Differences between bipolar disorder type I and type II

Bipolar disorder is a major mental health problem characterized by the appearance of acute episodes of clinically relevant sadness and mood swings, but the expression may be different depending on the subtype diagnosed.

The differences between the types are remarkable, and to determine precisely which of the two suffers, it is necessary to make a thorough examination of both the symptoms present and their history.

In addition, there is a third type: cyclothymia. In this particular case, the symptoms are less intense for each of their poles, although this also has a substantial impact on different areas of life.

In this article, we will discuss the differences between Bipolar Disorder Type I and Type II, in order to shed light on the issue and help with the accuracy of the diagnosis or treatment process, which are critical in influencing their clinic and prognosis.

General characteristics of bipolar disorder subtypes

Before we delve deeper into the differences between bipolar I and II type disorders, it is important to know the main characteristics of each of the disorders that make up the category. These are usually problems that can start in adolescence. In fact, in the event that depression occurs during this time, it can be understood as one of the risk factors for bipolarity in the future (but never decisively).

Bipolar disorder type I has, as a distinguishing feature, the history of at least one manic episode in the past or present (mood swings, irritability and hyperactivity), and can alternate with stages of depression, sadness and difficulty experiencing pleasure). Both extremes reach very high severity, so they can even lead to psychotic symptoms (especially against the background of mania).

Bipolar disorder type II is characterized by the presence of at least one hypomanic phase (of lesser impact than manic but of similar expression) and another depressive, which occur in no apparent order. For this diagnosis, it is necessary that a manic episode has never occurred before, because otherwise it would be a subtype I. To make this nuance requires a thorough analysis of past experiences, as mania can go unnoticed.

Cyclothymia would be equivalent to dysthymia, but of the bipolar prism. In this same line, there would be acute phases of mild depression and hypomania, the intensity and / or the impact would not allow to diagnose any of them separately (subclinical symptoms). The situation would persist for at least two years, causing disturbances in the quality of life and / or participation in important activities.

Finally, there is an undifferentiated type, which would include people who have symptoms of bipolar disorder but do not respond to any of the diagnoses described above.

Differences between bipolar disorder type I and type II

Bipolar disorder type I and type II, as well as cyclothymia and undifferentiated disorder, are included in the category of bipolar disorder (formerly called manic depression). Although they belong to the same family, there are important differences between them that must be taken into account, as proper diagnosis is essential to provide treatment tailored to the care needs of each case.

In this article, we will deal with possible differences in variables related to epidemiology, Such as distribution and prevalence by sex; as well as in other clinical factors such as depressive, manic and psychotic symptoms. Finally, the specific form of presentation (number of episodes) and the severity of each case will be taken into account. In the long term, in addition, the particularity of cyclothymia will be approached.

1. Breakdown by sex

There is some data suggesting that major depression, the most common of the problems included in the category of mood disorders, is more common in women than in men. The same is true for other psychopathologies, such as those included in the clinical spectrum of anxiety.

However, in the case of bipolar disorder, there are slight differences from this trend: data suggests that men and women suffer from type I with the same frequency, but not the same for type II.

In this case, women are the population most at risk, as is the case with cyclothymia. They are also more prone to mood swings associated with the time of year (seasonal sensitivity). These results are subject to discrepancies depending on the country in which the study is conducted.

2. Prevalence

Bipolar disorder type I is slightly more common than type II, with a prevalence of 0.6% versus 0.4%, According to meta-analysis work. It is therefore a relatively common health problem. In general (if both modalities are considered at the same time), it is estimated that up to 1% of the population may suffer from it, a figure similar to that seen in other mental health problems other than this (such as schizophrenia).

3. Depressive symptoms

Depressive symptoms can occur in both type I and type II bipolar disorder, but there are important differences between the two that should be taken into account.. The first is that in type I bipolar disorder, this symptom is not necessary for diagnosis, although a very high percentage of people who have it end up having it (over 90%). In principle, only one manic episode is necessary to corroborate this disorder.

In type II bipolar disorder, however, its presence is mandatory. The person who suffers from it must have experienced it at least once. It usually tends to occur recurrently, interspersed with periods in which the mood acquires a different sign: hypomania. In addition, it has been observed that depression in type II is generally more durable than in type I, hence another of its differentiating characteristics.

In the case of cyclothymia, the intensity of depressive symptoms never reaches the threshold of clinical relevance, unlike in bipolar disorder types I and II. In fact, this is one of the main differences between cyclothymia and type II.

4. Manic symptoms

Expansive, sometimes irritable mood is a common occurrence with bipolar disorder in one of its subtypes.. It is not an uplifting joy, nor associated with a state of euphoria congruent with an objective fact, but acquires a crippling intensity and does not correspond to precipitated events that can be identified as its cause.

In type I bipolar disorder, mania is a necessary symptom for diagnosis. It is characterized by a state of extreme expansion and omnipotence, which results in impulsive acts based on disinhibition and a feeling of invulnerability. The person is too active, engaged in an activity to the point of forgetting to sleep or eating, and engaging in acts that carry a potential risk or that can lead to serious consequences.

In type II bipolar disorder, the symptom exists, but does not present with the same intensity. In this case, a great expansion is shown, unlike the mood which is usually shown, sometimes acting expansively and irritably. However, the symptom does not have the same impact on life as the manic episode, so it is considered a milder version of it. As with type I bipolar disorder when it comes to mania, hypomania is also necessary for the diagnosis of type II.

5. Psychotic symptoms

Most psychotic phenomena associated with bipolar disorder are triggered against the background of manic episodes.. In this case, the severity of the symptom may reach the point of shattering the perception of reality, so that the person forms delusional beliefs about their abilities or personal relevance (consider someone so important that others must approach it in a special way, or make sure you have a relationship with famous personalities in art or politics, for example).

In hypomanic episodes, associated with type II, there is never a sufficient severity for them to come to express such symptoms. In fact, if they were to appear in someone with bipolar type II disorder, they would suggest that what is actually being experienced is a manic episode, so the diagnosis should be changed to bipolar type I disorder.

6. Number of episodes

It is estimated that the average number of episodes of mania, hypomania or depression that a person will experience throughout their lifetime is again. However, there are some obvious differences between those who suffer from this diagnosis, which are due to both their physiology and their habits. So, for example, those who use illicit drugs have a higher risk of experiencing clinical changes in their mood, as well as those who have poor adherence to pharmacological and / or psychological treatment. In this sense, there is no difference between subtypes I and II.

In some cases, some people may express a particular course due to their bipolar disorder, in which a very high number of acute episodes is observed., Mania and hypomania or depression. They are fast cyclists, who exhibit up to four clinically relevant turns each year of their life. This form of presentation can be associated with both type I and type II bipolar disorder.

7. Severity

It is possible that after reading this article many people will conclude that type I bipolar disorder is more serious than type II because in this sense the intensity of manic symptoms is greater. The truth is, this isn’t exactly the case and subtype II should never be considered the mild form of bipolar disorder. In both cases, there are significant difficulties in daily life, and therefore there is a general consensus on their equivalence in terms of severity.

While in subtype I the episodes of mania are more serious, in type II depression is mandatory and its duration is longer than that of type I. In contrast, type I psychotic episodes can occur during manic phases, which implies additional perspectives of intervention.

As can be seen, each of the types has its own peculiarities, so it is essential to articulate an effective and personalized therapeutic procedure that respects the individuality of the person who suffers from it. In all cases, the choice of psychological approach and medication should be tailored to the care needs (although mood stabilizers or anticonvulsants are necessary), focusing on how the person is ‘he is living with his mental health problem.

Bibliographical references:

  • Hilty, DM, Leamon, MH, Lim, RF, Kelly, RH & Hales, RE (2006). A review of bipolar disorder in adults. Psychiatry (Edgmont), 3 (9), 43-55.
  • Phillips, ML and Kupfer, DJ (2013). Diagnosis of bipolar disorder: challenges and future directions. Lancet, 381 (9878), 1663-1671.

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