The Differences Between Bipolar I and Bipolar II

Why Not All Bipolar Diagnoses Are the Same

BP I and II Difference?
© 2014 Marcia Purse

More people—and maybe you're one of them—have become interested in bipolar II because celebrities like Catherine Zeta-Jones and Demi Lovato have revealed they're diagnosed with bipolar II disorder. But if you have only average knowledge of bipolar disorder, you may not know that there are two major forms of the illness—bipolar I and bipolar II (also known as bipolar 1 and 2), which are separate diagnoses.

There are significant differences between these two forms of bipolar disorder. Below are some of the most significant distinctions between bipolar I and II. 

Bipolar I and Bipolar II

A person with bipolar I has manic episodes, while someone with bipolar II has hypomanic episodes.The main difference between mania and hypomania is a matter of severity. In the hypomania of bipolar II, a person has a sustained mood that is elevated (heightened), expansive (grand, superior), or irritable. This mood has to be noticeably different from his or her normal mood when not depressed. In mania, that mood is extremely abnormal and is also combined with increased activity or energy that is also abnormal.

For example, Hank, when he has hypomanic episodes, is exceptionally cheerful, needs only three hours sleep instead of his usual seven, spends more money than he should, and speaks far more rapidly than usual, along with other symptoms of hypomania.

While there are cheerful people who need little sleep, spend a lot and talk fast who don't have bipolar disorder, this behavior is noticeably different from his own stable mood. So while it's abnormal for Hank, it's not outside the range of possible behavior in general.

On the other hand, Hank's friend Robert, who has manic episodes, is out-of-control happy, even during serious events (he burst out laughing disruptively during a funeral).

He ran around outside at midnight shouting how much he loved all his neighbors (along with other symptoms of mania). This is abnormal behavior for anyone.

Note: Someone with bipolar I disorder may also have hypomanic episodes, but someone with bipolar II does not ever have a manic episode. If a manic episode occurs in someone with bipolar II, the diagnosis will be changed.

Mania Versus Hypomania

In addition, there are other important distinctions between mania and hypomania:

  • Mania may include psychotic symptoms— delusions or hallucinations—but hypomania does not. For example, at times Robert firmly believes he is the mayor of his town and introduces himself to people as such, telling them about grandiose and sometimes bizarre plans he has for making improvements to services and infrastructure. If Hank had a similar delusion, his diagnosis would be bipolar I rather than bipolar II. Present psychosis automatically rules out hypomania. Note: Although present psychotic symptoms are one of the things that differentiate bipolar I mania from bipolar II hypomania, someone with bipolar II may experience hallucinations or delusions during depressive episodes without the diagnosis changing to bipolar I.
  • While hypomania may interfere to a degree with daily functioning, in patients with mania, day-to-day life is significantly impaired. For example, Robert missed an important business meeting because of a spur-of-the-moment decision to take flying lessons. Hank may be longing to take flying lessons while hypomanic, but if he does, he takes them at a reasonable time when he has no other obligations.
  • Manic patients must be hospitalized because of their severe symptoms. For example, during an irritable manic episode, Robert began throwing dishes, silverware, and pots and pans at his wife because he wasn't satisfied with that night's dinner. He was subsequently hospitalized because he had become a danger to others. Hank's hypomania does not escalate to such an extreme extent.


    U. S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health: "Bipolar Disorder." 

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