Many people think of rapid mood changes when they think of Bipolar Disorder. But there are several different categories of mood disorders depending on a person’s symptoms, and not all of these categories include the highs of mania and lows of depression. Only a doctor or mental health professional can provide a diagnosis for a mood disorder, and it may take years of observation to get an accurate diagnosis.

Bipolar Disorder I

Bipolar I disorder requires symptoms to meet the full criteria for what is known as a manic episode. You do not have to experience depression to be diagnosed with Bipolar I, but many people with the diagnosis experience both kinds of mood episodes.1

A manic episode must include at least three of the following symptoms:

  • increased talkativeness
  • increased self-esteem or grandiosity
  • decreased need for sleep
  • increase in goal-direct activity, energy level, or irritability
  • racing thoughts
  • poor attention
  • increased risk-taking (spending money, risky sexual behaviors, etc.)

Mania is much more extreme than a sudden burst in energy or motivation or a happy mood. It often results in problems in work, school, and relationships, and it some cases it may require hospitalization. A manic episode is also just as frequently characterized by an irritable mood as an elevated one for people with Bipolar I, so never assume a manic episode is not present because a person doesn’t not appear happy or enthusiastic.2

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Bipolar Disorder II

To qualify for a diagnosis of Bipolar II Disorder, a person has to have experienced a depressive episode and a less severe form of mania which is known as hypomania. A person experiencing mania will exhibit manic symptoms but is able to continue with day-to-day responsibilities and may even see an increase in job performance or other goal-directed activity. The elevated mood, however, is not so severe that the person requires hospitalization or experiences significant disruption at home or work.3

To meet the criteria for a depressive episode, a person must experience 5 or more of the following symptoms:

  • depressed mood
  • changes in sleep
  • changes in eating
  • fatigue or lack of energy
  • loss of pleasure in activities once enjoyed
  • restlessness or slowing down
  • feelings of guilt or worthlessness
  • indecision or difficulty concentrating
  • thoughts of suicide

Many people with Bipolar II Disorder are diagnosed with depression because they fail to report the elevated mood symptoms of hypomania to their doctor. People with Bipolar II also may be at higher risk for substance use and eating disorders. They are also more likely to have a relative in their immediate family with a psychiatric illness. 4 To summarize, a Bipolar I diagnosis requires a manic episode but also can include depression. A Bipolar II diagnosis requires both a depressive episode and a hypomanic episode.

If you’ve experienced manic and depressive symptoms for several years without meeting the requirements for a full manic or depressive episode, then your doctor may diagnose you with what is known as Cyclothymic Disorder. Some people with Bipolar Disorder also meet the criteria for rapid cycling, which requires 4 mood episodes of depression, mania, or hypomania in a twelve-month period. Rapid cycling can occur with both types of Bipolar Disorder.5

Your Bipolar diagnosis can affect the course of treatment and medication recommended by your doctor, so it’s important to report all mood symptoms to your doctor. Treating depression and not mania could increase risk of mania episode or of suicidal thoughts and behaviors, so it’s imperative to keep track of both highs and lows.6 Because drugs and alcohol can trigger episodes of mania or depression, you may have to complete detoxification from substances before you are given a diagnosis.

Keeping track of your mood, energy level, attention span, and behaviors every day can help you receive the most accurate diagnosis. Staying informed and staying patient with the diagnostic process also gives you the best chance for managing symptoms and reducing the frequency and intensity of mood changes. With the right team of support and the right tools for keeping track of your symptoms, it is possible to manage mental illness and live a full and goal-directed life. What steps can you take today to plug into the best resources for your mind and body?

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Last Updated: May 13, 2019