Bipolar Disorder Diagnosis Are There Different Types of Bipolar Disorder? By Lindsey Toler Lindsey Toler Lindsey Toler, MPH, is a public health professional with over a decade of experience writing and editing health and science communications. Learn about our editorial process Updated on May 01, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Carly Snyder, MD Medically reviewed by Carly Snyder, MD Facebook LinkedIn Twitter Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments. Learn about our Medical Review Board Print PeopleImages / Getty Images Table of Contents View All Table of Contents Mood Episode Types Misdiagnosis Treatment Bipolar disorder is a complex condition characterized by drastic, unexpected shifts in a person's mood. Contrary to popular belief, there is more than one type of bipolar disorder. In fact, according to the American Psychiatric Association (APA), there are five types, each defined by the presence, type, frequency, and intensity of your moods. What Are Mood Episodes? People with bipolar disorder experience periods of unusually intense emotion, changes in energy and activity levels, and uncharacteristic behaviors. These distinct periods are called mood episodes. There are three main mood episodes: Manic: During a manic episode, you may feel extremely energized and happy, or sometimes even unusually angry or irritable. You feel like you have extra energy to burn. This period lasts at least one week. Hypomanic: Less severe manic episodes are called hypomania. Hypomanic episodes are also shorter than manic episodes—they usually only last a few days. Depressive: A major depressive episode is a period of at least two weeks during which you experience five or more depressive symptoms nearly every day for most of the day. Some people can even experience symptoms of depression and mania at the same time (or one right after the other). This is called a mixed episode. Changes in the DSM-5 for Bipolar Disorder Types of Bipolar Disorder The APA classifies bipolar disorder according to the type, duration, and severity of a person's mood episodes. According to fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are five different types of bipolar disorder a doctor may diagnose you with: Bipolar I disorderBipolar II disorderCyclothymic disorderOther specified bipolar and related disorderUnspecified bipolar and related disorder Other specified bipolar and related disorder, together with unspecified bipolar and related disorder both used to fall under the category of bipolar disorder not otherwise specified (NOS) in the DSM-IV. The "not otherwise specified" category, however, was removed and broken out into these two condition names in the DSM-5. Bipolar I Disorder To be diagnosed with bipolar I disorder, you must have experienced one or more manic episodes. These episodes must last at least seven days or be so severe that you need to be hospitalized immediately. Although some people also experience depressive or hypomanic episodes, you can be diagnosed without them. Bipolar II Disorder Bipolar II disorder is characterized by having both hypomanic and depressive episodes. Also, to be diagnosed with bipolar II, you must never have experienced a full-blown manic episode. Bipolar II is not simply a milder form of bipolar I disorder. It is a distinctively different disorder. Bipolar II vs. Bipolar II Cyclothymic Disorder Also called cyclothymia, this mood disorder is considered a milder and chronic form of bipolar disorder. Unlike bipolar I and II disorders, the highs and lows of cyclothymia are not severe enough to fit the criteria for manic or major depressive episodes. However, these symptoms must be present for at least two years with no symptom-free period for more than two months. Although the mood episodes are less extreme than those of bipolar disorder, it's critical to seek help. Not only can these symptoms interfere with your daily life, but they also increase your risk of developing bipolar I or bipolar II disorder later in life. Other Specified Bipolar and Related Disorder This type of bipolar disorder is diagnosed when you have symptoms of bipolar disorder (such as manic or depressive episodes), but they don't fit into other bipolar categories. For instance, you may rapidly cycle between manic and depressive episodes. Or maybe you have hypomanic episodes without depressive episodes. Understanding Bipolar NOS Unspecified Bipolar and Related Disorder This diagnosis is similar to specified bipolar and related disorder; however, it's used when a doctor doesn't have enough information to make a specific diagnosis. By using the "unspecified" diagnosis, however, you'd be able to receive emergency medical treatment if necessary, without needing to meet the full criteria of a bipolar diagnosis. Misdiagnosis Of all the mental health disorders, bipolar is perhaps one of the most commonly misdiagnosed. Sometimes it's not clear which one of the types of bipolar disorder your symptoms align with. Bipolar disorders can also be difficult to diagnose because it shares symptoms with so many other conditions. Here are a few mental health conditions that often get mistaken for bipolar disorder and how you can tell the difference. Attention-deficit hyperactivity disorder (ADHD): Both disorders come with overlapping symptoms. However, while ADHD is a chronic condition, bipolar disorders are episodic. Additionally, bipolar disorders only affect your mood, whereas ADHD impacts your attention and behavior. Borderline personality disorder (BPD): The main difference between these conditions is the length of the mood swings. Bipolar mood cycles can last for weeks or months, whereas BPD mood swings may last a few hours or days. Additionally, BPD mood swings are often triggered by something. Clinical depression: While bipolar disorders include symptoms of mania, clinical depression is unipolar, meaning there is no “high." Doctors may initially misdiagnose bipolar II disorder as clinical depression because hypomanic episodes often go unnoticed. Schizoaffective disorder: When you have schizoaffective disorder, psychotic symptoms appear out of the blue and are unattached to mood changes. With bipolar disorder, psychotic symptoms only arise during a mood episode. Being correctly diagnosed is an important step toward getting the right treatment. The most important thing you can do to increase your chances of receiving an accurate diagnosis is to tell a doctor about all the symptoms you’ve been experiencing. What Are the Signs of Bipolar Disorder in Men? Treatment Treatment for any bipolar disorder generally involves medications and some form of psychotherapy. Medications Medication is the key to stabilizing most bipolar disorders. However, the type of medication a doctor prescribes depends on your symptoms and their severity. If you experience a manic and hypomanic episode, for example, a doctor may prescribe a mood stabilizer. Examples of mood stabilizers include: Lithium Depakote (valproic acid) Tegretol (carbamazepine) On the other hand, if you primarily experience depression symptoms, you'll likely be prescribed a selective serotonin reuptake inhibitor (SSRI) such as Zoloft (sertraline), Prozac (fluoxetine), or Lexapro (escitalopram). Because antidepressants can trigger manic episodes, they are generally prescribed along with a mood stabilizer. If you experience psychotic symptoms during a manic or depressive episode, a doctor will likely prescribe an atypical antipsychotic. If your psychotic symptoms occur during a depressive episode, a doctor may prescribe one of the following four atypical antipsychotics FDA-approved for bipolar depression: Vraylar (cariprazine) Latuda (lurasidone) Symbyax (olanzapine-fluoxetine) Seroquel (quetiapine) Vraylar and Seroquel are the only two that are FDA-approved antipsychotics designed to treat psychotic symptoms that occur during manic episodes. It can take a while to find the right bipolar medication. Due to constant mood cycles, most people with bipolar disorder take more than one medication. Psychotherapy Depending on your situation, psychotherapy might also be necessary. In fact, research shows that psychotherapy combined with medication can be more beneficial than medication alone. Psychotherapy can help relieve the stress associated with your extreme moods. It can also help you improve your ability to manage relationships with others. Psychotherapies that are effective for bipolar disorder include: Cognitive-behavioral therapy Family-focused therapy Interpersonal and Social Rhythm Therapy As with medication, there is no single therapy approach that everyone will find useful. A Word From Verywell If you or someone you know is experiencing symptoms of bipolar disorder, it's important to talk to a physician. A physician may want to rule out any potential physical health issues that may be contributing to your symptoms. A physician may also refer you to a psychiatrist or other mental health professional for an evaluation. Be sure to speak openly about your behaviors, moods, and anything else you notice. Open, honest communication is essential to receiving a correct diagnosis and treatment plan. The 7 Best Online Bipolar Disorder Support Groups of 2021 Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Mental Health. Bipolar disorder. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. Datto C, Pottorf WJ, Feeley L, LaPorte S, Liss C. 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