Types of Bipolar Disorder: Symptoms and Treatment

The term “bipolar” is sometimes used colloquially to describe shifting or volatile emotions. It is fairly common for someone to say, “You’re being so bipolar right now,” or “I’ve been feeling bipolar lately” as they allude to the typical ups and downs of the human emotional experience.

However, this informal use of “bipolar” is problematic for a number of reasons. One reason is because using the term incorrectly perpetuates an incomplete and inaccurate understanding and undermines the very real and distressing experiences of people with bipolar disorder.

Types of Bipolar Disorder

Rather than an adjective used to casually describe emotions, bipolar disorder is a mental health condition that encompasses a number of specific diagnoses outlined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5).

Types of Bipolar Disorder can include: Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and several disorders that describe symptoms that do not meet criteria for the disorders above (these include Substance/Medication-Induced Bipolar And Related Disorder, Bipolar And Related Disorder Due To Another Medical Condition, Other Specified Bipolar And Related Disorder, and Unspecified Bipolar And Related Disorder).

Terms Associated with Different Types of Bipolar Disorder

Before elaborating on the differentiations between these diagnoses, it is helpful to understand terms associated with the symptoms and types of bipolar disorder.

Mood Episodes

Mood episodes are distinct periods of time where an individual exhibits specific moods and behaviors that are noticeably different from their typical moods and behaviors (www.nimh.nih.gov). These mood episodes can be identified as manic, hypomanic, or depressive.

It’s helpful to understand the criteria for each of these episodes because determining whether an individual has experienced a mood episode (or multiple mood episodes) and identifying which type (or types) of mood episode they experienced is a key component to accurately diagnosing different types of bipolar disorder.

Manic and Hypomanic Episodes

When looking at criteria for Bipolar Disorders, mania and hypomania are considered two different types of mood episodes. They have the same symptoms, but they are differentiated by their severity and length.

In order to be identified as mania, the diagnostic symptoms must be present for at least one week for most of the day nearly every day. Mania is more severe and results in significant impairments in various aspects of life, such as work, school, or social interactions.

Mania may lead to psychosis or hospitalization, and if symptoms lead to hospitalization, it is considered a manic episode regardless of duration (www.mayoclinic.org). In order to be labeled as hypomania, diagnostic symptoms must last for at least four days, for most of the day nearly every day.

Hypomania is less severe and does not cause marked impairment. There is a noticeable change in functioning, but individuals experiencing hypomania may report feeling good and functioning well. However, hypomania symptoms are important to be mindful of in order to provide an accurate diagnosis and because hypomania can lead to mania or depression (www.nimh.nih.gov).

According to the DSM-5, in order to be diagnosed with a manic or hypomanic episode, an individual must exhibit an uncharacteristically elevated or irritable mood and increased activity and energy.

Additionally, three or more of the following symptoms must be present:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Increased talkativeness
• Flight of ideas or racing thoughts
• Distractibility
• Increase in goal-directed activity or psychomotor agitation
• Excessive involvement in activities with high potential for painful consequences (for example: risky sexual activities, spending sprees, etc.)

Major Depressive Episode

Another type of mood episode is called a major depressive episode. According to the DSM-5, in order to qualify as a major depressive episode, an individual must experience significant distress or impairment.

Additionally, they must exhibit at least five of the following symptoms over a two-week period, and at least one of the symptoms must be a depressed mood or loss of interest or pleasure in activities:

• Depressed mood
• Loss of interest or pleasure in most or all of activities
• Significant weight loss or weight gain, or change in appetite
• Insomnia or hypersomnia (excessive sleeping)
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished concentration or indecisiveness
• Recurrent thoughts of death or suicidal ideation

Other Features and Diagnostic Labels

Sometimes, an individual may present a mood episode with symptoms of both manic and depressive episodes, which is referred to as an episode with mixed features. There are a number of other terms associated with a bipolar disorder diagnosis to help provide additional information about how the symptoms present specifically and uniquely in each individual.

For example, it might be noted that an individual exhibits signs of anxious distress or psychosis. Additionally, there are terms to describe when bipolar symptoms occur, such as during pregnancy or with a seasonal pattern. Other terms are used to describe the timing of symptoms, such as rapid cycling. Rapid cycling is used when an individual experiences four or more episodes of mania or depression in one year (www.mayoclinic.org).

Diagnosis Criteria

Below are a number of diagnoses from the DSM-5 and a brief explanation of the diagnostic criteria. It is important to note that this article is not intended for diagnostic purposes. It is simply meant to provide education and to promote a greater understanding of the various types of bipolar disorder.

If you feel you may meet criteria for any of the diagnoses below, I encourage you to reach out to a doctor or mental health professional. It is crucial to meet with a professional because there are several other factors to keep in mind, such as criteria differences between adults and adolescents, cultural differences in the way symptoms may present or be described, physical health conditions that may exacerbate symptoms, and differential diagnoses.

Other mental health diagnoses present overlapping or similar symptoms to bipolar disorder. A professional can help rule out other potential diagnoses or identify co-occurring diagnoses. This is helpful in order to receive the most effective treatment, in regards to both therapy and medication.

Bipolar I Disorder

In order to be diagnosed with Bipolar I Disorder, an individual must have experienced at least one manic episode, as defined above. While it is not diagnostically necessary to also experience hypomanic or depressive episodes, it is common for individuals with Bipolar I Disorder to report one or more of these episodes, or mixed episodes, as well.

Bipolar II Disorder

In order to be diagnosed with Bipolar II Disorder, an individual must have experienced at least one major depressive episode and at least one hypomanic episode over the course of their life. An individual must also have never experienced a manic episode, as this would meet criteria for a Bipolar I diagnosis.
In the past, Bipolar II Disorder was stereotyped as a “milder” version of Bipolar I Disorder. However, this is not an accurate conceptualization of this diagnosis. This stereotype overlooks the significant distress that individuals experience due to periods of depressive episodes as well as the challenges inherent with patterns of mood inconsistencies.

Cyclothymic Disorder

In order to be diagnosed with cyclothymic disorder, an individual must experience at least two years of periods where they exhibit hypomanic symptoms but do not meet criteria for a hypomanic episode, as well as periods where they exhibit depressive symptoms but do not meet criteria for a depressive episode.

For children or teenagers, the criteria length is shortened to one year. These periods must occur for at least half of the time and the individual must not report symptom-free periods for over two months at a time.

Other Types of Bipolar Disorder

In addition to the three types of bipolar disorder above, the DSM-5 recognizes additional diagnoses for individuals who present with symptoms of a bipolar disorder but do not meet the full criteria for any of the three types above.

The following are brief overviews of these additional diagnoses:

Substance/Medication-Induced Bipolar and Related Disorder

Several substances, including both illicit drugs and prescribed medications, are associated with the behaviors and symptoms of mania, hypomania, or depression. This diagnosis applies to individuals whose symptoms were induced by substances or medications.

Bipolar And Related Disorder Due To Another Medical Condition

Similar to substance- or medication-induced symptoms, a number of medical conditions may present symptoms similar to bipolar disorder. These conditions may include Cushing’s disease, multiple sclerosis, or a stroke (www.mayoclinic.org).

Other Specified Bipolar And Related Disorder

Many individuals experience symptoms of bipolar disorder that cause significant distress or impairment but do not meet the full criteria for bipolar I, bipolar II, or cyclothymic disorder. This diagnosis allows a clinician to communicate an individual’s symptoms as well as the specific reason they do not meet the full criteria for another bipolar disorder.

For example, a clinician may categorize an individual’s symptoms as “short-duration cyclothymia.” The DSM-5 provides this option because it can be helpful for conceptualizing treatment options, empowering the individual to understand their diagnosis, and encouraging further study of this disorder.

Unspecified Bipolar And Related Disorder

This diagnosis is similar to “Other Specified Bipolar And Related Disorder” but differs from it in that the clinician does not specify a reason that the criteria is not met for one of the disorders above. “Unspecified Bipolar And Related Disorder” is used in situations when there may not be enough information for a clinician to be more specific, such as in an emergency room setting.

Treatment Options for the Different Types of Bipolar Disorder

For individuals with a bipolar disorder diagnosis, the idea of finding peace can feel overwhelming, but there are promising treatments, such as medication and therapy.

Certain types of behavioral therapy that have been beneficial for people with bipolar disorder include Cognitive Behavioral Therapy and Dialectical Behavior Therapy. Cognitive Behavioral Therapy is a type of behavioral talk therapy that explores the way our thoughts, feelings, and behaviors are connected.

Dialectical Behavior Therapy is a form of Cognitive Behavioral Therapy, but it includes some some key distinctions from Cognitive Behavioral Therapy. An important distinctive aspect of Dialectical Behavior Therapy is that it focuses on building therapeutic skills in four core areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

These are just two types of potential therapy options; it is helpful to research the various types of therapy to determine which may be the most beneficial for you.

What to Expect From Christian Counseling for Bipolar Disorder

The approach to Christian counseling can vary greatly from provider to provider. My approach, specifically, is tailored to each individual. I understand that terms such as religion, church, spirituality, God, Jesus, and the Bible can elicit powerful responses from people. Responses may range from shame, hatred, or disgust to joy, curiosity, or hope, and everything in between.

I recognize that some people have been hurt by the church or by Christians and want nothing to do with it at all. Some people may be grappling with what they believe, and some may have found incomparable freedom in their faith that they yearn to explore further. I welcome everyone, no matter where they stand or what experiences they bring to our sessions. My goal is to meet you exactly where you are and work together toward the healing you desire.

To me, the beauty of Christian counseling is that it offers support that recognizes the ways spirituality can be intertwined in all aspects of our lives, and treatment builds on a foundation of spiritual truths that offer us healing and peace.

I do not believe that Christianity or spirituality is at odds with evidenced-based treatment; on the contrary, I see them as profound compliments to each other. I believe that incorporating the teachings of Jesus and other spiritual truths in counseling is a powerful way to experience peace.

As Christians, we believe that God is actively working in our lives, and Christian counseling is one way to dig deeper into that truth. Finding a counselor who you feel safe and comfortable with is a crucial foundation to effective therapy.

Many counselors offer risk-free initial appointments to allow you to get to know them, ask questions, and determine whether they are a good fit. This is a great opportunity to meet with different counselors, to be empowered and in control of your treatment, and to find someone who you feel you can trust.

Help and support are available, and taking the first step may require a great deal of courage. Counseling can be incredibly effective in alleviating the debilitating impact of bipolar disorder. I invite you to reach out to myself or another mental health professional to schedule your initial risk-free appointment.