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What are the different types of bipolar disorder?

There are three main types of bipolar disorder. Bipolar I disorder is characterized by frequent and disruptive mood swings with severe depression and mania. Bipolar II disorder has less severe mood swings than Bipolar I disorder. In this case, a person experiences hypomania rather than extreme mania and longer periods of mild depression. Cyclothymia is even more mild, with less severe mood highs and lows. Besides these, a person who exhibits bipolar symptoms without qualifying for a full bipolar diagnosis is classified as Bipolar Disorder Not Otherwise Specified.

Donna Hill Howes, RN
Family Practitioner

Doctors have identified four distinct types of bipolar disorder. The various forms of the disease are distinguished by the intensity, frequency, and duration of specific symptoms. According to the National Institute of Mental Health, the four types of bipolar disorder include: bipolar I disorder, characterized by manic or mixed episodes (depression and mania) that may be so severe that hospitalization is necessary; bipolar II disorder that primarily causes depression and occasional mixed episodes, but no full-blown mania; bipolar disorder not otherwise specified, which is a category that includes people with bipolar symptoms that don't fit into the previous two forms of the disorder; and cyclothymic disorder, a mild form of bipolar disorder that may be managed without medication.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

Sheri Van Dijk
Psychiatrist (Therapist)

Outlined below are the current categories of bipolar disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM):

Bipolar I — Bipolar I is the traditional, most widely recognized form of bipolar disorder, usually involving recurrent episodes of mania and depression, although about 10 percent of people with this diagnosis never suffer major depression. In order to receive a diagnosis of bipolar I, you must have experienced one or more full-blown manic episodes that cannot be attributed to the use of alcohol or drugs (including antidepressants, which can sometimes cause someone to flip into a manic state), or to other general medical conditions. It is not uncommon for people with this form of bipolar to experience psychotic symptoms.

Bipolar II — Bipolar II involves periods of major depression and at least one period of hypomania. If you have had these severe changes in mood but have never experienced symptoms of a full-blown manic episode, you generally receive a diagnosis of bipolar II. People with this form of bipolar do not experience psychotic symptoms and do not require hospitalization for their symptoms when hypomanic. Over time, a small number of people with bipolar II shift to bipolar I due to the onset of mania.

Cyclothymia — According to the DSM, cyclothymia is when a person experiences long-term problems with fluctuating moods involving numerous periods of hypomania and periods of depressive symptoms. When they manifest, however, these symptoms are not severe enough to be diagnosed as a manic or major depressive episode. Cyclothymia can therefore be seen as a milder form of bipolar disorder, involving upswings that are similar to hypomania and downswings in mood that are fairly mild forms of depression. These episodes alternate throughout a person's life; but because a small number of such people develop full-blown bipolar disorder (either type I or II), this diagnosis is only given when a person experiences at least two years of these symptoms without the emergence of a manic or major depressive episode.

The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life (New Harbinger Self-Help Workbook)

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The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life (New Harbinger Self-Help Workbook)

Even if you've just been diagnosed with bipolar disorder, it's likely that you've been living with it for a long time. You've probably already developed your own ways of coping with recurring...
Dr. Thomas Jensen
Psychiatrist (Therapist)

There are currently four types of bipolar disorder defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV. There is strong genetic evidence that these are artificial distinctions and that, in fact, this is a spectrum illness.

Bipolar Type I is characterized by one or more manic episodes. A depressive or hypomanic episode is not required to fall into this category, but often occurs.

Bipolar Type II is characterized by no manic episodes, but hypomanic episodes and at least one Major Depressive Episode. Hypomanias are essentially manias that don't cause severe life impairment, but the distinction is often quite gray in real life.

Cyclothymic Disorder is a history of one or more hypomanias, and periods of depression that do not meet criteria for a Major Depressive Disorder.

Bipolar Not Otherwise Specified (NOS) is a rather ill-defined category that essentially includes the people who don't quite fit into the above categories.

While not yet a diagnostic category, Bipolar Type III has been considered for inclusion as well. This would reference people who have only had a mania that was medication induced (for example, by an antidepressant).

Rapid cycling is added to the diagnostic label if four or more episodes occur per year.

Dr. Ruth White, MPH
Social Work Specialist

There are several diagnoses that describe bipolar disorder. Bipolar I disorder is considered the classic form of the disease and is marked by recurrent episodes of mania and depression with possible mixed episodes. Bipolar II disorder is marked by milder episodes of hypomania that alternate with major depressive episodes with no full manic episodes. Rapid-cycling bipolar disorder is the diagnosis given when a person experiences four or more depressive or manic episodes within a twelve-month period.

Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More

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Dr. Tarique D. Perera, MD
Psychiatrist (Therapist)

Bipolar disorder is characterized by depression and at least one manic episode. In this video, Tarique Perera, MD, a psychiatrist with Contemporary Care of Connecticut, discusses the different types of bipolar disorder.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.