Posted by: jedwardswright | April 2, 2011

Bipolar Disorder: More Than “Manic-Depressive” Part 2


Once upon a time, in Psychiatryland, life was much simpler. Either you were diagnosed with “manic-depressive disorder”, or you weren’t.  Either you were bouncing off the walls half the time, and in the pit of despair for the other half, or you didn’t qualify. This made the job of being a psychiatrist much easier. The job of being a patient was another matter.

Now the medical profession has discovered that things aren’t quite that cut-and-dried. It turns out, as is so often the case that this black and white picture comes with shades of gray. With that realization has come a change in terminology: manic-depressive is out and bipolar disorder is in.

Officially, there are now three main forms of bipolar disorder.  I suppose if doctors weren’t so gosh-awfully technical (and had more funny-bones) they could have called those sub-types “Bad,” “Badder” and “Baddest,” because that is pretty much what the division means. On the other hand, I doubt that anyone suffering from these conditions considers their situation to be less significant than anyone else’s.

Bipolar I Disorder is the most severe type, with symptoms that correlate best with the former Manic-Depressive diagnosis, then comes Bipolar II Disorder, and finally Cyclothymia  ( which surprisingly is not called Bipolar Disorder III. Go figure.)  What this means is that if you think that you might be mildly manic and depressed, you could be right.  There are also variations referred to as Rapid-Cycling and Mixed Bipolar. One site also listed a catch-all term called Bipolar Disorder Not Otherwise Specified (BP-NOS).

Are you confused yet? Let’s break this down into manageable chunks.


Bipolar I Disorder is distinguished by

  • at least one manic episode
  • severe mood swings that interfere with relationships, employment and/or education
  • delusions of grandeur and bizarre behavior, sometimes amounting to a break with reality
  • mania so pronounced that hospitalization may be necessary
  • clinical depression with feelings of hopelessness, withdrawal, and suicidal tendencies
  • mixed states” in which manic behavior is accompanied by depression

Bipolar II Disorder is distinguished by

  • hypomania (a less severe form of mania) which may present as very extroverted social behavior with unrealistic optimism, or increased irritability
  • a greater ability to continue with employment or school and maintain daily routines
  • an amplified tendency to participate in risky or impulsive behavior
  • episodes of serious depression which are separate from hypomania
  • depressive periods lasting longer than hypomanic periods
  •  the ability to live relatively stable lives in between episodes of hypomania and depression

Cyclothymia is distinguished by

  • milder episodes of hypomania and depression
  • the ability to continue daily routines with occasional disruptions

As you can see, these three sub-types of bipolar disorder are mainly characterized by their degree of severity.  Consult a psychiatrist if you believe you may be experiencing symptoms of bipolar disorder, as these explanations are quite general and a psychiatric evaluation is required to properly diagnose and categorize your condition.

Early treatment of bipolar disorder can prevent symptoms from worsening, and minimize the disruption to employment, education and relationships.  If you suspect that you may have undiagnosed bipolar disorder, please do not delay in seeking medical advice.

People with bipolar disorder are often diagnosed with clinical depression initially, until manic symptoms become evident. If you are concerned that you may have been inaccurately diagnosed, express your concern to your doctor as soon as possible, as a change in treatment may be necessary. Bipolar disorder can also coexist with a number of other mental health problems

Other Terms

Cycling refers to switching between mania (or hypomania) and depression. In some people with bipolar disorder, cycling may occur along with the changing seasons.

Rapid-Cycling Bipolar Disorder refers to bipolar disorder, at any level, which quickly switches between mania and depression. The term is generally used when there are four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. Cycling may even occur within a single day.

Mixed Bipolar Disorder or “mixed states” refers to bipolar disorder when mania and depression coexist in the same period of time.

The term Bipolar Disorder Not Otherwise Specified (BP-NOS) may be used to classify a patient’s condition when symptoms indicate bipolar disorder is likely but in some aspect the case does not completely fulfill all the medical criteria for the condition.  For example, symptoms may be fewer in number or last an insufficient amount of time to qualify as typical.

Psychosis may occur in patients with Bipolar Disorder I, in either the manic or depressive states.  This is the term used to describe a break with reality in a mentally ill person. Symptoms may include delusions and/or visual/auditory hallucinations. In some people with Bipolar Disorder, sudden psychosis (sometimes referred to as a psychotic break) may be the first evidence that there is a mental health problem.

There are many online resources for information about bipolar disorder.  Here are some that I have found helpful in creating this post.



NAMI National Alliance on Mental Illness

NIMH National Institute of Mental Health

Other Resources

DBSA Depression and Bipolar Support Alliance

Celebrities Catherine Zeta-Jones and Carrie Fisher Have Bipolar Disorder: Article

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