There are nuances to understanding mental health, for sure – but there are also technicalities when diagnosing a mental health disorder as well. If you are diagnosed with Bipolar, you deserve to know which side of the “spectrum” you fall on. It will help you and your loved ones better understand the disorder as well as target the appropriate interventions needed. Often times we hear, “she has ADHD;” maybe, but what type? ADHD Inattentive Type, ADHD Hyperactive Type or ADHD combined type? “He has Schizophrenia;” is it catatonia? Paranoia? The same is true with Bipolar Disorder; there is Bipolar I and Bipolar II. Even beyond the diagnosis of I or II, there are further distinctions; frequency of episodes/“duration” (recent, in remission, days, daily, weeks, etc) and type of episodes (manic, hypomanic, depressive). To keep it simple, let’s talk about what the difference between I and II.
BPI: is when a person experiences single or recurrent manic or hypomanic episodes that are preceded or followed by a major depressive episode. (more manic and hypomanic behaviors are noted)
BPII: is one or more major depressive episodes and at least one hypomanic episodes. There are no pure manic or mixed episodes (mania and depression) in BPI. If that were the case, it would be classified as BPI. (more depression is noted)
What is a hypomanic episode? Remember, when “episode” follows a description of mood, there is a time frame attached to it. A hypomanic episode lasts at least 4 days and is characterized by (not an all inclusive list) elevated or expansive moods, irritability, feelings of a grandiose sense of self, euphoric, creative, pressured speech and flight of ideas. This “episode” is a clear break from the individual’s usual mood and functioning.
Manic episodes are similar in nature, but can include delusions, hallucinations or other psychotic features. Mania is much more severe and at times dangerous (“delusions of grandeaur;” you feel like Superman and will fly, intense, impulsive behaviors of a sexual, addictive and/or monetary nature.
What is a major depressive episode? There are two types: Either a single episode in which at least four symptoms are present almost daily for more than two weeks time OR a recurrent episode in which the episodes themselves come and go for two months – at the least. Again, the behaviors are a break from the person’s normal functioning. Characteristics of the episode are (not an all inclusive list); loss of interest in usual activities, irritable, sleeplessness or too much sleep, change in appetite, feeling tired and lethargic, difficulty focusing and possible suicidal ideation.
Don’t get stuck in thinking that Bipolar disorder is just a big shift from happy to sad, or psychotic to totally deflated. As with any disorder, you want to understand what you or a loved one is suffering from. If diagnosed BPI; interventions and medications should be equalizing both moods, but focusing on the manic and/or hypomanic episodes. If BPII is diagnosed; more attention should be paid to the depressive episodes and the corresponding symptoms.