It may take loved ones to recognize the symptoms.
By definition, bipolar disorder includes extreme mood shifts that bounce from one pole to the other—between high-energy mania and low-energy depression. How that actually plays out in a patient’s life can vary, however, and not all manic episodes look the same.
To reflect this variation, doctors have defined four types of bipolar disorder: bipolar I, bipolar II, cyclothymic, and “other specified and unspecified bipolar and related disorders.” The two most common are bipolar I and bipolar II.
The Difference Between Bipolar I and Bipolar II
Both bipolar I and bipolar II involve both manic and depressive episodes, but it’s the magnitude of the manic episode that sets the two types apart.
“Bipolar I means you have true manic episodes,” says Gail Saltz, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. “When you have mania, you have psychotic symptoms.”
Psychosis may involve hallucinations, delusions, and a break from reality, according to the National Alliance on Mental Illness (NAMI). Because of the psychotic symptoms, some people with bipolar I are wrongly diagnosed with schizophrenia.
“Bipolar II means you have depression alternating with hypomania,” says Dr. Saltz. “You never become actually manic [and] you never have psychotic symptoms.”
As the prefix hypo- suggests, hypomania is a less severe version of true mania.
People experiencing hypomania might feel an “expansive mood,” says Dr. Saltz, but no break from reality. That said, hypomania can still wreak havoc on someone’s life and require treatment.
People with both bipolar I and bipolar II experience similar states of depression, characterized by low energy, feelings of hopelessness, lethargy, or a lack of enjoyment in previous interests. Learn more about the symptoms of depression here.
Symptoms of Psychosis vs. Symptoms of Hypomania
If you think you or a loved one may be dealing with bipolar disorder, it’s not your responsibility to figure out the exact type. However, it *is* important to be aware of hypomania and recognize that symptoms of bipolar disorder may be less obvious than you thought.
If someone is experiencing an episode of hypomania, they might exhibit these symptoms, according to Dr. Saltz:
Feeling special and elated
Higher sex drive
Risky sexual behavior
Racing thoughts and flights of ideas
Someone with hypomania may be able to function well in their social and professional lives, according to NAMI. They may be able to hide their symptoms, or people may brush it off as simply a “good mood.” Still, decisions made during episodes of hypomania may have frustrating and exhausting consequences.
True mania typically involves psychosis. When someone is experiencing psychosis during a manic episode, they may display the following symptoms:
Hearing or seeing things that aren’t there
Having completely irrational thoughts
Behaving impulsively and unpredictably
Taking unusual risks
Getting into trouble frequently
Manic episodes from bipolar I may last a week or longer and may be so severe that the person requires hospitalization, according to NAMI. Unlike bipolar II disorder, which might be considered high functioning, it’s more difficult for someone with bipolar I disorder to fly under the radar.
“A lot of times you see people with bipolar I disorder because they’ve gotten in trouble with the law, or because they’re having [problems] related to gambling, or spending, or sex,” says Ben Michaelis, PhD, a psychologist in New York City.
How Loved Ones Can Help
It’s hard to truly imagine what it feels like inside the mind of someone with bipolar disorder—or any other type of mental illness—but the experience could be described as disorienting. The high energy levels or racing thoughts may feel “normal” or even “good,” and the psychotic symptoms may feel totally real and natural.
“One’s judgment may be impaired—even in the earlier stages of illness,” says Dr. Saltz. “It’s often the case that people who are suffering don’t recognize it in themselves. It really is the people around them who see what’s going on.”
Not surprisingly, people with bipolar disorder may be more likely to seek treatment during depressive episodes than during manic episodes, according to the National Institute of Mental Health. They might enjoy the elated mood and high energy, whereas the overwhelming sadness and fatigue during depression are more likely to prompt willingness to get help.
One way you can help is by recognizing the manic symptoms—especially the more subtle hypomanic symptoms—and making the person aware of how the manic behavior has consequences. It’s crucial to spot the difference between depression and bipolar disorder, since the two are treated very differently.
If you have depression or bipolar disorder and are experiencing thoughts of self-harm or suicide, call 911, go to the emergency room, or call the National Suicide Prevention Lifeline: 1-800-273-8255.
Dr. Samuels is an assistant professor of clinical psychiatry and clinical pediatrics at Weill Cornell Medicine and an assistant attending psychiatrist at NewYork-Presbyterian Hospital.Gail Saltz
Dr. Saltz is a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medicine and a psychoanalyst with the New York Psychoanalytic Institute.Ben Michaelis
Dr. Michaelis is a clinical and media psychologist in New York City.
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Bipolar disorder is a mental illness that
involves both having had an experience
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of a manic episode, as well as
experiencing depressive episodes.
00:00:12,211 --> 00:00:17,871
00:00:17,871 --> 00:00:22,130
So the main types really
are bipolar I and bipolar II.
00:00:22,130 --> 00:00:25,840
Bipolar I means you have
true manic episodes, so
00:00:25,840 --> 00:00:30,190
you have, when you have mania,
you have these psychotic symptoms.
00:00:30,190 --> 00:00:35,610
Bipolar II means you have the depression,
alternating with hypomania.
00:00:35,610 --> 00:00:40,370
You never become actually manic,
you never have psychotic symptoms.
00:00:40,370 --> 00:00:42,860
You only alternate to hypomania.
00:00:42,860 --> 00:00:50,190
Hypomania is expansive mood,
you feel sort of special, fantastic,
00:00:50,190 --> 00:00:57,030
or highly irritable, you might spend more
money than is appropriate or you have,
00:00:57,030 --> 00:01:00,360
something called hypersexualized,
so you have a higher sex drive.
00:01:00,360 --> 00:01:04,520
You might even act out sexually
more that you normally would.
00:01:04,520 --> 00:01:09,160
You have flight of ideas, so
thoughts are coming very quickly, and
00:01:09,160 --> 00:01:11,900
you might even be speaking very quickly.
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So this sort of sped up state,
that's a little higher than a kite.
00:01:15,670 --> 00:01:21,850
That does not include any sort of
psychotic symptom or break with reality.
00:01:21,850 --> 00:01:25,180
So nothing that is
a hallucination of any sort,
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nothing that hear things that aren't
there or see things that aren't there, or
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half thoughts that really
are completely irrational.
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If you do have one of those thoughts,
I'm talking to God,
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the Martians are in the television,
something that is really a delusion,
00:01:41,940 --> 00:01:46,650
a break with reality, or you hear things
or see things, that is psychosis.
00:01:46,650 --> 00:01:48,300
The difference between
bipolar I disorder and
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bipolar II disorder really
is a matter of magnitude.
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And the way you can usually tell
the difference is in the first one,
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in a bipolar I, it really has to do
with the consequences of the behavior.
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If the person's getting into trouble, a
lot of times you see people with bipolar I
00:02:02,460 --> 00:02:05,000
disorder because they've gotten
into trouble with the law, or
00:02:05,000 --> 00:02:08,550
because they're having some problem
related to gambling, or spending, or
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sex, or these other activities that get
them into sort of the legal system.
00:02:12,870 --> 00:02:14,830
The problem with bipolar disorder,
00:02:14,830 --> 00:02:19,170
as is the case with many of these
mental health issues, is that one's
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judgement may really be impaired,
even in the earlier stages of illness.
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So it's often the case that people who
are suffering don't recognize it in
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themselves, and it usually is the people
around them that see what's going on.
00:02:31,370 --> 00:02:35,220
In fact, people in hypomania may
be feeling really pretty good and
00:02:35,220 --> 00:02:36,530
I don't want to go in for treatment.
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I feel great.
00:02:37,420 --> 00:02:38,966
I don't know what you're talking about.
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So it really is incumbent upon
others to note in family members or
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in friends something is going on and
to help them to seek treatment.
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00:02:54,515 --> 00:02:58,394
If you ever feel like you might want
to harm yourself or somebody else,
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please call 911 immediately or
proceed to your nearest emergency room.
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It's also good to have on hand
the National Suicide Prevention Lifeline,
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which is 1-800-273-8255.
Bipolar disorder. Arlington, VA: National Alliance on Mental Illness. (Accessed on April 18, 2021 at https://www.nami.org/learn-more/mental-health-conditions/bipolar-disorder.)
Bipolar disorder. Bethesda, MD: National Institute of Mental Health. (Accessed on April 18, 2021 at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.)Bipolar disorder. Washington, DC: U.S. National Library of Medicine. (Accessed on April 18, 2021 at https://medlineplus.gov/bipolardisorder.html.)