Bipolar II Disorder (How Can You Cope With it?)

In this brief guide, we will look at Bipolar II disorder, Bipolar I vs Bipolar II, Bipolar Disorder Symptoms, Bipolar II medication and some other types of Management of Bipolar Disorder.

Bipolar II Disorder

Bipolar II Disorder is a subtype of Bipolar disorder where the individual modulates between phases of hypomania and Depression, and this is a milder type than Bipolar I disorder.

Bipolar II Disorder is characterized by significant mood swings between elation and grand plans coupled with overactivity and then the individual may experience periods of significant low mood and not wanting to do anything, and it is also possible that they may experience some somatic symptoms like loss of sleep or appetite as well.

Individuals with bipolar II disorder may usually go to a clinician during a major depressive episode and it is often seen that the clinician may not even realize that there was hypomania present at any point, unless they take a very keen history or talk to family or friends who may have interacted with the individual during the hypomanic phase. 

In Bipolar II disorder, it is common for the hypomanic episodes themselves to not cause impairment of social functioning or the ability to work as well, on the contrary, the impairment results comes from major depressive episodes or because of the unpredictable mood changes that accompany the mania and depression.

There is also a presence of fluctuating, unreliable interpersonal relationships or manner of relating to other people, and there may be some disruption of occupational functioning, but these are seen more during the depressive episode because in the hypomanic phase the individual might usually be in a funny and good mood and like relating to people.

Another feature of bipolar II disorder is that the patient often does not view the hypomanic episodes as pathological or disadvantageous, which may be because they enjoy feeling the sense of excitement and talent they feel in these phases, and it often works in their favor as well.

However, others around them may not share this sentiment, and people around the individual with Bipolar II disorder may often be perturbed by their erratic behavior. 

Clinical information from close friends or relatives is very crucial in diagnosing bipolar II disorder, as the individual is unlikely to give all the necessary details themselves.

Bipolar 1 vs Bipolar 2

The key distinction between Bipolar 1 vs Bipolar 2 lies in the severity of symptoms, and where Bipolar 1 disorder is characterized by Mania and severe depression, Bipolar 2 may be characterized by hypomania and a more moderate form of major depressive disorder.

One commonly seen feature in bipolar II disorder is impulsivity, which may sometimes be the reason behind suicide attempts as well, as these individuals are not always happy or elated as the stereotype behind mania would suggest, and they can also be raging or irritable.

However, in Bipolar I disorder, the depression is usually much more severe, and suicide may be a bigger risk during the depressive phase in Bipolar I.

There is also some evidence that there may be high levels of creativity in some individuals with  bipolar disorder, especially Bipolar 2 type, as it is the less severe of the two.

Another essential feature of Bipolar I disorder that is not seen in Bipolar II is that the manic episode in Bipolar I is characterized by more elevated, expansive, or irritable mood which may not necessarily be as evident in Bipolar II disorder, and this may also lead to increased activity or energy.

Usually in case of Bipolar I Disorder, the energy does not vary at all from the get go, even if the symptoms have just appeared, and the person may seem erratic right away, which may not be the case with Bipolar II Disorder.

Bipolar Disorder: Symptoms

For Bipolar disorder to be diagnosed, there need to be alternating phases of either Mania and Major Depressive episode (Bipolar I), or hypomania and Major depressive episode (Bipolar II).

To understand what it means to have symptoms of mania, hypomania and depression, let us look at the symptoms of each below:

Mania

Here are the DSM 5 symptoms of Mania:

“A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
  • More talkative than usual or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
  • Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.”

Hypomania 

Hypomania is found in Bipolar II disorder along with depression, and the DSM Criteria for this disorder are as follows:

“A Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:

  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
  • More talkative than usual or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
  • Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

The disturbance in mood and the change in functioning are observable by others.

The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).”

As one might see, the symptoms of mania and hypomania are not that different, but there’s still a difference in severity that needs to be considered.

The qualitative difference of mania and hypomania is perhaps more well-defined in the International Classification of Mental and Behavioral Disorders (ICD 10), and one might also refer to that for more details.

Depression

Depression is common to both Bipolar I and Bipolar Two disorders, but the depression in Bipolar I tends to be much more severe, and the criteria for Depressive phase is given below:

“Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, it can be an irritable mood.)

  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)nearly every day (not merely self-reproach or guilt about being sick).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. 

The symptoms cause clinically significant distress or impairment in social, occupational,

or other important areas of functioning.

The episode is not attributable to the physiological effects of a substance or another medical condition.

Bipolar II Medication

Bipolar II medication that is most commonly prescribed are antipsychotics or antidepressants, particularly if the patient has sought treatment in the middle of the depressive episode.

Once the clinical picture has become clear, the psychiatrist may prescribe the following medications for Bipolar 2 disorder:

  • Aripiprazole (Abilify) 
  • Asenapine (Saphris) 
  • Cariprazine (Vraylar) 
  • Quetiapine (Seroquel)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon) 

Management of Bipolar II Disorder

The management of Bipolar II disorder is much easier than that of Bipolar I disorder, and psychotherapy may help a lot in this condition given its relatively low severity.

The psychotherapeutic techniques used in the treatment of Bipolar II disorder are as follows:

  • Cognitive Behavioral Therapy
  • Psychoeducation (Mostly for the family or friends)
  • Psychodynamic Psychotherapy
  • Behavior therapy
  • Therapy to increase adherence to medication
  • Supportive psychotherapy
  • Interpersonal therapy
  • Rational Emotive Behavior therapy
  • Mindfulness Based Cognitive therapy.

Conclusion

In this brief guide, we looked at Bipolar II disorder, Bipolar I vs Bipolar II, Bipolar Disorder Symptoms, Bipolar II treatment and some other types of Management of Bipolar Disorder.

Bipolar disorder, whether it is Bipolar 1 or Bipolar 2, is not something that needs to be seen as something one cannot get over or manage, and it is completely conquerable for anyone who seeks the help they need.

Bipolar disorder often feels like a difficult diagnosis, and many people are also often confused about when something is just mood swings and when it counts as a bipolar disorder, which is why being aware of Bipolar symptoms can help tremendously.

If you or someone you know may be suffering from Bipolar disorder, please seek the appropriate help to treat it, and if you have any questions or comments for us about Bipolar 1 or Bipolar II disorder, let us know.

Frequently Asked Questions (FAQs): Bipolar II Disorder

What is the difference between bipolar 1 and 2?

The difference between Bipolar 1 and 2 is that while Bipolar 1 has mania and severe depression symptoms, Bipolar 2 has less severe depression and hypomania.
The main difference between Bipolar 1 and Bipolar 2 is primarily of the severity and sometimes the duration of phases may differ slightly.

Does Bipolar 2 get worse with age?

Yes, Bipolar 2 may get worse with age if it is left untreated. 
Usually, the hypomania symptoms of Bipolar 2 can turn into mania symptoms if the disorder is left untreated and the depression symptoms may also become much more severe and more frequent than when the disorder first started.

How is bipolar type 2 diagnosed?

Bipolar type 2 may be diagnosed with the help of a clinician who takes a detailed case history of the individual and ascertains based on the diagnostic criteria given by the DSM 5 or ICD 10 whether the individual has Bipolar 2.
Scales like Young Mania Rating Scale or Beck Depression Inventory may often be used in the analysis of symptoms of Bipolar 2 disorder, based on whether the individual is in a depressive or hypomanic state.

 

Citations

Diagnostic and Statistical Manual (DSM 5)

International Classification of Mental and Behavioral Disorders (ICD 10)

https://www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder#1

Divya is currently a Clinical Psychology Trainee in a Master of Philosophy program and holds a Master’s in clinical psychology. She has a special interest in Personality studies and disorders, having researched the subject before, and Neuropsychology; with an additional interest being Mood disorders. She likes to write about Psychiatric issues, having worked in multiple specialty setups during her time as a clinical psychology student, and in her free time she likes to cook and read.

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