar Disorder — The Lancet
  20. Adjunctive Psychotherapy for Bipolar Disorder: State of the Evidence — The American Journal of Psychiatry
  21. Treatment of Cyclothymic Disorder: Commentary — Psychotherapy and Psychosomatics
  22. Progression Along the Bipolar Spectrum: A Longitudinal Study of Predictors of Conversion from Bipolar Spectrum Conditions to Bipolar I and II Disorders — Journal of Abnormal Psychology
Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance writer at MyHealthTeams. Learn more about her here.

A MyDepressionTeam Member said:

Everything in this article about bipolar 1 was like looking in a mirror...it described to a T

posted about 2 months ago

hug (2)

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