Mental Health, Mental Illness in Marriage

How to Distinguish Bipolar I from Bipolar II

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Bipolar disorder is a psychological illness which causes unusually high and in a number of cases, extremely low moods. It affects a person’s energy levels and their ability to function in every day. 

There are several types of bipolar disorder, the most widespread being bipolar I and bipolar II.

In the following paragraphs, learn about the similarities and differences between bipolar I and bipolar II. We also consider the symptoms, causes and available treatment options.

Types of Bipolar Disorder

An individual with bipolar disorder may experience extreme changes in mood.
Those with bipolar disorder experience abnormal highs or perhaps even lows in mood. During a “high,” also known as a manic episode, individuals feel intense energy or perhaps even elation.

During a “low,” or depressive episode, they experience symptoms of depression, including sadness, hopelessness, and despair.

There are four distinct types of bipolar disorder:

  • bipolar I disorder
  • bipolar II disorder
  • cyclothymic disorder, or cyclothymia
  • other specified and unspecified bipolar disorder

Only a medical doctor can diagnose a person with one of the above types based on the duration and intensity of their symptoms.

Bipolar I and bipolar II are by far the most widespread forms of bipolar disorder. They are also the far more severe of the bipolar disorders.

Bipolar I vs. bipolar II

Bipolar I and II have similar patterns in which symptoms occur. Nevertheless, individuals who have bipolar II will experience less severe manic episodes than individuals with bipolar I.  This particular type of mania is referred to as hypomania.

In order to receive a diagnosis of bipolar II, a person must also experience a major depressive episode, which does not apply in a diagnosis of bipolar I.

Only a medical doctor can diagnose bipolar I based on the presence of a manic episode alone.  Individuals with bipolar I disorder have at least one manic episode that persists for a week or longer or severe mania that requires hospitalization.

Those with bipolar II disorder do not usually require hospitalization during hypomanic periods. Doctors often misdiagnose bipolar II as depression because the hypomanic symptoms can be quite subtle.

In between these episodes of depression and mania, individuals who have either of these types of bipolar may experience periods of stable mood. It is possible to have symptoms of depression and mania at the same time. This is referred to as bipolar with “mixed features.”


The primary symptoms of bipolar I and bipolar II are mania, hypomania, and depression.


During a manic episode, individuals can experience:

  • extreme enthusiasm, happiness, or elation
  • anger, rage, restlessness, or irritability
  • increased energy, characterized by being overactive or over-talkative
  • less need for sleep and difficulty sleeping
  • racing thoughts
  • difficulty concentrating and making decisions
    reckless behavior
  • pleasure-seeking behaviors, such as increased interest in drugs, alcohol, and sex
  • inflated self-esteem, grandiose thinking

Periods of mania can interfere with a person’s daily activities and their relationship and interactions with others.

A number of individuals may be unable to achieve a calm state or perhaps even to have rational thoughts during a manic episode.


In a state of hypomania, individuals experience symptoms similar to those in mania, except less severe.

Hypomania can still interfere with an individual’s quality of life, and family and friends may notice that the individual is experiencing mood changes.


Those with bipolar disorder may experience depressive symptoms which are the same as those experienced in cases of clinical depression. These include:

  • sadness
  • hopelessness
  • low energy and fatigue
  • changes in sleeping patterns
  • changes in appetite
  • poor concentration
  • loss of interest in formerly enjoyable activities
  • low self-esteem
  • aches and pains that have no apparent physical cause
  • thoughts of death or suicide
  • suicidal behavior

Doctors consider these symptoms to be a depressive episode if they persist for two weeks or longer.


According to the National Institute of Mental Health (NIMH), approximately 2.8% of adults in the United States experience bipolar disorder in a given year. An estimated 4.4% of individuals experience bipolar at some point in their lives.

The condition affects men and women almost equally. Onset occurs at an average age of twenty-five, but it can|is able to happen to men and women of any age.


Only a medical doctor can assess an individual to make a diagnosis of bipolar disorder.

To|obtain a diagnosis of bipolar disorder, individuals will need to see a psychiatrist or psychologist. They will review the individual’s medical history and symptoms.

This psychiatric assessment will focus on the individual’s thoughts, feelings, and behaviors.

Some individuals might find it helpful to have a loved one present to provide the doctor with helpful information about other symptoms, particularly during manic periods.

The psychiatrist or psychologist may also ask an individual to keep a mood journal to track their moods, sleep patterns, and other symptoms. This journal can help with a diagnosis.

The psychiatrist or psychologist will compare the person’s symptoms to the criteria for bipolar disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders DSM5.

The psychiatrist or psychologist may carry out blood tests, a physical examination, or even brain imaging tests to rule out other causes of the symptoms.


Treatment for bipolar I disorder and bipolar II disorder typically consists of medications, psychotherapy, and lifestyle changes.

As bipolar disorder is a long-term condition, treatment will be long-lasting. A number of individuals may have a treatment team which} includes a psychologist, therapist, and psychiatric nurse practitioner.


Doctors commonly prescribe mood stabilizers, such as lithium, for bipolar disorder. They will often also prescribe antipsychotic drugs for manic episodes and antidepressants for depression, as antidepressant medications may “trigger” manic episodes in some individuals.  Doctors might recommend a combination of antidepressant and antipsychotic drugs to reduce depression while stabilizing mood.

For individuals who have sleep or anxiety problems, anti-anxiety medications, such as benzodiazepines, may help. However, this strategy may come with a risk of dependence to benzodiazepines.

Individuals can get started taking medications right away, even if they are not currently experiencing a manic or depressive episode.

It is vital to continue taking medications even during periods of stable mood to avoid relapse.


Psychotherapy is an essential component of treatment for bipolar I and II disorders. Therapy may take place on a one-to-one basis, as part of a group, or perhaps in a family setting.

There are several different types of therapy that can help in treating bipolar I and bipolar II, including:

  • Interpersonal and social rhythm therapy (IPSRT), which focuses on establishing a structured routine to help people cope with symptoms.
  • Cognitive behavioral therapy (CBT), to challenge negative thoughts and replace them with positive ones.
  • Family-focused therapy, to enhance communication with family members and to foster family support.

Lifestyle Changes

Many individuals can make lifestyle changes to manage their symptoms and help stabilize their moods. Examples of these changes include:

  • avoiding alcohol and drugs
  • exercising regularly
  • eating a balanced diet
  • establishing a sleep routine
  • attending a support group for people with mood-related disorders
  • practicing mindfulness and meditation
  • reducing stress where possible
  • learning more about their condition

Some individuals also find it helpful to keep a daily mood journal. Keeping a journal can allow individuals to see patterns in their thoughts, moods, and behaviors.

A mood journal also helps identify triggers for manic or depressive episodes. This may help an individual take appropriate action before a slight mood change becomes worse.


Although bipolar I and II are life-long conditions, many individuals are able to manage their symptoms with lifestyle changes, therapy, and medications.

Maintaining regular contact with mental health professionals and seeking support from family and friends can make it easier to cope with challenging symptoms.

Anyone who believes they may be experiencing symptoms of bipolar I or II should speak to a doctor for a proper diagnosis.

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