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

Updated February 1, 2023by BetterHelp Editorial Team

Content Warning:Please note that this article mentions suicide, self-harm, and other potentially triggering topics. Read with discretion. 

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 disorder is now 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 how they may present.

Bipolar Disorder 2 Is Hard to Diagnose. You Can Learn More About Symptoms

What Is Bipolar Disorder?

Bipolar disorder affects approximately 5.7 million US adults yearly. It is a spectrum disorder with various subtypes, each with its own diagnostic criteria. 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 symptoms of mania 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 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 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

  • 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. 

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 episodes may vary depending on a diagnosis of bipolar I disorder, bipolar II disorder, or another subtype. Specific symptoms within each phase may vary. 

Bipolar I

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 depression, although they are not a requirement. 

Bipolar II

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. 

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. It may be marked by more rapidly cycling moods and symptoms, sometimes within the same day or week. It does not include symptoms of mania. 

Bipolar Disorder, Not Otherwise Specified (NOS)

Bipolar disorder NOS is diagnosed that may be made if an individual has symptoms of bipolar disorder 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 symptoms in common, many individuals may wonder how the distinction is made. Below are a few differences. 

Mania

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

Hypomania

Both bipolar I and bipolar II disorder may feature hypomanic phases. In bipolar I disorder, hypomania 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 symptoms of hypomania or mania and depression within a short period. 

Depression

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. 

People with bipolar II disorder may not experience as much impairment from hypomania but could experience it from depression. Although bipolar II may be seen as "less severe," 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

In those who experience bipolar depression, there 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 disorder 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, whereas in bipolar II disorder, it does not 

  • 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 distinguish symptoms of subtypes like bipolar I and bipolar II disorder. 

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. 

Bipolar Disorder 2 Is Hard to Diagnose. You Can Learn More About Symptoms

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.

Counseling Options 

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, accessibility, 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 the 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 or another subtype, consider reaching out to a provider for further guidance. Support is available. 

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