What Are the Differences Between Bipolar I and Bipolar II Disorder?

Bipolar disorder is a mental health condition characterized by fluctuations in mood and energy levels. Each person with the condition is affected differently. However, the length and intensity of manic, hypomanic, or depressive episodes will determine the type of bipolar disorder a person is diagnosed with.

Read more to learn about the types of bipolar disorder and the differences between bipolar I and bipolar II.  

Types of Bipolar Disorder

Types of bipolar disorder are differentiated by their symptoms and the duration of those symptoms. There are a few types of bipolar disorder, including:

• Bipolar I disorder: One episode of mania must occur and last for at least one week. Mania is characterized by an extreme elevation of mood and energy. An episode of hypomania or depression may precede or occur after the manic episode.
• Bipolar II disorder: At least one episode in which symptoms of hypomania (a less-intense form of mania) persist for at least four days, as well as the occurrence of one major depressive episode.
• Cyclothymic disorder: Over the course of two years, symptoms of hypomania and depression persist, but do not meet the criteria for a full-blown episode.

Regardless of the type, bipolar disorder can significantly impact a person's daily life.

Differences Between Bipolar I and Bipolar II

Bipolar I and II are similar in that periods of elevated mood and symptoms of depression can occur in both types of the condition.

The main difference between the two types is the degree to which mania presents.

In bipolar I disorder, a person experiences a full manic episode, which causes extreme changes in mood and energy. Symptoms are severe enough that they may interfere with a person's functioning at home, school, or work.

Less severe symptoms occur during a hypomanic episode, which are present in bipolar II disorder. In hypomania, a person experiences an elevated mood, but it isn't as intense and doesn't last as long as a manic episode.

Ultimately, these types share similar symptoms, but the way in which they are experienced can be different.

Symptoms

During a manic episode, a person can experience the following symptoms for at least a week:

• Euphoria/elevated mood or irritability
• Decreased need for sleep
• Distractibility (e.g., poor focus and multitasking)
• Excessive talking 
• Participation in risky activities (e.g., excessive spending, sexual encounters, and substance use)
• Racing thoughts
• Inflated sense of self
• Psychosis (hallucinations, delusions,and disorganized thinking)
  

Symptoms of hypomania mirror those of mania, except they last for a shorter period, at least four days, and are less severe. 

Depression in bipolar disorder might look like:

• Sadness or low mood
• Low energy
• Feelings of hopelessness, powerlessness, and worthlessness
• Changes in sleeping patterns (typically a need for more sleep)
• Lack of interest or joy in daily activities
  
• Decreased appetite
• Isolation and withdrawal
• Feelings of guilt
• Psychomotor agitation
• Thoughts of death or suicidal thoughts
  

Causes

While the cause of bipolar disorder is not entirely understood, genetics and environmental factors may contribute to the onset of the condition.

The risk of developing bipolar disorder is higher in people with a first-degree relative (a parent or sibling).

Environmental factors such as maltreatment during childhood, trauma, or experiencing significant life events may also influence the onset of the disorder, as stress may be a trigger. For those who have bipolar disorder, lack of sleep can trigger a manic or hypomanic episode.

Further research is needed to enhance understanding and expand on the potential causes of bipolar disorder.

Diagnosis

There is no definitive test a person can take to determine if they have bipolar disorder. However, getting a mental health evaluation with a psychiatrist or licensed psychologist is the first step toward getting a diagnosis.

During an assessment, a licensed mental health professional gathers information about a patient’s psychological health, including the intensity and severity of symptoms. This process allows them to get a complete picture of a patient’s history and current concerns to make an accurate diagnosis.

To specifically diagnose bipolar I vs. bipolar II, a mental health professional will need to review any manic, hypomanic, and depressive episodes that have occurred.

They may also recommend that patients seek a physical evaluation so a healthcare provider can rule out potential medical conditions that could be causing symptoms.

Upon diagnosing a patient with bipolar disorder, conversations about treatment will begin. 

Treatment

Though they are different types, treatments for bipolar I and bipolar II are very similar.

Medications are used to help stabilize the mood of patients with bipolar disorder. These can include:

• Mood stabilizers, such as lithium, valproic acid, and lamotrigine, may be used to combat mania and depression.
• Antipsychotics can treat mania and psychosis.
• Alpha-2 adrenergic agonists, such as Igalmi (dexmedetomidine) may be used to treat agitation associated with bipolar I or II. 
• Antidepressants are an option, but they may not be prescribed to treat bipolar I disorder, as they can trigger episodes of mania.

Working closely with a psychiatrist can help with finding the right medication combination for you. It also creates an opportunity for patients to consistently monitor their symptoms, discuss any changes, or get questions about medication answered. 

Talk therapy is also effective for treating bipolar disorder, especially in conjunction with medication. Patients can learn more about a diagnosis, identify triggers and patterns, and establish coping and safety plans as needed.

Various therapy methods can be used in the treatment of bipolar disorder, including cognitive behavioral therapy and family-focused therapy. A cognitive approach helps clients to develop healthy thoughts and behaviors, and cope with difficult feelings. Family-focused strategies can provide education and understanding for family members and a person’s support system.

Additionally, treatment interventions that focus on creating a routine and healthy habits can benefit people with the condition.

Coping

Being diagnosed with bipolar disorder can be overwhelming.

On one hand, it may be a relief for some to have a diagnosis, which can help patients learn more about the condition and provide context for their experiences. On the other hand, a diagnosis can stir up feelings of anxiety or fear about their prognosis.

Part of living with and receiving treatment for bipolar disorder is learning to accept the condition and take care of yourself. Helpful coping strategies might include:

• Working consistently with a mental health care team (psychiatrist and therapist)
• Establishing a support system
• Getting consistent sleep (sleep disruption is the most common trigger for a manic episode)
• Identifying and engaging in self-care activities like exercising, which can help alleviate depressive symptoms
  
• Being compassionate toward yourself
• Joining a mental health support group
  

Summary

Bipolar disorder is a mood disorder characterized by extreme changes in a person's mood and energy. There are various types of bipolar disorder, including bipolar I and bipolar II. In bipolar I, a person must experience at least one manic episode (heightened, elevated mood). In bipolar II, a person may experience a hypomanic episode.

A Word From Verywell

The symptoms of bipolar disorder can vary from mild to extreme. The best way to determine if you have bipolar I or bipolar II is to speak with a psychiatrist or licensed mental health professional. Understanding which type of the disorder you have can help you live with the condition. Your provider can create an individualized treatment plan to manage your symptoms and improve your quality of life. Finding ways to cope with the diagnosis or symptoms can improve well-being.