What's The Difference Between Bipolar I & II?

You might have heard the word "bipolar" thrown around a lot, but how much do you really know about bipolar disorder? One element of bipolar disorder that often isn't discussed in the media is the fact that it actually has varying "types," and isn't just one cookie-cutter diagnosis. The Diagnostic Statistical Manual, or DSM, is the basis for defining and diagnosing mental conditions, and it outlines a clear divide between types: bipolar I and bipolar II. But it's not just a matter of degree, and you can't call one version less damaging or serious than another. Understanding the spectrum of bipolar disorders as a culture would do a lot to demystify the condition, and help us understand what people with either type are going through.

We have a conception of bipolar disorders as huge highs and huge lows; this is the type represented by Mark Ruffalo in his star turn in Infinitely Polar Bear, for example. That's certainly a real thing (bipolar I, as it happens), but there's also another side to the equation, where the highs are less high and the lows often just as low. (And no, manic depression is no longer considered the correct diagnostic term for this type of bipolar disorder.)

So here are the real differences between bipolar I and II, and why that difference matters more than you might think.

The Difference Comes Down To Mania Versus Hypomania

The distinction between different kinds of bipolar disorder comes down to the "manic" side of the equation and how it manifests in different people. In both types of bipolar, depressive episodes may occur, but bipolar I is identified when it's accompanied by one or more episodes of mania, while bipolar II is diagnosed when it's paired with hypomania.

What's the difference? It's mostly a matter of degree. Mania is the more intense experience: staying up all night, working madly, doing irrational things, having creative spurts, feeling hugely grandiose and full of love, having no social barriers and acting compulsively. Sounds like fun, but it's not. The Mayo Clinic's definition for mania is "abnormally and persistently elevated, expansive or irritable mood that lasts at least one week [with] persistently increased goal-directed activity or energy." These are the periods where bipolar sufferers might spend all their money, do something spectacularly inappropriate, get arrested, or put themselves in serious danger.

Hypomania is less intense. It's supposed to be shorter in intensity (mania should last for at least a week, while hypomania should be around four days), and the impulsivity, confidence and excess energy, like a wheel going far too fast, are less serious in degree. It can be so slight that people just think of it as "increased energy" or "feeling weirdly energised and positive," rather than a genuine hypomanic period. According to an expert interview on Healthline, this can lead to a problem with diagnosis, wherein hypomanic individuals are declared to be depressives, and don't actually realize they have periods of minor mania too. This is bad news, because anti-depressants don't actually work as effective medications for bipolar disorders.

The reality is that symptoms of both bipolar disorders aren't exactly black and white. PsychCentral, which cheerfully calls bipolar I "raging" and bipolar II "swinging," records studies of pure mania that identify many different types, from psychosis and paranoia to sheer hedonism, all the way to aggression and hypersexuality. Unfairly enough, depressive episodes in bipolar conditions don't have a similar "lesser" element. Whether you've got bipolar I or II, your depressive episodes are likely to be severe, which means that bipolar II isn't necessarily easier to live with than bipolar I. The one exception, according to Psych Central, is a variant of bipolar I which has "mixed" episodes, where an episode contains both manic and depressive elements at once (euphoric and suicidal at the same time).

Why The Distinction Matters

One of the biggest reasons for distinguishing between the two types of bipolar disorder, according to the Black Dog Institute, which specializes in mental health support, is proper treatment. Apparently, bipolar type I is usually treated with lithium and other "mood stabilizers," but the particular shape of mood disordering in bipolar II means this may not actually be a suitable course of treatment.

Being aware of the fact that there's not just one blanket model of bipolar disorder is necessary to fully understand people who've got it. You may know several people who present their bipolar disorder in different ways; while this likely reflects their personal treatment options and factors like substance abuse and age (the average age of onset for bipolar disorders is 25), it's also probably to do with what specific kind of bipolar they actually have.

There's also not a hard-and-fast wall between the disorders. An expert for Psychology Today, Dr. Russ Federman, points out that, in some cases, bipolar hypomania may turn into mania, but it's not the case for everybody and can be exacerbated by lifestyle factors like doing drugs, not getting enough exercise, and not sleeping at night. He calls the boundary between the two the hypomanic "ceiling," but it doesn't seem that bipolar I goes the other way and dampens down into hypomania all that often.

It's important to know that there are also other features on the bipolar spectrum, not just I and II. One is cyclothymic disorder, which is related to bipolar II but features only mild depression and lower levels of hypomania; it's not given the "bipolar" label because it's not severe enough, but it's definitely sufficiently significant to have a big impact on your life. And that needs its own unique treatment, too.

Basically, there's one rule: don't make blanket assumptions about all bipolar disorders being the same. Listen when somebody tells you what they've got, and understand where it stands in the landscape of mood disorders and bipolar specifically.

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