What Is the Bipolar Spectrum?

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Bipolar disorder is a mental health condition marked by manic or hypomanic episodes and often periods of major depression.

Although bipolar disorder is not officially classified as a spectrum in the Diagnostic and Statistical Manual of Mental Disorders (DSM), some providers and people who live with a bipolar-type disorder find it helpful to conceptualize their symptoms on a spectrum.

Learn more about the bipolar spectrum, symptoms, types of bipolar disorder, and treatment options below.

Symptoms of Bipolar Disorder

Bipolar disorders are marked by mood episodes. There are four primary types of mood episodes seen in individuals on the bipolar spectrum.

Manic Episodes

A manic episode is defined as “a distinct period of abnormally and persistently-elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy.”

In order for a mood episode to be classified as manic, it must last a minimum of one week and include at least three of the following symptoms:

  • Feelings of grandiosity or inflated self-esteem
  • Decreased need for sleep
  • Pressured speech, significantly more talking than usual
  • Feeling as though thoughts are racing and disconnected from each other
  • Distractibility that was not present prior to the onset of the episode
  • Increased activity towards goals or increased movement
  • Engaging in impulsive, high-risk activities

Hypomanic Episodes

A hypomanic episode has similar symptoms to a manic episode but needs to only last four days to be considered a hypomanic episode.

As with a manic episode, a hypomanic episode requires at least three of the symptoms listed above to meet the diagnostic criteria.

Depressive Episodes

Many people with bipolar-type disorder also experience depressive episodes. A depressive episode consists of a depressed mood or loss of interest in previously enjoyable activities, lasts at least two weeks, and includes a minimum of five of the following symptoms:

  • Low or depressed mood most of the day nearly every day
  • Lowered interest in most or all activities that were previously enjoyable or pleasurable
  • Weight loss or gain of more than five percent of body weight without attempts to diet or gain weight
  • Increased or decreased sleep
  • Agitation or slowed movement
  • Low energy every day or most days
  • Feelings of worthlessness or guilt
  • Poor concentration
  • Thoughts of suicide or self-harm

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Mixed Episodes

Some people experience mixed episodes of bipolar disorder, commonly referred to as “mixed features.”

Mixed features of a bipolar-type disorder occur when an individual meets the criteria for a manic or hypomanic episode and also experiences at least three of the following criteria during the majority of days during that episode:

  • Significant low or depressed mood
  • Lowered interest or pleasure in activities
  • Slowed movement which is observable by others
  • Low energy
  • Feelings of worthlessness or guilt
  • Passive or active suicidal thoughts or thoughts of death

Types of Bipolar Disorder

The DSM recognizes multiple subtypes of bipolar disorder based on symptom presentation, severity, and treatment recommendations:

  • Bipolar I Disorder: In order to qualify for a diagnosis of bipolar I disorder, an individual must have experienced at least one full manic episode. This episode may include psychotic symptoms or require hospitalization. Although many people with bipolar I disorder have a history of depressive episodes, this is not a requirement for a diagnosis.
  • Bipolar II Disorder: People with bipolar II disorder have a history of at least one major depressive episode and one hypomanic episode. They cannot have a history of full manic episodes.
  • Cyclothymic Disorder: Sometimes unofficially referred to as bipolar III disorder, cyclothymic disorder occurs when an individual has a history of hypomanic symptoms that have not met the full criteria for an episode as well as depressive symptoms that do not meet the full criteria for a depressive episode.
  • Other Specified Bipolar Disorder: This diagnosis is granted when an individual exhibits symptoms of bipolar disorder but does not meet the full criteria. The provider will note how the symptoms differ from the diagnostic criteria, such as noting that the hypomanic episodes are too short in duration, the hypomanic or depressive episodes have fewer symptoms than the diagnostic criteria require, or the symptoms have been present for a shorter time than the diagnostic criteria requires.
  • Unspecified Bipolar Disorder: This diagnosis indicates that an individual exhibits symptoms of a bipolar-type disorder but does not meet the full criteria for any of the bipolar-type disorders listed above. Often, this diagnosis is granted in settings such as the emergency room when limited history information is available.

Diagnosing Bipolar Disorder

Trained healthcare professionals, including psychologists and psychiatrists, receive training in identifying the symptoms and diagnosing bipolar disorders. Other physicians may also have training in assessing for and diagnosing bipolar disorder.

An evaluation to diagnose bipolar disorder may include:

  • A clinical interview, including questions about personal and family history and current symptoms
  • A mental status examination and behavioral observations made by the provider
  • Symptom checklists to determine whether symptoms meet the criteria for a depressive, manic, hypomanic, or mixed episode
  • Personality tests to provide norm-referenced data about symptoms

Treatment for Bipolar Disorder

People with bipolar disorder often benefit from medication intervention and/or therapy to manage their mood episodes and symptoms.

Medication

Medications used to treat bipolar-type disorders include mood stabilizers, antidepressant medications, and antipsychotic medications. Depending on the individual, they might need a combination of medications to treat their symptoms.

Therapy

Therapy can also be effective for people with bipolar-type disorders. Some research has shown that mindfulness-based interventions can be helpful, though the current data has limitations. Cognitive-behavioral therapy can improve mood stability and decrease the frequency of episodes as well.

If an individual is experiencing severe psychotic symptoms or active suicidal ideation, they might require hospitalization to stabilize them and ensure their safety. Usually, psychiatric hospitalizations are short-term and focus on immediate safety and stability. However, some people require more long-term care in this setting.

Coping With Bipolar Disorder

Society and media stigmatize bipolar-type disorders and there is significant misinformation about these conditions. This can make it difficult to seek support and help, but having a treatment team that you trust is important for managing symptoms.

People with bipolar disorders can also benefit from peer support groups as well as personal support systems to help them manage stress and notice if they might be entering an episode.

Although the symptoms can be scary, bipolar-type disorders are manageable and treatable with the proper support in place.

8 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.
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