Part Two of Bipolar and Related Disorders

Part Two of Bipolar and Related Disorders compares and contrasts Bipolar I and Bipolar II Disorders.  Characteristics of manic, hypomanic, and depressive episodes are described below, as well as the similarities and differences between Bipolar I and Bipolar II Disorders.

Characteristics of Mania and Hypomania

The Diagnostic and Statistical Manual of Mental Disorders (2013) lists the following characteristics of mania or hypomania:

  1. “Elevated, expansive mood
  2. Inflated self-esteem or grandiosity
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective experience [of racing thoughts]
  5. Increase in energy or goal-directed activity
  6. Increased or excessive involvement in activities that have a high potential for painful consequences.  [Examples of this include, but are not limited to, buying sprees and sexual indiscretions.]
  7. Decreased need for sleep”.

Meeting the criteria for mania or hypomania requires that three or more of the previously mentioned symptoms are present and that they “represent a noticeable change from usual behavior” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

You may be asking, “If mania and hypomania have the same characteristics, what, if anything, makes them different?”

One, the amount of time the symptoms are present varies.  Characteristics or symptoms that are “present most of the day, nearly every day” for at least one week indicate a manic episode.  The presence of characteristics or symptoms for “at least 4 consecutive days and present most of the day, nearly every day” indicates a hypomanic episode (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Two, symptoms that cause social or occupational impairment and/or necessitate hospitalization are considered manic.  If the symptoms are not severe enough to disrupt social and occupational functioning, they are considered hypomanic.

Characteristics of Depression

The Diagnostic and Statistical Manual of Mental Disorders (2013) lists the following characteristics of depression:

  1. “Depressed mood
  2. Markedly diminished interest or pleasure in all, or almost all, activities
  3. Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide”.

A depressive episode requires that the individual experience five or more of the nine previously mentioned symptoms for most of the day and nearly every day for at least two weeks, and that at least one of the symptoms is either ‘depressed mood’ or ‘loss of interest or pleasure’.  Also, the presence of the symptoms of depression must represent a change in previous functioning that causes “significant distress or impairment in social, occupational, or other important areas of functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

 Similarities Between Bipolar I and Bipolar II Disorders

There are several criterions that both Bipolar I and Bipolar II have in common.  First, their mood episodes (manic, hypomanic, or depressive) must not be “better explained by Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, Other Specified or Unspecified Schizophrenia Spectrum, and Other Psychotic Disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Second, “the mood episodes are not attributable to the physiological effects of a substance or another medical condition” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Third, both disorders can be further specified based on the presence and patterns of additional symptoms.  Details regarding these specifiers are described in Part One of Bipolar and Related Disorders.

Bipolar I Disorder

A diagnosis of Bipolar I means an individual has experienced at least one manic episode.  The same individual may or may not experience a hypomanic or depressive episode prior to or after the manic episode.  It is important to note that a person may experience all three mood episodes in their lifetime, but not simultaneously.  The combination of mood episodes is one of the things that differentiate Bipolar I and Bipolar II Disorders.

Bipolar II Disorder

A diagnosis of Bipolar II means an individual has experienced at least one hypomanic episode; at least one major depressive episode; and that they never experienced a manic episode.  Diagnosis also requires that the individual’s depressive symptoms and/or their swing from depression to hypomania “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Stay Tuned for Part Three!

Part Three of Bipolar and Related Disorders details Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, and Bipolar and Related Disorder Due to Another Medical Condition.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 4 April 2018]. dsm.psychiatryonline.org

 

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