Where bipolar I and II differ is the length and intensity of the high and the presence of major depression. Bipolar I requires one experience of mania, but does not require an episode of major depression (however many people do experience symptoms of depression).
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies mania to be a period of abnormality, featuring an elevated, persistent or irritable mood, severe enough to impair functioning, with three or more symptoms of:
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual
Flight of ideas
Distractibility
Increased goal-directed activity
Excessive involvement in activities that have high potential for painful consequences.
For an episode to be defined as manic it must last at least one week. Someone experiencing mania may not know they are ill or in need of treatment, and occasionally an episode will include an experience of psychosis or delusional thoughts.
Many people who experience mania describe their actions as euphoric, a feeling of invincibility, where no idea is too big or too optimistic.
For bipolar II a person must experience at least one of major depressive episode lasting two-weeks, and one experience of hypomania that lasts at least four days.
Similar to mania, a hypomanic episode features an elevated, persistent or irritable mood, with increased energy, and three or more symptoms of:
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual
Flight of ideas
Distractibility
Increased goal-directed activity
Excessive involvement in activities that have high potential for painful consequences.
Unlike mania, an episode of hypomania is not considered severe enough to impact social functioning or to require hospitalisation. It does not include psychosis and the impact of an episode is not considered a ‘significant impairment’. In fact, it is possible for people who experience hypomania to continue to operate within their regular, although modified, routine.
This is not to say bipolar II is a ‘milder’ disorder. The impact and trauma associated with hypomania is just as real and just as debilitating. The experience of depression and the impulsivity associated with bipolar II can also contribute to suicide attempts.
Because someone may not consider their highs to be ‘out of the ordinary’, symptoms of hypomania are not always easy to identify. Therefore, friends and relatives, those who witness someone’s symptoms, offer important information required for diagnosis.