Bipolar disorder has four distinct types and is a bigger problem than people realize. Currently, this disorder affects more than 5.8 million Americans. With the rates of mental illnesses rising in the U.S., it’s clear this battle will not end soon.
The characteristics of bipolar disorder revolve around normal, manic, and depressive phases. The term “Euthymia” refers to having a normal mood. This ‘normal’ phase means being in a positive, tranquil, and stable mental state.
In the manic phase, the individual has an abnormal elevated arousal state. As such, they could be feeling euphoric, hyperactive, energetic, or irritable. They could also have frenzied speech, delusions, and a decreased need for sleep.
Depressive phases manifest in form of deep sadness, low mood, despair, and lethargy. Sufferers feel ashamed, hopeless, worthless, and unlovable. They sleep during the day and experience insomnia at night.
Read on to learn the types and causes of bipolar disorder.
Causes of Bipolar Disorder
According to the Centers for Disease Control and Prevention (CDC), bipolar disorder’s average start is 25 years.
Though it is more common in women, men have an earlier onset of the disease. Women may start with a depressive phase while men may start with a manic episode.
Doctors don’t know the exact cause of this disorder. Even so, the likely causes are:
- Genetic factors and family history
- Stressful or traumatic events
- Alcohol and drug abuse
- Presence of another anxiety disorder, such as depression
- Biological or neurological changes, for example, due to hormonal imbalances
- Environmental factors, such as having a bipolar parent
Various studies show certain genes increase the chance of having the disease. As for family history, many bipolar patients have someone in the family who has the disease as well. To be clear, having this family history does not mean the illness will occur.
Stressful events could involve death or being in an abusive relationship. They could involve suffering long-term illness. Such events trigger immense grief, pain, and even illness due to a weakened immune system.
Over time, this stress becomes chronic and starts affecting other areas of the person’s life. Signs of this appear as anxiety, weight gain, affected memory, and high blood pressure.
Alcohol and drug abuse rewire the brain thus making it dependent on the substances. This rewiring is part of the biological or neurological changes causing mental illnesses. The substances can also interrupt sleeping patterns and change a person’s mood.
Last, going through childhood adversity also plays a role in becoming bipolar. University of Manchester researchers found childhood adversity increased the risk of the disease. Examples of adversity range from neglect, the death of a parent, violence, to bullying.
Unfortunately, bipolar disorder lasts a lifetime. As such, patients must learn how to manage their symptoms. If not, they could become a danger to themselves and others.
It comes in four types: bipolar I, bipolar II, cyclothymic, and unspecified disorder.
Before we analyze these bipolar types, let’s first look at its signs and symptoms.
Signs and Symptoms of Bipolar Disorder
On average, it may take up to 6 years for someone to get a bipolar disorder diagnosis. This could be due to the difficulty of differentiating it from depression. It could also be due to the presence of a co-occurring disorder or addiction.
The American Journal of Managed Care says 56 percent of bipolar people have an addiction. Alcohol is the substance bipolar people abuse the most. Such substances complicate the disorder screening process. They make it difficult to make a timely and accurate diagnosis.
It’s tough to diagnose young patients as well. That’s because teenagers are at the age where they can experience constant mood swings. Some of them also experiment with many drugs. This skews the results of their medical checkups.
Patients go through about three incorrect diagnoses before doctors discover they are bipolar. Dr Wes Burgess wrote that in “Bipolar Handbook: Real-Life Questions with Up-to-Date Answers”. This means people suffer from their symptoms for years before they get treatment.
The problem with this condition going untreated is it may destroy the person’s life. It leads to bankruptcy, risky behavior, substance abuse, deteriorating relationships, and death. Moreover, struggling to understand ones risky actions can cause more stress.
As mentioned earlier, the various symptoms appear during one of the patient’s episodes. Out of the normal phase, the patient will be in a depressive or manic state.
In the manic state, the patient feels ‘high’ or ‘wired’. Wired is a term meaning someone is over stimulated, overexcited or overactive. Thus, the individual engages in irresponsible behaviors, such as going on spending sprees. They may also engage in reckless sexual behaviors.
Other symptoms include having distracted and racing thoughts, being talkative, and being sleepless.
With depressive episodes, the individual feels sad and empty. They feel weak, tired, and lethargic. They no longer find pleasure in activities they used to like. Plus, they don’t feel like doing anything.
Depressed people are unable to think critically or concentrate. They also become forgetful. Moreover, they carry a lot of guilt and feelings of worthlessness. They no longer socialize and this makes them very lonely. They may start isolating themselves on purpose.
Unlike the manic who doesn’t sleep, the depressed person goes from one extreme to the next. At night, they suffer from insomnia. Even if they manage to sleep, they keep waking up during the night. Then, during the day, they feel very sleepy and end up sleeping for long hours.
If this depressive state lasts long, the patient may start contemplating suicide. They feel no one loves them anymore. They also believe no one will miss them when they are gone. They think it would be better for everyone if they were no longer alive.
Aside from these two extreme states, there’s also a fourth state called hypomania. This is a less severe form of mania. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) sees hypomania as distinct from mania.
Hypomania is the first stage of manic episodes. It lacks the symptom of psychosis that defines mania. It appears during the mid to late teenage years. The difference between mania and hypomania is the hypomanic remains functional and productive.
Some prescription drugs such as norepinephrine can trigger hypomania. Such effects make people worry prescription pills are more dangerous than illicit drugs. The good news is lowering the dosage of the pills will remove the bad side effect. Alternatively, the patient can withdraw from or change the medication.
When hypomania gets extreme, it has the name hyperthymia. This is a state where the patient experiences hypomania on a long-term basis. Yet, hyperthymia is more stable. It has the following symptoms:
- High-energy and tirelessness
- Extroversion and attention seeking behavior
- High productivity and performance
- Extreme talkativeness and tendency to repeat oneself
- Risk-taking behavior
- Strong sex drive
Let’s take a deeper look at the types of bipolar disorder.
In-depth Look at the Types of Bipolar Disorders
Bipolar I Disorder: Definition, Causes, Symptoms, and Treatment
Bipolar 1 disorder goes by the name manic-depressive disorder. The pronunciation is “bipolar one”.
A person must experience at least one manic episode to have the bipolar 1 classification. They must also have a depressive episode at some stage. The depressive episodes last longer than the manic ones.
Manic episodes progress from the hypomanic stage to full-blown mania. Thus, the patient has the atypical elevated mood and energy. Experiencing one manic episode is the key to making an accurate diagnosis.
Later, the individual may cycle through the manic and depressive phases. This causes a disruption in their lives. Their mood may go from feeling euphoric to being irritable. Add the reckless behavior and this disorder can have serious repercussions.
For example, people in the manic phase might feel overconfident. They might carry themselves in a grandiose manner. As such, this might lead them to spend all their money to match their perceived status.
Untreated manic episodes last for weeks or months. Thereafter, the depressive phase takes over. These depressive episodes have the same symptoms as clinical depression.
Psychosis: Symptoms, and Causes
In dire circumstances, the manic episodes may trigger psychosis. In this state, the individual is no longer in touch with reality. It ranges from engaging in abnormal behavior to being in a disturbed mental state.
The symptoms of psychosis include hallucinations, persecutory delusions, catatonia, and disturbed thought patterns. Catatonic expressions involve being in trance, experiencing seizures, or doing something repeatedly.
Some of the causes of psychosis are the same as the bipolar 1 causes. These include genetics, neurobiology, chronic stress, and early environmental factors.
Other causes range from sensory and sleep deprivation to caffeine intoxication. Psychoactive drugs such as methamphetamines and LSD also play a role.
Diagnosing and Treating Bipolar I Disorder
Diagnosing bipolar 1 involves ruling out substance-induced symptoms and other mental disorders. As you know, some medications, drugs, toxins, and treatments can cause bipolar-like symptoms.
Mental disorders like schizophrenia can have bipolar 1 symptoms. Examples include delusions, social withdrawal, and disorganized thoughts and speech patterns.
Thus, the doctor must do several medical assessments. They may use drug tests, ultrasounds, CAT scans, and an EEG (electroencephalogram). Other tests will check the blood, urine, thyroid, and liver.
Once they get a bipolar 1 diagnosis, the patient will receive Lithium medication. They might also use antipsychotics, electroconvulsive therapy, and anti-seizure drugs.
Bipolar II Disorder: Definition, Causes, Symptoms, and Treatment
The pronunciation of this disorder is “bipolar type 2” or “type 2 bipolar”. To diagnose bipolar 2, there must be at least one episode each of hypomania and major depression.
One key feature of bipolar II disorder is the patient should never have had a manic episode. Plus, the hypomania must last more than four days.
Type two bipolar patients suffer depression longer than they do with hypomania. Due to this, there is a tendency to misdiagnose it as unipolar depression. Doctors don’t spot the hypomania symptoms. This is because people with hypomania continue functioning normally in their daily lives.
A hypomanic episode appears normal because everyone sometimes has the same experiences. These include feeling happy, energetic, sleeping less, and wanting to compete with others. Yet, an important difference is bipolar II patients can suffer mixed episodes. This means they could have both hypomanic and depressive symptoms.
The episodes may even cycle from one to the other in a rapid and distinct manner. Doctors call this “rapid cycling”. The depressive episodes become more frequent and mirror symptoms of clinical depression. Symptoms can be thoughts of worthlessness, despair, and suicide.
Diagnosing and Treating Bipolar II Disorder
Diagnosing type two bipolar is difficult because patients suffer a long depressive phase. They never account for the times when their mood is higher than normal. Thus, doctors focus on treating depression without being aware of the hypomania.
Getting the right diagnosis prevents the adverse effects of antidepressants on bipolar patients. Doctors use mood disorder screening tests to identify disorders in the bipolar spectrum. The spectrum is a framework for defining different disorders and mental health illnesses.
Bipolar 2 treatment uses psychotherapy, mood stabilizers, dopamine agonists, and antipsychotic medication.
Doctors must prescribe different mood stabilizers to prevent recurrent episodes. They can also try benzodiazepines to control insomnia and anxiety.
Cyclothymic Disorder: Definition, Causes, Symptoms, and Treatment
Cyclothymia is a mild form of bipolar disorder. Its unofficial name is “bipolar 3”. It has persistent or recurring changes to and from mild depression to hypomania. Normal moods do not last more than 8 weeks.
The DSM-V notes that cyclothymic disorder does not have dramatic mood changes. The depressive states are brief and don’t have the symptoms of major depression. Moreover, hypomania doesn’t reach full mania levels.
Still, the emotional highs and lows must last for at least 2 years to get the term cyclothymia. There should not be a gap of more than two months between symptoms.
About 1 percent of Americans have cyclothymia. Its onset is around adolescence. The pattern of this disorder is unpredictable. No one is sure about its causes either. Yet, family history and genetics seem to be the likely ones.
Diagnosing and Treating Bipolar 3
This illness does not present the full-blown symptoms of other disorders. Despite this, the depressive episodes make the patient seek treatment.
Patients experience chronically unstable moods and engage in risky behavior. These mood swings create problems in relationships. There could be instances of alcohol and drug abuse as well.
Doctors struggle to diagnose this disorder because it can co-occur with other disorders. It can also present the same symptoms as another disorder. An example is the increased energy present in Attention Deficit Hyperactivity Disorder (ADHD).
Bipolar 3 treatment involves the use of mood stabilizers such as lithium. Making sure the mood remains stable could prevent the risk of suicide.
Unspecified Bipolar Disorder: Definition, Causes, Symptoms, and Treatment
Some bipolar disorders don’t have a specific pattern. They also don’t match the other three disorders. Yet, they still have to meet the criteria for abnormal mood changes.
The subtypes of bipolar disorder are bipolar 4 and 5. They are subthreshold types of disorder. This means their symptoms are not as pronounced.
Bipolar IV Disorder
In this subtype, hypomanic and manic episodes come from taking antidepressant drugs. Doctors prescribe antidepressant medication to treat other types of mental illness. Unfortunately, this can trigger bipolar disorder.
Patients must then learn to cope with the manic and depressive feelings. They must learn to avoid substances like alcohol as well.
Bipolar V Disorder
This subtype involves people who have genetic bipolar disorder. The patient only suffers from major depression despite a family history of bipolar disorder.
Comparing the Bipolar Disorders
Now that you know what these disorders entail, we can look at their key differences. We can start by comparing bipolar 1 vs. 2.
Bipolar Disorder and Co-Occurring Disorders
It is common for various mental illnesses to occur alongside other disorders. For example, about half of mental disorder patients have a substance abuse disorder.
Overlapping bipolar spectrum conditions include ADHD, Borderline Personality Disorder (BPD), and eating disorders. You can also count other anxiety disorders.
Such comorbid conditions complicate the treatment process. They may also increase the effect of the symptoms. In worst-case scenarios, they may increase the likelihood of suicide.
Difference Between Type 1 and Type 2
The main difference between type 1 and type 2 bipolar is full manic episodes. Bipolar II patients don’t go beyond hypomania. Second, bipolar II disorder has more frequent cycling than bipolar I disorder. It also has a more chronic course than type 1.
When it comes to diagnosis, it is much easier to confirm bipolar 1 than bipolar 2. This is because type 1 looks for evidence of a manic episode. Type 2 depends on identifying hypomania after emerging from a depressive state.
Bipolar II patients are more likely to commit suicide than those with bipolar I disorder.
Difference Between Type 1 and Type 3
It is simple to differentiate type 1 bipolar and type 3 bipolar. Bipolar 1 involves more severe episodes. With bipolar 3 the symptoms are milder and do not get into a full manic episode.
Though it is more difficult to diagnose bipolar III, treatment options don’t vary by much. It’s not safe to use antidepressants to treat bipolar III cyclothymic disorder. Thus, the mood stabilizers in bipolar 1 will work for bipolar 3.
Difference Between Type 2 and Type 3
Bipolar II disorder has episodes of hypomania and major depression. Bipolar 3 does not reach the level of a major depressive state. It is possible to go from bipolar 3 to 1 or 2 but it doesn’t work the other way around.
The emotional highs and lows of bipolar 3 are milder than those in bipolar 2. The hypomania in bipolar 3 doesn’t reach the level of bipolar 2. Moreover, none of these disorders gets to a full manic state as with type 1.
As for the unspecified disorders, bipolar 4 can emerge due to taking medications for bipolar 1, 2, and 3. Bipolar 5 has to deal with major depression, the same type as with bipolar 2.
To wrap up, let’s look at the disorders that occur alongside bipolar disorder.
Living with Bipolar Disorder
Bipolar disorder patients can learn to cope with this lifelong illness. They must also make every attempt possible to reduce and manage their symptoms.
Common steps involve using medication, going to therapy, and avoiding episodic triggers. The patient can make lifestyle changes such as taking up exercise. They should focus on sleeping well, reducing stress, and avoiding substance abuse.
The preferred medication includes lithium, Carbamazepine, Lamotrigine, and antipsychotic medications such as Olanzapine. Therapies can include psychotherapy, electroconvulsive therapy (ECT), and cognitive behavioral therapy (CBT).
Preventing childhood abuse or drug misuse may avert the risk of bipolar disorder. Yet, that won’t account for the genetic and familial factors. More research is necessary to enhance prevention measures and to improve diagnostic mechanisms.