The jury is still out as to exactly how many types of bipolar disorder there actually are.
Bipolar disorder is sometimes conceptualized as a spectrum of disorders, where severity occurs along a continuum.
The DSM-5, the bible of psychiatry, lists three specific bipolar types and any types not fitting the diagnostic criteria for one of these three specific types gets categorized as:
- Substance/Medication-Induced Bipolar and Related Disorder
- Bipolar and Related Disorder Due to Another Medical Condition
- Other Specified Bipolar and Related Disorder
- Unspecified Bipolar and Related Disorder
Despite the authority of the DSM-5 for many US psychiatrists, it is very important for you to understand that there is no clear consensus as to how many types of bipolar disorder exist.
The classification of bipolar disorder types is a controversial area with the spectrum theory coming under both increasing attack and consideration.
More on this later . . .
(Arguably there is one more bipolar type that deserves separate attention: treatment resistant bipolar disorder).
Bipolar Type 1
Bipolar Type 1 is characterized by at least one manic or mixed episode.
The mania in Bipolar 1 is serious and can even involve bipolar psychosis.
It can also include episodes of major depression or hypomania.
Substance-induced episodes due to the effects of medications, drugs or exposure to toxins or episodes caused by a medical condition must be ruled out before a patient can be diagnosed as having bipolar I disorder.
Additionally, other mental health disorders must be excluded, as well.
Learn more about manic bipolar
Bipolar Type 2
Bipolar Type 2 disorder often goes undiagnosed or Major Depressive Disorder is diagnosed instead, as the hypomanic episodes are not considered. Bipolar Type 2 is characterized by at least one hypomanic episode, (hypomania meaning literally ‘below mania’), and one major depressive episode.
Usually in Bipolar Type 2 the depressive episodes are more intense and more frequent than the hypomania, making those with Bipolar II still a suicide risk.
Hypomanic behavior in individuals is often seen as high-functioning when it is contrasted with the behaviors exhibited during major depressive episodes.
Often, only physicians and psychiatrists specializing in mood disorders would recognize the high confidence, ambition and unrealistic goals as a symptom of hypomania.
During these episodes, you may experience racing, disorganized thoughts, anxiety, irritability, insomnia or a combination of all of these symptoms.
Sometimes these negative, agitated symptoms make it difficult to tell the difference between depression and a bipolar II hypomanic episode.
The DBSA (Depression and Bipolar Support Alliance) have combined a self-check for Bipolar Type 2 in this neat summary of the bipolar disorder types.
The third bipolar type is called Cyclothymic Disorder.
This is a serious mental and mood disorder that causes depressive and hypomanic but not full hypomanic or depressive episodes.
Medically it is defined as recurrent cycles of both of these types of symptoms .
This includes symptoms such as trouble making decisions, difficulty concentrating, guilt, memory impairment, self-criticism, pessimism, hopelessness, irritability, social withdrawal, fatigue and insomnia.
Some people with this type of bipolar disorder are fully functioning and in some cases, hyper-productive.
Because people with cyclothymia and hypomania can be so high-functioning, creative and out-going, the condition often goes undiagnosed.
It is only during extreme depressive episodes that some individuals seek help at all. Others just live with the disease and chalk it up to being moody.
A good way to understand why we currently categorize bipolar types in a particular way is to discover the history of bipolar disorder.
Other Specified Bipolar and Related Disorder
If you do not fit into any one of these categories, you may be diagnosed as Other Specified Bipolar and Related Disorder (previously known as Bipolar Disorder Not Otherwise Specified [NOS]) .
Estimates place two and a half percent of the population in this category, more than I and II combined.
Bipolar I and II have specific conditions that must be met for the diagnosis. For example, one specifier states there must be a full remission between two episodes before an individual is diagnosed as one of the three bipolar disorders.1
If you do not meet all of the specifiers of one of the types of bipolar disorder, you will probably be diagnosed as Other Specified Bipolar and Related Disorder.
Part of the bipolar spectrum disorder theory is to allow for a broad range of patients to fall into a category known as soft bipolar.
Bipolar Type 3?
Some experts such as Dr Jim Phelps also consider the types of bipolar disorder to include Bipolar Type 3 – when an antidepressant causes the patient to switch into mania or hypomania.
Finally, see Bipolar Spectrum Disorder: A Problematic Concept to understand why some experts want to more strictly define and limit the types of bipolar disorder, and fear a loose adoption of the spectrum theory leads to over-diagnosis.2