4 Main Types of Bipolar Disorder, Symptoms, Causes, Diagnosis & Mental Health Treatment

4 Types of Bipolar Disorder

Bipolar disorder is a mood disorder that can cause intense mood swings:

• Sometimes you may feel extremely “up,” elated, irritable, or energized. This is called a manic episode.
• Other times you may feel “down,” sad, indifferent, or hopeless. This is called a depressive episode.
• You may have both manic and depressive symptoms together. This is called a mixed episode. [1]

Bipolar Disorder I

• Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.

Bipolar Disorder II

• Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.

Cyclothymic Disorder

• Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.

Other Specified

• Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.

Symptoms that Lead to Different Types of Bipolar Disorder Diagnosis

The exact cause of bipolar disorder is unknown. Several factors likely play a role in the disorder. They include genetics, brain structure and function, and your environment.

Scientists have not yet discovered a single cause of bipolar disorder. Currently, they believe several factors may contribute, including:

• Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute: A child from a family with a history of bipolar disorder may never develop the disorder. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.
• Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.
• Brain structure and function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. [2]

You are at higher risk for bipolar disorder if you have a close relative who has it. Going through trauma or stressful life events may raise this risk even more.

The symptoms of different types of bipolar disorder vary. But they involve mood swings known as mood episodes:

• The symptoms of a depressive episode can include:
  • Feeling very sad, hopeless, or worthless
  • Feeling lonely or isolating yourself from others
  • Talking very slowly, feeling like you have nothing to say, or forgetting a lot
  • Having little energy
  • Sleeping too much
  • Eating too much or too little
  • Lack of interest in your usual activities and being unable to do even simple things
  • Thinking about death or suicide
• The symptoms of a mixed episode include both manic and depressive symptoms together. For example, you may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Some people with bipolar disorder may have milder symptoms. For example, you may have hypomania instead of mania. With hypomania, you may feel very good and find that you can get a lot done. You may not feel like anything is wrong. But your family and friends may notice your mood swings and changes in activity levels. They may realize that your behavior is unusual for you. After the hypomania, you might have severe depression.

Your mood episodes may last a week or two or sometimes longer. During an episode, symptoms usually occur every day for most of the day.

To diagnose bipolar disorder, your health care provider may use many tools:

• A physical exam
• A medical history, which will include asking about your symptoms, lifetime history, experiences, and family history
• Medical tests to rule out other conditions
• A mental health evaluation. Your provider may do the evaluation or may refer you to a mental health specialist to get one.

Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia.

Mania. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.

Although someone with bipolar may find an elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.

Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.

What are Your Treatment Options?

Treatment can help many people, including those with the most severe forms of bipolar disorder. The main treatments for bipolar disorder include medications, psychotherapy, or both:

• Medications can help control the symptoms of bipolar disorder. You may need to try several different medicines to find which one works best for you. Some people need to take more than one medicine. It’s important to take your medicine consistently. Don’t stop taking it without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicines.
• Psychotherapy (talk therapy) can help you recognize and change troubling emotions, thoughts, and behaviors. It can give you and your family support, education, skills, and coping strategies. There are several different types of psychotherapy that may help with bipolar disorder.
• Other treatment options [3] include:
  • Electroconvulsive therapy (ECT), a brain stimulation procedure that can help relieve symptoms. ECT is most often used for severe bipolar disorder that is not getting better with other treatments. It may also be used when someone needs a treatment that will work more quickly than medicines. This might be when a person has a high risk of suicide or is catatonic (unresponsive).
  • Getting regular aerobic exercise may help with depression, anxiety, and trouble sleeping
  • Keeping a life chart can help you and your provider track and treat your bipolar disorder. A life chart is a record of your daily mood symptoms, treatments, sleep patterns, and life events.

Related Conditions

People with bipolar disorder can also experience:

• Anxiety
• Attention-deficit hyperactivity disorder (ADHD)
• Posttraumatic stress disorder (PTSD)
• Substance use disorders/dual diagnosis

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