The difference between bipolar 1 and 2, and how to recognize symptoms

The main difference between bipolar 1 and bipolar 2 is the intensity of manic episodes.

Those with bipolar 1 experience more severe mania, whereas people with bipolar 2 may have less intense manic symptoms, and more depressive episodes.

However, bipolar disorder exists on a spectrum, so it’s possible your symptoms don’t fit with either type 1 or 2.

This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center.

Bipolar disorder refers to a group of complex mental health disorders that affects about 4.4% of all people in the US at some point in their lives – one of the highest rates globally.

People with bipolar disorder have extreme mood swings, also called cycles or episodes, that may range from a deep depression to a manic high. It is a lifelong condition, but some people go years without having episodes; others may experience several per year.

While there are two main types of bipolar disorder – bipolar 1 and bipolar 2 – the disorder also exists on a spectrum. Here are the main distinctions between different types of bipolar disorder:

What is the difference between bipolar 1 and bipolar 2?

The main difference between bipolar 1 and 2 is the intensity of manic episodes. Bipolar 1 involves periods of severe mania whereas bipolar 2 involves periods of less severe hypomania.

A manic episode lasts for at least one week, and its effects are intense and debilitating, affecting someone’s personal life and ability to work.

Symptoms include erratic behavior like talking too rapidly and loudly, breaking the law, and driving or spending money recklessly. A manic episode may also cause someone to have overblown feelings of self-importance or to experience hallucinations and delusions. There must be at least one episode of mania for a diagnosis of bipolar 1.

Meanwhile, those with bipolar 2 experience similar, but less intense symptoms in a hypomanic episode. They may feel euphoric and excited for a few days. They may be extremely physically active, appear agitated, and have difficulty sleeping.

Not everyone who has hypomanic episodes has bipolar disorder. It is possible for someone to be diagnosed as having bipolar 2, and then to have an episode of mania that changes their diagnosis to bipolar 1.

Prevalence of depressive episodes is another difference between bipolar 1 and 2. A bipolar 2 diagnosis requires a patient to experience one or more depressive episodes. Although those with bipolar 1 may also experience a major depressive episode, it is not a diagnostic requirement.

Bipolar 1 diagnostic criteria

A 2018 study published in Therapeutic Advancements in Psychopharmacology found that about 0.6% of all people have bipolar type 1, making it more commonly diagnosed than bipolar type 2.

[Criteria for a diagnosis]

https://www.mayoclinicproceedings.org/article/S0025-6196(17)30544-X/pdf of bipolar 1 include:

At least one lifetime manic episode

The manic episode was not the result of medication, substances, or another medical illness

A depressive episode may be present, but is not required for diagnosis

Bipolar 2 diagnostic criteria

Bipolar 2 affects 0.4% of all people, according to a 2018 study published in Therapeutic Advancements in Psychopharmacology.

Women are more likely than men to have bipolar 2, and to experience more episodes of depression, says Crystal Clark, MD, an associate professor of psychiatry and behavioral sciences and OB/GYN at Northwestern University.

[Criteria for a diagnosis](https://www.mayoclinicproceedings.org/article/S0025-6196(17)30544-X/pdf) of bipolar 2 include:

At least one-lifetime hypomanic episode

At least one-lifetime major depressive episode

Neither of these episodes was the result of medication, substances, or another medical illness

The bipolar spectrum

As well as the extremes of mania and depression that characterize bipolar 1 and 2, there are related disorders with milder symptoms that fall into what’s called the bipolar spectrum.

Cyclothymia is a form of bipolar disorder characterized by less intense mood swings over a period of at least two years.

People with cyclothymia experience symptoms of hypomania and depression like extreme happiness and low energy, but may not fit all the diagnostic criteria of a manic or depressive episode. To be diagnosed with cyclothymia, one cannot have more than two symptom-free months in a row.

Unspecified bipolar disorder is when a person has symptoms of depression and hypomania or mania, yet their overall health picture doesn’t completely match existing categories. For example, a person may have manic episodes, but they don’t last long enough to qualify as bipolar 1. This is more common with children or adolescents, whose cycles may be as short as a day.

Still, they typically go on to have full-fledged episodes and to be diagnosed with bipolar 1 or 2, says David Miklowitz, PhD, a professor of psychiatry at the UCLA Semel Institute and author of The Bipolar Disorder Survival Guide. For that reason, clinicians often treat unspecified bipolar disorder mainly as an indication that a person is at risk for developing bipolar 1 or 2.

Another clue is a family history of bipolar disorder, as genetics is the biggest risk factor for eventually developing it.

How to get a bipolar disorder diagnosis

Health providers diagnose bipolar disorder through patient interviews, typically following a questionnaire on mood disorders.

However, it’s a difficult diagnosis to make. Some symptoms develop and reveal themselves over time, or they look similar to other mental health problems. When symptoms are less severe, like those of hypomania, they are usually not debilitating, and may appear to be personality traits, like being an extreme extrovert or overachiever.

In fact, there is an average seven year delay from the time a person first visits a health professional with symptoms to receiving a bipolar diagnosis from a mental health professional.

“Most often people are presenting with symptoms to their health provider when they are depressed, and it looks very similar to major depressive disorder. With hypomania, when people have high levels of energy, and need to sleep less, and are maybe goal oriented or productive, they are like, ‘Well, that’s great,'” Clark says.

Mania may also be misdiagnosed as borderline personality disorder, or confused with attention-deficit hyperactivity disorder (ADHD). Bipolar is often misdiagnosed as ADHD because manic symptoms resemble hyperactivity and the lack of motivation associated with depression can seem like inattention.

When to see a doctor

There are two ways to know if you need to see a doctor regarding your symptoms, Miklowitz says. The first is if you answer yes to any of the following questions:

Am I unable to do my work?

Is it difficult to get through the day?

Am I feeling anxious or depressed?

Am I flying high and making reckless choices?

The second way is when other people express being disturbed or worried about changes in your behavior, whether you agree with them or not. Miklowitz says the following questions from friends indicate your symptoms are starting to affect your interactions with others:

Is something going on with you?

You seem to be acting recklessly, are you okay?

You seem to be having a tough time at work, is there something going on?

Treatment for all bipolar disorders typically involves medication and regular psychotherapy.

Takeaways

The main difference between bipolar 1 and 2 is the severity of manic episodes. People with bipolar 1 must experience a manic episode and may or may not experience a major depressive episode. Meanwhile those with bipolar 2 experience hypomania and must experience a depressive episode to be diagnosed.

Bipolar disorder exists on a spectrum. Therefore, even if you don’t experience all the symptoms of bipolar 1 and 2, you may have some other form of bipolar like cyclothymia. Reach out to a doctor if your symptoms or behavior are interfering with your day to day life and relationships.

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