Bipolar iI disorder

Bipolar II disorder is defined by the presence of a hypomanic episode in addition to at least one prior episode of depression.  In Australia, a diagnosis of bipolar II disorder is usually made by a psychiatrist using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria.

An abbreviated list of the hypomanic episode criteria according to the DSM-5-TR is below:

A.  A period of elevated or expansive, irritable mood and increased activity and energy, lasting at least 4 days in a row that is present most of the day nearly every day.

B.  The presence of 3 or more of the following symptoms:

Inflated self-esteem

This can look like: thinking that you have great talents or other abilities, feeling very attractive to others, being on top of the world and wanting to share this with others.

Decreased need for sleep

This can look like: feeling rested after only a few hours of sleep with this lasting for many days, being busy and active when you are usually asleep, having so many ideas that you don’t want to rest.

Flight of ideas or racing thoughts. 

This can look like: having too many thoughts that are hard to follow, having difficulty identifying thoughts as they are moving so quickly from one to the other, having many new ideas (e.g. new projects, business plans and activities).

More talkative than usual

This can look like: talking very quickly to keep up with the racing thoughts, people having a hard time following what you are saying, communicating more often with others and with greater intensity (e.g. posting more on social media than usual).

Distractibility

This can look like: having trouble staying on one task, having so many thoughts

and ideas that it’s difficult to follow them all, jumping from one idea to the next to

try to keep up.

Increase in goal-directed activity or psychomotor agitation

This can look like: not being able to sit still, feeling the need to move all the time,

following through with ideas and plans (e.g. starting a new business).

Excessive involvement in activities that can have a high potential for painful consequences. 

This can look like:  taking drugs, excessive shopping, driving dangerously, engaging in sexual activity that is out of character.

C.  The episode is a change in functioning that is out of character.

D.  The change is observable to others.

E.   The episode is not severe enough to cause hospitalization or severe impairment.

F.   The episode is not caused by drugs or another medical condition.

The symptoms of a hypomanic episode are similar to those of a manic episode, but the symptoms are not as severe and do not require hospitalisation.

Difference between Bipolar I and Bipolar II disorder

The key difference is that a mania episode in Bipolar I disorder will usually cause significant impairment in functioning, often resulting in hospitalisation and psychosis. A hypomania episode will not cause this same level of impairment.

Although many people report that hypomania episodes are enjoyable, others will report that they still experience negative consequences due to a hypomania episode at work and in relationships. 

For a Bipolar II disorder diagnosis, a previous history of depression is also required, unlike Bipolar I disorder, however there are several other differences between Bipolar II and Bipolar I disorder.  For example, people living with Bipolar II disorder experience more symptoms of depression and more often than those with Bipolar I disorder.  Rapid cycling is also more frequent for those with Bipolar II disorder.

Depression symptoms in Bipolar II disorder

People living with Bipolar II disorder will usually experience depression symptoms more frequently than hypomania. An abbreviated list of the Major Depressive Disorder episode criteria according to the DSM-5-TR is below:

A. Five or more of the following symptoms for 2 weeks of longer (must include depressed mood or loss of interest or pleasure).

1. Depressed mood most of the day nearly every day.

2. Loss of interest in activities most of the day nearly every day.

3. Weight loss/loss of appetite or weight gain/increase in appetite nearly every day.

4. Insomnia or hypersomnia (sleeping more than usual) nearly every day.

5. Psychomotor agitation or retardation nearly every day.

6. Fatigue and loss of energy nearly every day.

7. Feelings of worthlessness or excessive guilt nearly every day.

8. Difficulty thinking or concentrating and making decisions nearly every day.

9. Recurrent thoughts of death or dying, suicidal ideation or suicide attempt.

B.  The symptoms cause impairment or significant distress.

C. The episode is not caused by drugs or another medical condition.

Many people living with bipolar disorder also report depression symptoms outside of a full episode.  Hypersomnia (eg sleeping more than 10 hours a day) and loss of energy are some of the symptoms that are often reported frequently.

Treatment

Medication is often required for the ongoing management of Bipolar II disorder.  This may include the use of mood stabilisers (such as lithium), anti-depressants and anti-psychotic medications.  Guidelines for the treatment of bipolar disorder are published by the Royal Australians and New Zealand College of Psychiatrists (https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/mood-disorders-cpg).

These guidelines cover a range of areas and treatment types but updated advice is required from your medical practitioner. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1), 21.