Written by: Daniella Marchese
Edited by: Shruti Shaji
According to an article published by the American Journal of Psychiatry, 4.5% of the United States adult population, almost 15 million people, is affected by bipolar disorder, (Rhee et. al., 2020, p. 706). Bipolar disorder affects many individuals and the communities of people around them. People need to learn about the warning signs and symptoms of bipolar disorder and understand that there are treatments available to help those with bipolar disorder. There are also many misconceptions about bipolar disorder in today’s society. Some people think it is just mood swings while others believe there are no cures. However, this article will serve to explain the differences between bipolar I and II disorders and discuss management options.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorder is recognized as a bridge between depressive disorders and schizophrenia spectrum and other types of psychotic disorders (American Psychological Association, 2013). Bipolar disorder is described as extreme highs— episodes of mania or hypomania—and extreme lows— depressive episodes. Before discussing the differences between the two types of bipolar disorder, it is important to understand key terms when defining these disorders. First, manic and hypomanic episodes must include “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy lasting 1 week” and three or more of the following symptoms: inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, distractibility, poor decision making, and increased risk-taking (American Psychological Association, 2013, pp. 124-125; Mayo Clinic, 2022). Hypomanic and manic episodes are different in that a manic episode will cause more noticeable disruptions in daily life, such as work and school. It may also trigger an episode of psychosis, which is a break from reality, and requires hospitalization (Mayo Clinic, 2022). Another important term when defining bipolar disorder is a major depressive episode. During a depressive episode, an individual must experience five or more of the following symptoms over a two-week period: depressed mood or loss of interest or pleasure, significant weight loss, insomnia or sleeping too much, restlessness or slowed behavior, fatigue, feelings of worthlessness, inability to concentrate or indecisiveness, and thinking about, planning or attempting suicide (American Psychological Association, 2013, p. 125; Mayo Clinic, 2022). After understanding the different terms, we can now define bipolar I and bipolar II disorders
There are many differences between bipolar I and bipolar II disorder; differences in severity and symptoms call for different treatments. Bipolar I disorder is when an individual has experienced “at least one manic episode,” which may have been preceded or followed by a hypomanic or depressive episode and cannot be explained by any schizophrenia spectrum or other psychotic disorders (American Psychological Association, 2013, p. 126). Bipolar II disorder is when someone has experienced “at least one hypomanic episode and at least one major depressive episode” without the presence of a manic episode and symptoms are not better explained by any schizophrenia spectrum or other psychotic disorders (American Psychological Association, 2013, p. 134). There is also a presence of frequent, unpredictable alternation between periods of depression and hypomania (American Psychological Association, 2013, p. 134). A major difference between bipolar I and bipolar II disorders is the presence of a manic episode, which involves psychosis and the possible need for hospitalization or disruptions so significant in daily life that would impair “social or occupational functioning” (American Psychological Association, 2013, p. 124). Furthermore, according to an article in the Journal of Affective Disorders on the differences between bipolar I and II disorders, there are also differences in the severity of illness, where bipolar I “showed more extensive manic symptoms,” yet bipolar II showed “more serious and complicated natures in all other aspects evaluated,” including higher rates of family history or psychiatric illness and higher rates of axis I comorbidity (mental disorders more commonly found in public, such as anxiety disorders) (Baek et. al., 2011, p. 65). These differences indicate the importance of treating bipolar I disorder and bipolar II disorder as entirely separate entities.
Although many people believe there is no treatment for bipolar disorder, this is not true. Management of bipolar disorder options vary. Different prescriptions include antipsychotics, mood stabilizers, and antidepressants. Although mood stabilizers were widely used in 1997-2000, their use has largely decreased; instead, antipsychotic medications are widespread now (Rhee et. al., 2020). The prevalent medication for treating bipolar disorder is lithium, due to its effectiveness in reducing suicide risk (Geddes & Miklowitz, 2013). Aside from prescription treatments, the use of psychotherapy to treat bipolar disorder has decreased, as well (Rhee et. al., 2020). This is largely due to many psychiatrists not providing this service, according to Dr. Rhee and colleagues. Despite this, according to professors from the University of Oxford, Dr. Geddes and Dr. Miklowitz, there is a need for “integration of pharmacotherapy with targeted psychotherapy” for the management of both bipolar I and II disorder (Geddes & Miklowitz, 2013, p. 5). They discuss the benefits of psychotherapeutic intervention, such as educating and managing patients and families on the stressors that may trigger an episode, such as family distress and negative events that are associated with relapses. They also help patients and families identify early signs of recurrence and how to intervene in these instances. Another key part of psychotherapy in conjunction with psychopharmacology is to find a balance and maintain regular lifestyle habits (Geddes & Miklowitz, 2013, p. 5). How intensive the treatment is depends on the severity of symptoms. For example, people with bipolar I disorder may require more intensive treatment, as the episodes they have may be more intense. However, it is important to work with psychiatrists, psychologists, or mental health counselors to find the right treatment plan for each person.
Even though bipolar I and II disorders may have similar names, it is very important to understand the differences between the two entities. Through research and education, these distinctions can be understood and can help individuals with bipolar I or II disorder.
References:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (5th ed).
Baek, J. H., Park, D. Y., Choi, J., Kim, J. S., Choi, J. S., Ha, K., Kwon, J. S., Lee, D., & Hong, K.
S. (2011). Differences between bipolar I and bipolar II disorders in clinical features,
comorbidity, and family history. Journal of Affective Disorders, 131(1–3), 59–67.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. Lancet (London,
England), 381(9878), 1672–1682. https://doi.org/10.1016/S0140-6736(13)60857-0
Mayo Clinic. (2022, December 13). Bipolar disorder.
0355955
Rhee, T. G., Olfson, M., Nierenberg, A. A., & Wilkinson, S. T. (2020). 20-year trends in the
pharmacologic treatment of bipolar disorder by psychiatrists in Outpatient Care Settings.
American Journal of Psychiatry, 177(8), 706–715.
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