Differentiating Subtypes of Bipolar Disorder

Bipolar disorder isn't just about having mood swings. It's a serious mental health condition that used to be referred to as manic depression. There are two main types of bipolar disorder that differ in terms of severity, duration, and nature of their symptoms.

This article discusses the symptoms of bipolar disorder, including symptoms of both mania and depression. It also covers potential complications that may occur.

Signs & Symptoms of Bipolar Disorder

People with bipolar disorder experience dramatic shifts in mood that may include periods of depression and mania. The nature and severity of these symptoms depend on the type of bipolar disorder that they have.

• Bipolar I: Individuals with bipolar I experience at least one manic episode in their lives. Although not required for the formal diagnosis, the vast majority will also experience major depressive episodes during the course of their lives.
• Bipolar II: Individuals with bipolar II have at least one hypomanic episode (a less serious form of mania) and at least one major depressive episode.
  

Bipolar Mania or Hypomania Symptoms

Symptoms of a manic or hypomanic episode include:

• Being easily distracted
• Decreased need for sleep
• Delusions or hallucinations
• Elevated or expansive mood
• Grandiosity or inappropriate behavior
• Impulsive risk behaviors (including gambling and lavish spending)
• Increased sexual desire
• Irritability, hostility, or aggression
• Physical agitation and relentless movement
• Racing thoughts
• Talking excessively

Manic episodes must last at least seven days to meet the criteria for bipolar I disorder and can last much longer. Hypomanic episodes involve the same symptoms, but the individual's functioning isn't markedly impaired, and there are no psychotic symptoms.

Bipolar Depression Symptoms

During a depressive episode, an individual may experience the following symptoms:

• Crying for no reason or prolonged periods of sadness
• Difficulty concentrating or indecisiveness
• Extreme fatigue, including the inability to get out of bed
• Feelings of guilt or hopelessness
• Loss of interest in activities that usually give you pleasure
  
• Loss of interest in health, nutrition, or physical appearance
  
• Sleeping excessively or difficulty sleeping
• Suicidal thoughts or an impulse to self-harm

Problems with cognitive skills, such as subjective memory trouble, difficulty concentrating, and indecision, can be the first things noticed by others when someone has bipolar depression.

Physical Symptoms Associated With Depressive Episodes

During depressive episodes, individuals may experience a variety of physical symptoms, including unexplained aches and pains.

Changes in weight are also common. While some people struggle to eat when they're feeling down, others turn to food for comfort. Thus, both weight loss and weight gain can be symptoms of a depressive episode.

Psychomotor agitation, an increase in activity caused by mental rather than physical tension, or psychomotor retardation, slowing of both thought and physical activities, may also occur.

Rare Symptoms

While less common, people may sometimes experience a mood disorder known as cyclothymia. This condition causes mood changes that are not as severe as those in bipolar I or bipolar II disorder. Cyclothymia often emerges in adolescence. In many cases, it can be a precursor to bipolar I or II disorder.

Complications & Comorbidities

Bipolar disorder can lead to complications in a person's life. It can also present differently in certain groups. There is no cure for bipolar disorder, but the symptoms can be managed effectively with appropriate treatment. Some potential complications that can occur if the condition is not treated include:

• Difficulties in school or work
• Financial and legal problems
• More severe symptoms, including psychosis
• Relationship problems
• Self-medicating with drugs or alcohol
• Suicide or attempted suicide

Differences in Men and Women

Bipolar disorder occurs in men and women at approximately the same rates. However, the presentation of symptoms and course of the condition may differ depending on the sex an individual was assigned at birth. 

Men are often diagnosed at an earlier age, experience more severe episodes, and are more likely to have co-occurring substance use issues. Women tend to have more depressive episodes and more rapid cycling between manic and depressive episodes.

In Children

While bipolar disorder is most frequently diagnosed in adults over the age of 18, it can also occur in children. The course of the condition tends to be more severe when this diagnosis happens during childhood. 

Symptoms also often manifest differently in children than in adults. Some of the symptoms that children may experience include:

• Aggressiveness
• Decreased need for sleep
• Depressed moods
• Frequent mood swings
• Hyperactivity
• Irritability
• Restlessness
• Risk-taking behaviors
• Temper tantrums
  

Because these symptoms are not always specific to bipolar disorder and are often associated with other conditions, it is essential to receive an evaluation and diagnosis from a healthcare professional. Getting an accurate diagnosis early on can lead to more effective interventions and improve treatment outcomes.

Co-Occurring Conditions

There are a number of conditions that can co-occur alongside bipolar disorder or that have similar sets of symptoms that may complicate diagnosis. Some of these co-occurring conditions include:

Attention Deficit Hyperactivity Disorder (ADHD)

Hyperactivity and distractibility are two of the hallmark symptoms of attention deficit hyperactivity disorder (ADHD). However, they are also quite predominant in bipolar disorder, especially as it relates to children. To further complicate things, these conditions can often co-occur.

Alcohol or Substance Use

It is very common for those with bipolar disorder to struggle with alcohol and substance use. This is often an attempt, even on an unconscious level, to self-medicate. To make matters worse, alcohol may interact with the medications used to treat bipolar disorder.

Borderline Personality Disorder 

Borderline personality disorder causes impulsivity, suicidal behavior, reactivity of mood, inappropriate anger, and transient paranoia, which are also associated with bipolar disorder. It is possible for an individual to be diagnosed with both of these disorders as well.

Depression

The one thing that distinguishes depressive disorders (unipolar depression) from bipolar disorder is mania/hypomania. If a patient with depression swings into an episode of mania, the diagnosis becomes a bipolar disorder.

Eating Disorders

It is not uncommon for those with bipolar disorder to experience eating disorders. Moreover, depression, anxiety, and irritability often result from eating disorders.

Panic Disorder

Panic disorder is characterized by recurrent, spontaneous panic attacks. Panic disorder is often comorbid (occurs together) with mood disorders and other psychiatric disorders. Panic attacks are also common in those with bipolar disorder.

Schizophrenia

Schizophrenia is a mental disorder that causes intense disturbances in cognition (thinking), behaviors, and emotions. Symptoms of the condition include delusions, hallucinations, disorganized speech and thinking, disorganized behavior, catatonic behavior, inappropriate moods, flattened emotions, lack of speech, and a reduction in goal-directed behavior. The symptoms of schizophrenia are easily confused with those of bipolar disorder.

Schizoaffective Disorder

Schizoaffective disorder involves having symptoms of major depression or mania, along with specific symptoms of schizophrenia. However, the delusions or hallucinations must persist for periods when the mood symptoms aren’t present. As you might expect, there is a great deal of confusion and controversy surrounding differentiating this disorder from bipolar disorder.

Frequently Asked Questions