Bipolar II: What Is It And How Is It Different?

Medically reviewed by Melissa Guarnaccia, LCSW
Updated March 4, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include suicide which could be triggering to the reader. If you or someone you love is having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988. Free support is available 24/7. Please also see our Get Help Now page for more immediate resources.
Bipolar II was first formally recognized in the Diagnostic And Statistical Manual, Fourth Edition (DSM-IV) in 1994. Before the 90s, the condition was often grouped under the diagnosis of manic depression or major depressive disorder. However, bipolar disorders are not regarded as manic depression anymore. Now, it’s regarded as a spectrum with variations, including bipolar I, bipolar II, and other subtypes. 

Perhaps due to the stigmas often surrounding bipolar disorder, some may not understand the difference between bipolar I and bipolar II disorder. Understanding bipolar II disorder and what makes it different can be valuable in understanding the symptoms and taking a bipolar test to see how they may present.

Think you may be experiencing symptoms of bipolar disorder II?

What is bipolar disorder?

Bipolar disorder statistics show that bipolar disorder affects approximately 5.7 million US adults yearly. It is a spectrum disorder with various subtypes, each with its own diagnostic criteria. Having family with bipolar disorder is one of the risk factors for developing it yourself. Often, the condition is marked by periods of mania, hypomania, or depression. Understanding each type of mania and how bipolar depression can appear may be valuable in understanding bipolar II disorder.

Mania definition

Mania is often marked by an elevated mood, increased energy, euphoria, and irritability. Other manic symptoms could include: 

  • Insomnia, sometimes going days without sleep 

  • Hallucinations or psychosis 

  • Feeling invincible or experiencing delusions of grandeur 

  • Talking fast, sometimes not making sense

  • A heightened ability to complete tasks 

  • Risky or impulsive behaviors

  • Distractibility 

In the DSM-V, a manic episode involves a distinct period of "abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week or any duration if hospitalization is necessary." Mania is only a symptom of bipolar I disorder and not bipolar II. Often, it may cause consequences in a person's life. 

Hypomania definition

In the DSM-V, a hypomanic episode includes a distinct period of persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four days and present for most of the day. It may include symptoms of inflated self-esteem, decreased need for sleep, fast talking, distractibility, and involvement in risky activities. 

However, unlike a manic episode, a hypomanic period is marked by hypomanic symptoms that are not severe enough to cause social or occupational impairment. It also does not involve psychotic features, which are unique to mania. Any type of bipolar disorder can experience hypomania, but it is the only type of mania experienced by those with bipolar II disorder.   

Depression definition

Some individuals experience depression as a symptom of bipolar disorder, with symptoms similar to major depressive disorder. For an episode to be considered a bipolar depression episode, it may last two weeks or more. Common symptoms of depression can include: 

  • A persistent low or depressed mood

  • Loss of interest in previously enjoyed activities 

  • Difficulty sleeping or sleeping more than usual 

  • Changes in appetite 

  • Difficulty completing tasks or caring for oneself

  • Excessive or inappropriate guilt

  • Suicidal thoughts* 

*If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. 

According to the Substance Abuse and Mental Health Services Administration, bipolar II disorder is a “lifelong condition that doesn’t go away on its own.” Because individuals with bipolar disorder typically experience recurrent episodes, ongoing, enduring treatment is suggested. With proper care, the disorder’s symptoms can be managed, and its negative effects limited. 

Types of bipolar disorder

Bipolar disorder is a mood disorder with four subtypes. The phases of mania, hypomania, and depression can differ for each. The severity and frequency of manic and major depressive episodes may vary depending on a diagnosis of bipolar I disorder, bipolar II disorder, or another subtype. Specific symptoms within each phase may vary. 

Additionally, several specifiers may be provided alongside a bipolar diagnosis to further describe the symptoms an individual is experiencing. These include anxious distress (in which irritability, trouble focusing, and other symptoms of anxiety are present), mixed features (in which symptoms of mania and depression occur simultaneously), and rapid cycling (in which an individual experiences at least four or more manic, hypomanic, or depressive episodes in a one-year period). 

Bipolar I disorder

Bipolar I disorder is a bipolar spectrum subtype that includes at least one manic episode lasting at least one week or requiring hospitalization. People with this subtype may also experience hypomania and depressive symptoms, although they are not a requirement. 

Bipolar II disorder

Bipolar II disorder is a subtype of bipolar spectrum disorder characterized by periods of hypomania and at least one depressive episode. Although they do not experience mania, they may benefit from treatment for symptoms of hypomania and major depression. 

Cyclothymia

Cyclothymic disorder is a mood disorder within the DSM-5 that has features of hypomania and depression but does not meet the full criteria for bipolar disorder. Cyclothymic disorder may be marked by more rapidly cycling moods swings and mood symptoms, sometimes within the same day or week. It does not include the signs and symptoms of mania. 

Bipolar disorder, not otherwise specified (NOS)

Bipolar disorder NOS is diagnosed that may be made if an individual has bipolar disorder symptoms that don't fit one of the above three categories.

Bipolar I vs. Bipolar II: What's the difference? 

Since bipolar I and bipolar II disorder have bipolar symptoms in common, many individuals may wonder how the distinction is made. Below are a few differences. 

Manic symptoms

Bipolar I disorder is the only subtype of bipolar disorder marked by manic episodes, as described above. Along with the elevated mood episodes accompanying mania, people with bipolar type I disorder may experience symptoms of psychosis such as delusions or hallucinations. Those diagnosed with bipolar 2 disorder do not experience these symptoms. 

Hypomanic symptoms

Both bipolar I and bipolar II disorder may feature hypomanic phases. In bipolar I disorder, a hypomanic episode may be followed by mania. A person with bipolar II disorder may experience hypomania without symptoms of mania. Often, hypomanic episodes may be shorter than manic episodes. 

Mixed features

All subtypes of bipolar disorder may include mixed features, which are rapid cycling symptoms of hypomania or mania and depression within a short period. 

Depressive symptoms

Many individuals living with bipolar disorder have periods of mild to severe depression. However, depression is not required for bipolar I disorder, meaning those with the condition may only experience manic episodes. People with bipolar II disorder experience episodes of depression, which may be mild to severe. 

Level of impairment

People with bipolar I disorder may struggle with daily functioning during manic phases. Their work, relationships, and hygiene might become challenging, leading to potential job losses or dysfunctional relationships. Symptoms of bipolar disorder can lead to physical health complications—such as heart disease, sleep disruptions, and significant weight loss or gain—that can make self-care difficult. 

In individuals with bipolar II, depression and hypomania symptoms can significantly impact daily functioning.  Although bipolar II may be seen as a “milder form” or "less severe” version of bipolar I, it can have marked impacts on the individual diagnosed, and hypomania is not a "fun" or "lighthearted" form of mania. It can still cause impairment on a lesser level. 

Suicide risk

People with bipolar disorder who experience bipolar depression may be a risk of suicide. Studies have found that the risk may be upwards of 20% higher than in the general population. An overall review of the literature shows that there is no significant difference between the rates of suicide attempts in people with bipolar I and bipolar II disorder. However, those who experience bipolar I disorder without depression may have less of a suicide risk. 

Please note that if you are experiencing suicidal thoughts, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to a crisis counselor. They are available 24/7 to offer support. 

Summary of differences

In the final analysis, the differences between bipolar I disorder and bipolar II disorders include the following:

  • Manic episodes of at least one week or requiring hospitalization are present in bipolar I disorder but not bipolar II disorder 

  • Significant impairments are often present in bipolar I disorder, whereas lesser impairments may be present in bipolar II disorder 

  • In bipolar I disorder, hypomania may escalate to mania, serving as one of the warning signs that mania may be coming, whereas in bipolar II disorder, it does not escalate 

  • People with bipolar I disorder may not experience depression

Diagnosing bipolar disorder

The DSM-V is often used to diagnose mental health conditions. It is formally known as the Diagnostic and Statistical Manual of Mental Disorders and has been used in its fifth edition since 2013. Psychiatrists and psychologists might use this manual to identify psychiatric disorders and anxiety disorders and distinguish symptoms of subtypes like bipolar I, bipolar II disorder, and related disorders. 

Is there a bipolar disorder test? 

No lab test or brain scan can diagnose bipolar disorder. Instead, professionals may conduct psychological interviews or self-reported testing to understand an individual's symptoms. They may also observe the person's symptoms or behavior at the appointment. 

If a person has been admitted to a psychiatric hospital in the past for manic-like or suicidal episodes, they may use this information to make an informed diagnosis. You can also take a free screening quiz for bipolar disorder online through Mental Health America. However, note that online screening tests do not replace a diagnosis. Bring your results to your mental health provider to further discuss your symptoms and learn about ongoing treatment options. 

Think you may be experiencing symptoms of bipolar disorder II?

Recording treatment for bipolar disorder

Psychiatrists and other mental health professionals record symptoms, diagnoses, and treatments using the ICD-10 bipolar disorder codes. The ICD-10 is the International Classification of Diseases, edition 10, a cataloging system used in the US for diagnosis and insurance purposes. 

Recording these codes allows insurance companies to process claims. Additionally, providers might use bipolar disorder ICD-10 notations to help them track your symptoms over time. However, if you meet with a new provider, they won't be able to view your past codes unless they work for the same agency or mental health provider.

How is bipolar II disorder treated?

Most clinical practice guidelines for bipolar II disorder state that medication is the first-line treatment. Commonly utilized medications for bipolar disorder are mood stabilizers, antidepressants, and antipsychotic drugs. Always consult with a healthcare professional prior to starting or stopping any medication.

Through psychotherapy, people with bipolar II can receive emotional support, develop coping strategies, and address symptoms of comorbid conditions. Additionally, many individuals with bipolar and related disorders benefit from family interventions, in which family members learn how their interactions may influence the development and treatment of symptoms. According to the American Psychiatric Association, electroconvulsive therapy—a brain stimulation technique—can also be used for bipolar disorder. 

Counseling options for bipolar II and related mental disorders

Does bipolar make you crazy? Labeling persons with bipolar as "crazy" can be stigmatizing. Bipolar disorder is a serious condition that can be managed with proper medication, like mood stabilizers, and therapy. If you feel you may be experiencing symptoms of bipolar I disorder, bipolar II disorder, or another subtype of bipolar disorder, consider reaching out to a counselor. Millions of people experience this condition yearly, and you're not alone. If you struggle to find a provider in your area due to barriers like cost, availability, or schedule, you can also find a bipolar disorder therapist online. 

While an online therapist may not be able to provide a formal diagnosis, they can offer personalized treatment for your symptoms and provide you with coping mechanisms to use at home, as well as suggestions for other areas of support. You can also choose between phone, video, or live chat sessions and attend them from home, as long as you have an internet connection. One study on internet-based mindfulness therapy found that 95% of clients with bipolar disorder had an increased quality of life after treatment. 

If you're interested in reaching out to a provider to develop a treatment plan, consider signing up for an online platform like BetterHelp, which offers a growing database of trained and licensed mental health providers specializing in various areas of mental health. 

Takeaway

Bipolar II disorder is a mental health condition and mood disorder categorized by episodes of hypomania and depression. It may have more moderate symptoms than bipolar I disorder but can still cause impairment and difficulty for those living with it. If you think you might be experiencing symptoms of bipolar II disorder, a major depressive episode, or another subtype, consider reaching out to a provider for further guidance. Support is available. 
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