Types of Bipolar Disorder

More Than Just Manic Depression

Bipolar Disorder Forms
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Gone are the days when the term "manic depression" could be applied to any number of similar and dissimilar mood disorders. Today, we look at the characteristics and specificity of the range of illnesses and moods that comprise the spectrum of bipolar disorders.

These include three major forms of bipolar disease and several variations in mood that help detail both the severity and treatment of the disease.

While the pattern of mood cycling can vary, as can the types symptoms a person may experience, the definition of each can provide doctors far clearer criteria when making a bipolar diagnosis.

Forms of Bipolar Disorder

Bipolar disorders are broadly classified by the severity and occurrence of a manic and/or depressive episode. In many cases, a diagnosis may require the doctor to exclude all other possible causes of symptoms, including schizophrenia, drug use, or a neurological disease. The three major forms of bipolar disorder are:

  • Bipolar I disorder is the most severe form of the disease spectrum. It accounts a large proportion of disability in the U.S. and is currently the sixth leading cause of disability worldwide. Bipolar I is characterized by the occurrence of at least one manic episode, usually in an association with one or more depressive episodes. One episode of mania without depression can be enough to make a diagnosis so long as there are no other causes for the symptoms. Psychosis, defined as a break from reality, can sometimes occur in diagnosed individuals.
  • Bipolar II disorder is considered a less severe from the disorder but is taken no less seriously. Bipolar II is characterized by at least one major depressive episode and at least one episode of hypomania (a less severe form of mania). To meet the diagnostic criteria, the hypomanic episode will need to last for at least four days. Unlike bipolar I, bipolar II disorder is not associated with psychosis.
  • Cyclothymic disorder, also known a cyclothymia, is consider a mild form of the disease but can have just as profound an effect on those experiencing it. People with cyclothymia will have the same hypomanic episodes as those with bipolar II disorder, but the depression will not be severe enough to constitute a major depressive episode.

There is also a condition known as bipolar disorder not otherwise specified (NOS) which may suggest that a person is on the road to a bipolar disorder. It is most commonly used when a person experiences a rapid cycling of depression and hypomania, often within days of each other.

Moods Episodes of Bipolar Disorders

The three defining moods of the bipolar disorders are mania, hypomania, and depression. The periods of these moods are described as episodes. Mixed episodes are those in which symptoms of mania and depression coincide, often in contradiction to each other.

  • Mania is a serious condition in which mood is abnormally elevated. In some cases, a person may seem to be experiencing a burst of creativity and generosity. At others, the mood is characterized by grandiosity, risk taking, disruptive behavior, and even episodes of psychosis. This elevated state may be accompanied by rapid speech, flights of thoughts, and periods of little sleep.
  • Hypomania, while not as severe as mania, can often be just as disruptive. Hypomania is different from mania insofar as the person experiences no functional disability or psychosis. The person in a hypomanic state will typically have a decreased need for sleep, be extremely outgoing and energetic, will often be very talkative, and can moments of irritability or aggression.
  • Major depression in bipolar disorder is no different from that of any major depressive episode. Symptoms can be severe and will last for at least two weeks. Depression is characterized by low self-esteem, a loss of interest in normally enjoyed activities, low energy, and emotional pain without a clear cause. Psychosis, including delusions and hallucinations, may also be experienced as can thoughts of suicide (suicidal ideation).
  • Mixed episodes, also known as a mixed affective state, can be primarily manic/hypomanic or primarily depressed, but in each case involve symptoms of the opposite mood. A person may, for example, nervous hyperactivity may be overshadowed by a dark, foreboding thoughts. On the flip side, a person may have all the characteristics of depression but exhibit hypersexuality associated with mania.

Source:

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Arlington, VA: American Psychiatric Publishing; DOI: 10.1176/appi.books.9780890425596.744053.

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