Bipolar disorder is a complex mental health condition that causes shifts in mood and energy levels. For many people, it can be a debilitating, even disabling, disease. There are three main types of bipolar disorder: bipolar 1 disorder, bipolar 2 disorder, and cyclothymic disorder (also called cyclothymia). However, a healthcare professional may also diagnose you with one of four other types of bipolar disorder.

Learning the difference between the types of bipolar disorder can help you or your loved one better understand and manage the condition.

Types of Bipolar Symptoms

Bipolar disorder includes cycles of manic “highs” and depressive “lows.” The intensity of symptoms present during these manic or depressive episodes helps doctors determine the type of bipolar disorder a person has.

There are three broad categories of symptoms of bipolar disorder: mania, hypomania, and depression. Each category has its own set of symptoms.

Mania

Mania (or manic episodes) refers to the “highs” of bipolar disorder. During these episodes, a person may feel abnormally and overly happy, upbeat, or irritable, and have increased energy levels. Symptoms of mania can include:

• Needing less sleep
• Feeling overly confident
• Getting distracted easily
• Talking more or faster than usual
• Having racing thoughts
• Being extra focused on goal-driven activities
• Taking more risks than normal
• Having delusions or hallucinations (seeing or hearing things that aren’t there)

Hypomania

Hypomania is a milder form of mania. Hypomanic episodes are less intense, don’t last as long, and usually don’t cause major problems in daily life. People with hypomania don’t experience symptoms of psychosis such as hallucinations or need hospitalization.

Depression

Depression is the “low” part of bipolar disorder. Depression seen in bipolar disorder is very similar to major depressive disorder (or clinical depression). Symptoms may include:

• Feelings of sadness, hopelessness, or emptiness
• Tiredness or decreased energy
• Loss of interest in activities that you used to enjoy
• Feeling restless
• Having trouble thinking or focusing
• Feelings of worthlessness or guilt
• Losing or gaining weight (not related to eating habits)
• Thoughts or plans of suicide

Where Do Bipolar Types Come From?

The National Institute of Mental Health (NIMH) currently describes three main types of bipolar disorder:

• Bipolar 1 disorder (bipolar 1)
• Bipolar 2 disorder (bipolar 2)
• Cyclothymic disorder (cyclothymia)

Meanwhile, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association, the DSM-5-TR (fifth edition, text revision) lists four additional types. The additional types of bipolar disorder listed in the DSM-5-TR include:

• Substance- or medication-induced bipolar disorder (for example, from amphetamine use)
• Bipolar disorder due to another medical condition (like hyperthyroidism)
• Other specified bipolar disorder
• Unspecified bipolar disorder

A person may be diagnosed with “other specified bipolar disorder” or “unspecified bipolar disorder” if they have symptoms of bipolar disorder but don’t meet all the requirements for a specific type. The difference between the two is this:

• Other specified bipolar disorder means the healthcare provider explains why the symptoms don’t fit a full diagnosis.
• Unspecified bipolar disorder means the doctor does not give a reason, often because there isn’t enough information. For example, a doctor might use the term unspecified bipolar disorder if they don’t know your full medical history, like during a visit to the emergency room.

The reason the NIMH lists different types of bipolar disorder than the DSM-5-TR may be partly because NIMH uses newer ways of thinking about mental health. NIMH researchers focus on how mental health science is changing and how future diagnosis tools — like the DSM — might improve. While the DSM-5-TR is still a useful tool for providers, this article will focus on the categories used by the NIMH.

Bipolar 1 Disorder

Bipolar 1 disorder, or bipolar 1, is an extreme form of bipolar disorder. It involves at least one episode of manic symptoms. According to the NIMH, a manic episode must either:

• Last seven days or longer, with symptoms present most of the day
• Be so severe that the person requires hospitalization

Most people with bipolar 1 also have depressive episodes.

Sometimes, symptoms of mania and depression can happen at the same time. This is called a mixed episode.

When Does It Start?

Most people with bipolar 1 disorder begin showing symptoms between ages 15 and 25. But symptoms can start earlier or even later in life.

How Often Do Mood Changes Happen?

The frequency with which a person’s mood changes from mania to depression depends on the person. Some people go through rapid cycles. This means they have four or more episodes of mania or depression in one year.

Some people may cycle even faster. Ultrarapid cycling means mood changes happen over days or weeks. In contrast, ultradian rapid cycling means mood changes happen more than once a day. People with rapid cycling tend to have a poorer response to medication and may have more severe disease symptoms.

Bipolar 2 Disorder

Bipolar 2 disorder is different from bipolar 1 because it does not include manic episodes. Instead, people with bipolar 2 have moods that change between depressive episodes and hypomanic episodes.

Even though the symptoms of mania present in bipolar 1 disorder are more severe, research suggests that bipolar 2 disorder episodes may happen more often.

Bipolar 2 can also be hard to diagnose because its symptoms can look a lot like major depression (also called unipolar depression).

Like people with bipolar 1, people with bipolar disorder 2 can also rapid cycle. The difference is that people with bipolar 2 cycle between hypomania and depression.

When Does It Start?

Bipolar 2 usually starts a little later than bipolar 1. One study found that bipolar 2 symptoms first appear around age 30, while bipolar 1 symptoms usually start around age 24.

Cyclothymic Disorder

Cyclothymic disorder (cyclothymia) is a type of bipolar disorder marked by hypomanic and depressive symptoms. However, the symptoms are not strong or long-lasting enough to meet the criteria for a hypomanic or depressive episode.

Some researchers believe that cyclothymia often goes undiagnosed in children and teens. This is because it’s not always recognized in the field of pediatric psychiatry. Some scientists think cyclothymia might be a risk factor for other types of bipolar disorder, but others disagree.

When Does It Start?

Symptoms of cyclothymia usually begin in the teenage years or early adulthood.

Treating Different Types of Bipolar Disorder

Treatment options for bipolar disorder can vary depending on the type of bipolar disorder and on the person. Even two people with the same type of bipolar disorder may need different treatments.

Bipolar 1 and 2 are usually treated with a combination of medications. Treatment may include mood stabilizers, antidepressants, or antipsychotics. Psychotherapy (talk therapy) may also help treat bipolar disorder. One study found that people with cyclothymia may benefit from a treatment plan that includes both medications and psychotherapy.

Can You Have More than One Type of Bipolar Disorder?

You can only be diagnosed with one type of bipolar disorder at a time. However, some people are first diagnosed with one type of bipolar disorder and later develop a more severe form.

For example, one study followed people with cyclothymia or a condition called bipolar disorder not otherwise specified (BiNOS) for 4.5 years. It found that:

• 42 percent of people with cyclothymia or BiNOS later developed bipolar 2.
• 10.5 percent of people with cyclothymia or BiNOS developed bipolar 1.

The same study also showed that 17 percent of people who were first diagnosed with bipolar 2 later developed bipolar 1.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression, other mental health conditions, and their loved ones. On MyDepressionTeam, members 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.