What Is The Difference Between Bipolar 1 And 2?

Medically reviewed by Laura Angers Maddox
Updated March 14, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

As both professional and general understanding of bipolar disorder have evolved, many would find that the ways we describe the unique experiences of those living with it have as well. Many mental health professionals generally distinguish different subtypes of bipolar disorder based on the symptoms that they might produce. 

Bipolar I and II disorders are perhaps the most common and widely understood types of bipolar spectrum disorders for many. However, they still are thought to have some key differences that can separate them from each other. 

Understanding each one can support the formation of a more empathetic and understanding society as a whole, which can contribute to a general sense of validation for those who live with the disorder.

What is bipolar disorder?

Bipolar disorder (BPD), previously called manic depression, is generally defined as a mental illness that can be characterized by intense mood swings from extreme highs (mania) to extreme lows (depression). Symptoms of manic and depressive episodes can affect your energy levels, ability to function and, in some cases, may even cause hallucinations and delusions. 

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Living with any type of bipolar disorder can be hard

Many people who receive a BPD diagnosis might do so during their 20s, but it can be possible for symptoms to manifest during childhood or a person’s teen years as well. Experts believe that approximately 3% of adults in the United States have been diagnosed with bipolar disorder, and an even smaller percentage of this group can experience either bipolar I disorder or bipolar II disorder.

What is bipolar I and II disorder?

The umbrella term “bipolar disorder” can refer to three distinct diagnoses: bipolar I disorder (“bipolar I”), bipolar II disorder (“bipolar II”), and cyclothymic disorder.

An individual may also experience other specified or unspecified bipolar disorder if symptoms of mood episodes are present but don’t fulfill the criteria for the primary types of the condition. 

Bipolar I and bipolar II are categorized as “Bipolar and Related Disorders” in the DSM-V. Both types of bipolar disorder are characterized by mood episodes that feature manic symptoms (or hypomanic symptoms) and depressive symptoms. Both forms of the mental health condition can significantly impact an individual’s well-being, relationships, and ability to function. 

Whether they have type I or II, people with bipolar disorder will experience some form of mania. For many, symptoms of a manic or hypomanic episode will precede or follow those of a depressive episode. In severe cases of bipolar I and bipolar II disorders, psychotic symptoms can occur. 

The symptoms of these bipolar disorder types, however, can vary in their severity and duration. Additionally, each diagnosis can come with a slightly different type of experience—those with one type of BPD may experience mania more often than depression, for instance—but others may experience the opposite.

Bipolar I disorder

To diagnose someone with bipolar I, all a mental health professional might need to know is that the person in question has had at least one manic episode, which is a period of elevated mood, lasting more than one week.  

Although most people with bipolar I disorder might have episodes of mania and depression, a major depressive episode is not generally considered a necessary part of its diagnostic criteria. 

Symptoms of manic episodes

Because a main diagnostic criterion for bipolar I is a full manic episode, symptoms like those below may be most frequently experienced by those with the diagnosis:

  • Increased risky behavior, such as irresponsible spending or excessive substance use

  • An increase in energy levels and a lack of sleep

  • Racing thoughts

  • Feeling happier than usual, even euphoric

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  • Increased talkativeness

  • Distractibility

  • Feelings of grandiosity or superiority over others

  • Hallucinations, false beliefs, or delusions

Bipolar II disorder

To receive a diagnosis of bipolar II, you generally have to have at least one hypomanic period as well as a severe depressive period that can last at least 14 days (possibly more). Hypomania is considered a milder form of mania, with less severe symptoms that typically do not require hospitalization or cause significant impairment in everyday functioning. Hypomania can also be more acute, possibly lasting for around four days (or longer). 

Those who are living with bipolar II might still be able to function at work and in social situations. Additionally, those with hypomania may not have psychotic episodes or hallucinations. 

Symptoms of hypomanic episodes

Some examples of the symptoms of hypomania can include:

  • Poor, impulsive decision making

  • Feeling upbeat, talkative, and happier than usual

  • An average or slightly enhanced ability to perform at work and home life

  • Feeling more creative and productive than usual

  • Being in a good mood for seemingly no reason

Symptoms of depressive episodes

Major depressive episodes are periods of low mood and decreased energy. People with bipolar II disorder may the following signs of acute bipolar depression:

  • Intense feelings of sadness or disinterest in most activities

  • Inability to concentrate

  • Trouble making decisions

  • Sleeping more than usual, yet still feeling fatigued

  • Weight gain or loss, perhaps due to changes in appetite or eating patterns

  • Social withdrawal and isolation

  • Thoughts of harming oneself *

*If you or someone you know is experiencing suicidal thoughts, help is available. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7, or you can text the word “HOME” to 741741 to reach the Crisis Text Line.

Causes of bipolar I and II

Although experts have not found one proven cause of these disorders, there have been many studies done that have connected the disorder to things like genetics. In fact, many believe that genetics may be the number one risk factor for developing bipolar disorder.

However, there are many other things that can increase a person’s chance of developing any type of bipolar disorder. Examples can include:

  • Stressful, traumatic, or otherwise significant life events; such as divorce or job loss

  • Substance use; such as tobacco, alcohol, and illicit substances

  • Abuse of any kind

  • Experiencing the loss of a loved one

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Managing manic and depressive symptoms 

Treatment plans for bipolar I and II disorders usually consist of changes in lifestyle, therapy and medication. Many might find that bipolar spectrum disorders respond well to treatment—so no matter how severe your symptoms may be, your doctor can support you in starting a treatment regimen that is tailored to your needs. 

Medications

Some people living with bipolar disorders might find that prescription medications can help relieve or minimize the severity of symptoms. Different types of medication can be used to achieve this goal depending on your symptoms and individual needs. 

Examples of types of medication a psychiatrist or doctor may prescribe to a person with bipolar I or II include:

  • Antidepressants: These may be prescribed to help reduce the impacts of depression 

  • Mood stabilizers: These may help control or limit manic and hypomanic episodes

  • Antipsychotics: Medications in this class can be helpful when depression or mania persists despite the efforts of other treatment options

  • Anti-anxiety medications: These may help a person sleep better and experience less anxiety disorder-related symptoms if the condition co-occurs with bipolar disorder for some

Certain medications may be used more frequently depending on the type of bipolar disorder present. For example, some experts believe that antidepressants can be more useful in bipolar II compared to bipolar I, given that antidepressants can cause or exacerbate symptoms of mania—the predominate polarity in type I. Other medications can help individuals manage symptoms of both types of bipolar disorder. For example, the results of five placebo-controlled trials show that the antipsychotic quetiapine can reduce the symptoms of both bipolar I and bipolar II

Changes in lifestyle

Making certain changes in your day-to-day lifestyle can help many to stabilize their mood and manage their symptoms. 

Below are a few ideas to get you started.

  • Education: Learning all you can about bipolar disorder may help someone to better understand their own symptoms and impart their experiences with others

  • Sleep health: Getting enough sleep and having a routine may help you limit stress and minimize the impact of your symptoms.

  • Exercise: Taking care of your body through exercise and a balanced diet can help promote steady energy levels.

  • Substance use restriction: Substances can increase the severity of your symptoms and may interfere with the prescription medications you take. 

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Living with any type of bipolar disorder can be hard

How can online therapy help those living with bipolar I and II?

Talk therapy can be an important part of treatment for any mental health disorder and can be extremely effective in treating bipolar disorders. No matter which form of bipolar disorder you think you or a loved one may have, speaking to a professional can be highly beneficial. A therapist can help you understand your symptoms, work to find strategies to manage them, and offer support as you learn how to navigate either bipolar I or II disorder.

It may be especially easy to get help through resources like online therapy. You can use an internet connection to receive the care and guidance you may need to take charge of your symptoms, finding support from the comfort of your own home. Additionally, online therapy can save you the time and money you might typically spend commuting to and from an in-person office.

Is online therapy effective? 

Research suggests that digital therapy options can be effective for managing bipolar disorder symptoms, too. One recent review of several studies on online and smartphone-based treatment for bipolar disorder found that both treatment options could help patients manage their symptoms. 

Takeaway

The main difference between bipolar I and II disorders for many can be the type and severity of symptoms experienced by those living with either diagnosis. Regardless of which type of bipolar disorder one has, online therapy can help—and pursuing proper treatment can be important to safeguard one’s quality of life. BetterHelp can connect you with an online therapist in your area of need.
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