Understanding the 4 Types of Bipolar Disorder

Understanding the 4 Types of Bipolar Disorder

Bipolar disorder is a lifelong mental health condition that affects almost 3% of Australians over the age of 16. Bipolar disorder is often described as a spectrum, as some people may experience extreme mood changes for long periods of time, whereas others may only experience mild symptoms for shorter periods.

Understanding the 4 types of bipolar disorder will help with diagnosing and treating someone with this condition. Bipolar disorder has been sub-categorised into four categories to help understand an individual’s experience and treat it appropriately: bipolar I, bipolar II, cyclothymic disorder, and unspecified bipolar disorder.

While people experience a broad array of symptoms depending on the severity of their condition, there are some commonalities among the subtypes, but more importantly, there are key differences. Whatever type of bipolar disorder a person lives with, prompt diagnosis and effective treatment are key to managing the illness to achieve the best possible quality of life.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition that affects your mood, emotions, and energy levels. It can cause alternating periods of mania and depression which can swing from one extreme to another in a short period of time. Previously known as manic depression, bipolar disorder is either a chronic or episodic disorder, meaning it can occur occasionally and at irregular intervals without much warning.

Identifying the difference between bipolar disorder and major depressive disorder, or depression, can be difficult. The main factor that defines bipolar disorder is the presence of what are known as mania symptoms which can range from minimal to extreme. These symptoms include increased energy levels, racing thoughts, decreased need for sleep, excessive self-confidence, irritability, or fast speech and can be present for a short time or last for several weeks.

In fact, symptoms of mania are what define bipolar disorder and depressive symptoms need not be present at all, though they frequently are. The level and extent of mania and depression help us define the specific types of the disorder so they can be appropriately managed.

What Are The 4 Types of Bipolar Disorder?

According to the National Alliance on Mental Illness, there are four types of bipolar disorder which include:

Bipolar I

Bipolar I (or bipolar one) is the most common and severe type of bipolar. It involves one or more manic episodes with or without depressive episodes occurring. The mania can last up to a week or longer, and is a period of abnormally elevated or irritable mood and high energy, accompanied by abnormal behaviour and even losing touch with reality which can be dangerous for themselves and people around them.

Often there is a pattern or cycle between mania and depression which is where the term manic depression comes from. To be diagnosed with bipolar I, the mania can be severe enough that hospitalisation is necessary. In between the episodes of mania and depression, someone with bipolar I can live normal lives but may require medical intervention.

Symptoms of bipolar I disorder

Someone who is showing signs of bipolar disorder are likely to experience periods of high energy or irritability often followed by periods of extreme lows known as manic and depressive episodes. Abnormal behaviour during manic episodes may also include:

  • Flipping from one idea to the next suddenly
  • Rapid and loud speech that is likely uninterruptible
  • Hyperactivity and increased energy with need for little sleep
  • Excessive spending
  • Inflated self image
  • Hypersexuality
  • Substance abuse

In severe manic episodes, a person may lose touch of reality, becoming delusional or behaving bizarrely.

Bipolar II

Bipolar II (or bipolar two) disorder is diagnosed when a person shifts between less severe hypomanic episodes and depressive episodes. The up moods don’t reach full blown mania and the less intense high energy moods are called hypomania or hypomanic episodes. During the hypomanic episodes, people may experience the same symptoms as a manic episode, though frequently less severe or for a shorter time frame.

Symptoms of bipolar II disorder

People living with bipolar II are more likely to experience episodes of depression than of hypomania which can last weeks, months, or sometimes even years. Depressive episodes in bipolar II are similar to clinical depression with low energy, loss of pleasure, feelings of guilt and worthlessness, and possibly even thoughts of suicide.

Cyclothymic disorder

Also known as cyclothymia (or sometimes bipolar three), cyclothymic disorder is a relatively less severe but chronic form of bipolar and is characterised by repeated mood shifts between hypomanic and depressive symptoms which usually persists for more than two years. Generally, the periods of low and high energy are not as long as a full blown manic or depressive episode and there may be longer periods of normal moods as well.

People with cyclothymia can alternate between periods of mental illness and normal variations in mood. People with this condition can still live normal lives, although they may struggle with depression and irritability with the occasional hypomanic episode providing increased energy or other manic symptoms.

Symptoms of Cyclothymic disorder

The episodes of those with cyclothymic disorder are not severe enough to be classed in the criteria for manic or depressive episodes, but a person with this condition will notice a clear shift between hypomania and depression from their baseline. In most people, the pattern is irregular and unpredictable, but there can also be specific triggers that cause the episodes to manifest.

Unspecified bipolar disorder

Bipolar disorder not otherwise specified, or more recently called not elsewhere classified, is when the symptoms of bipolar disorder experienced by someone do not meet the clinical characteristics of the other three categories.

Symptoms of unspecified bipolar disorder

People will have symptoms of mania or hypomania that are too few in number or too short in duration compared to those diagnosed under the other bipolar disorder categories.

What is the Cause of Bipolar Disorder?

No one knows exactly what causes bipolar disorder despite ongoing research. We do know there are factors associated with bipolar disorder including physical, mental, and social characteristics which can increase chances of developing the condition. These could include:

  • Family history of the disorder or other mental illnesses, although there is not a specific gene involved, bipolar can be present in family members due to a common genetic makeup, or even common environmental factors.
  • Unique brain structure features may make you more susceptible to developing bipolar disorder.
  • Highly stressful events, you may be able to link the start of symptoms to a highly stressful period in your life.
  • Brain chemistry imbalance, the condition can be treated with psychiatric medications which act on the neurotransmitters (messenger chemicals) in your brain which indicates it is related to their function.
  • History of abuse or trauma, emotional distress can have an impact on your ability to regulate your emotions and mood.

Does a Bipolar Person Know When They are Manic?

A person with bipolar disorder may not be aware when they’re in a manic phase and they may be shocked at their behaviour after the episode subsides. During an episode, they may believe others around them are being negative or unhelpful or even lose touch with reality completely. Each diagnosis of bipolar disorder will vary in intensity and frequency of the episodes, or they may be unpredictable.

Although bipolar disorder is a relatively common mental health illness, it isn’t always diagnosed in a timely manner. Sometimes, it can take up to ten years of symptoms before a diagnosis is made, so a lot of people with this condition may not know they have it and it can be hard to manage without a proper diagnosis and understanding.