Different Types of Bipolar Disorder

In my work with people with bipolar disorder, I have found it quite common that they know very little about their illness. Often this is because receiving such a diagnosis can be overwhelming, and people frequently don’t know what questions to ask to best help themselves. Have you tried to educate yourself about bipolar disorder? Are you someone who is still questioning whether or not you have been given the correct diagnosis? Having such an illness can be a very difficult thing to accept. Maybe, because symptoms can vary so much from the traditional conceptualization of the illness as consisting only of manic and depressive episodes, you can’t relate to the diagnosis because you haven’t had full-blown mania or depression. As I mentioned earlier, it is becoming more evident to professionals that bipolar disorder often consists of more than just the extreme highs and extreme lows in mood—that, in fact, there are many symptoms outside of these variations in mood that characterize different types of the illness. Some researchers have proposed that the diagnosis of bipolar disorder should be changed to “bipolar spectrum disorder” to fully capture the wide range of symptoms that can be experienced by different people with the illness (Ghaemi, Ko, and Goodwin
2002).

On the other hand, perhaps you are a person who accepts the diagnosis, but you don’t have an accurate understanding of what it means. You might be unsure about what bipolar symptoms are, what might be symptoms of a separate, co-occurring disorder such as anxiety, and what is “normal” and completely unrelated to any disorder. This knowledge is extremely important in order for you to learn what you need to do to prevent relapses (the recurrence of symptoms) and to cope with manic, hypomanic, and depressive episodes. To help you understand what form of the illness you have, I have outlined the current categories of the illness below, as defined by the DSM.

Bipolar I

Bipolar I is the traditional, most widely recognized form of bipolar disorder, usually involving recurrent episodes of mania and depression, although about 10 percent of people with this diagnosis never suffer major depression (Frank and Thase 1999). In order to receive a diagnosis of bipolar I, you must have experienced one or more full-blown manic episodes that cannot be attributed to the use of alcohol or drugs (including antidepressants, which can sometimes cause someone to flip into a manic state), or to other general medical conditions. It is not uncommon for people with this form of bipolar to experience psychotic symptoms, as described above.

Bipolar II

Bipolar II involves periods of major depression and at least one period of hypomania. If you have had these severe changes in mood but have never experienced symptoms of a full-blown manic episode, you generally receive a diagnosis of bipolar II. People with this form of bipolar do not experience psychotic symptoms and do not require hospitalization for their symptoms when hypomanic. Over time, a small number of people with bipolar II shift to bipolar I due to the onset of mania.

Cyclothymia

According to the DSM, cyclothymia is when a person experiences long-term problems with fluctuating moods involving numerous periods of hypomania and periods of depressive symptoms.
When they manifest, however, these symptoms are not severe enough to be diagnosed as a manic or major depressive episode. Cyclothymia can therefore be seen as a milder form of bipolar disorder, involving upswings that are similar to hypomania and downswings in mood that are fairly mild forms of depression. These episodes alternate throughout a person’s life; but because a small number of such people develop full-blown bipolar disorder (either type I or II), this diagnosis is only given when a person experiences at least two years of these symptoms without the emergence of a manic or major depressive episode.

These are the current classifications of bipolar disorder. Because of the wide spectrum of symptoms that occur, the illness in its milder forms can be quite difficult to diagnose. In fact, more than two-thirds of the membership of a depression and bipolar support group in the United States reported that they had initially been misdiagnosed and treated for mental illnesses other than bipolar disorder, with the average time between the initial onset of symptoms and receiving a correct diagnosis of bipolar being approximately nine years (Thase 2006). In part, this can be attributed to the fact that the symptoms vary so widely from one person to the next, meaning that there really is no longer a standard presentation of bipolar disorder. Now let’s look at how bipolar disorder develops.

Excerpt from Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life by Sheri Van Dijk, MSW.