There are two types of the bipolar disorder. The length, frequency, and pattern of manic episodes and depression define each kind. This is very important to understand as sometimes people are misdiagnosed, particularly if they research on the internet, then self-diagnose. The root causes of these disorders may never be known in some cases, but quite often it is the result of early childhood trauma or abuse.
Bipolar 1 Disorder
Bipolar 1 is characterized by one or more manic/mixed episodes (which is when you experience symptoms of both mania and depression).
Bipolar 2 Disorder
Bipolar 2 is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.
The highs in Bipolar 2, called hypomania, are not as high as those in Bipolar 1 (manias). Bipolar 2 disorder is sometimes misdiagnosed as Major Depression if Hypomanic episodes go unrecognized or unreported. For example, if you have recurring depressions that go away periodically and then return.
Hypomania vs Mania
Hypomania is a lesser form of Mania and usually only lasts for a few days, whereas Mania can last several weeks or more.
With Hypomania, you might feel or behave as follows*:
- happy, euphoric, with a sense of well-being
- lots of energy
- racing thoughts
- creative and full of ideas and plans
- like you can perform tasks better and more quickly than normal
- impatient, irritable or angry
- confident, with high self-esteem
- attractive, flirtatious and/or with more sexual desire
- restless, on edge and having difficulty relaxing
- heightened senses – colours may seem brighter, sounds louder and things more beautiful
- more active than usual
- taking risks
- very friendly
- very talkative or writing a lot
- sleeping very little
- signing up for and taking part in lots of activities
- taking on extra responsibilities
- wearing colourful and/or extravagant clothes
- making lots of jokes and puns
- finding it hard to stay still – moving around a lot or fidgeting
Although similar, with Mania you might feel or behave as follows*:
- uncontrollably excited, like you can’t get your words out fast enough
- racing and jumbled thoughts
- like you are special and understand things other people can’t
- believing you are invincible or have special powers
- very easily distracted and unable to concentrate on anything
- loss of insight – not understanding that your behavior is unusual or that it could cause problems
- delusions and paranoia – thoughts that other people don’t understand or share
- seeing things, hearing voices or feeling things that other people don’t (see our pages on psychosis for more information)
- talking a lot and very quickly – to the point that others may not be able to understand or interrupt
- jumping quickly between unrelated topics, or saying things that don’t make sense to other people
- being rude, angry or aggressive
- doing or saying things that are inappropriate and out of character
- losing social inhibitions
- forgetting to look after yourself – forgetting to eat or drink, for example
- misusing drugs or alcohol
- taking serious risks with your safety
- spending money excessively and inappropriately
* MIND: “Understanding hypomania and mania”
Possible causes of hypomania or mania include:
- high levels of stress
- changes in sleep patterns or lack of sleep
- use of stimulants such as drugs or alcohol
- seasonal changes – some people are more likely to experience hypomania and mania in spring
- a significant change in your life – moving house or going through a divorce, for example
- childbirth (see postpartum psychosis)
- substance abuse
- loss or bereavement
- violence, trauma or abuse
- difficult life conditions – unemployment, poverty, social deprivation or homelessness
- as a side-effect of medication
- as a side effect of a physical illness or neurological condition
- family history – if you have a family member who experiences bipolar moods, you are more likely to experience mania or hypomania
- brain chemistry – there is some evidence to suggest that the function of the nerves in the brain could play a role, although this has not been definitively proven.
Just to make it more complicated, in my view, there is also Cyclothymia.
Cyclothymia, or cyclothymic disorder, is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity or duration of major depressive or full mania episodes. People with the cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.
You may be told you have cyclothymia if:
- you have experienced both hypomanic and depressive mood states over the course of two years or more
- your symptoms aren’t severe enough to meet the criteria for a diagnosis of bipolar I or bipolar II
- This can be a difficult diagnosis to receive, because you may feel that you are being told your symptoms are ‘not serious enough’. But in fact, cyclothymia can have a serious impact on your life.
Behavioural variant FTD
I include Behavioural Variant FTD in this article because it is so similiar to the above conditions and may, in fact, be the cause of them. Behavioural Variant is the most common type of FTD (Frontotemporal degeneration, or more commonly referred to as frontotemporal dementia, front-temporal lobar degeneration (FTLD), or Picks disease). The main distinction separating this form of dementia from other forms is the progressive decline in behavior and/or language (with memory usually relatively preserved).
Two-thirds of people with FTD are diagnosed with this type. During the early stages, changes are seen in the person’s personality and behavior.
A person with behavioural variant FTD may:
- lose their inhibitions – behave in socially inappropriate ways and act in an impulsive or rash manner. This could include making tactless or inappropriate comments about someone’s appearance.
- lose interest in people and things (apathy) – lose motivation. Unlike someone with depression however they are not sad.
- lose sympathy or empathy – become less responsive to the needs of others and show less social interest or personal warmth. They may also show reduced humour or laugh at other people’s misfortunes. This can make the person appear selfish and unfeeling.
- show repetitive, compulsive, or ritualised behaviours – this can include repeated use of phrases or gestures, hoarding and obsessions with timekeeping. It may also include new interests, such as music or spirituality.
- crave sweet, fatty foods or carbohydrates and forget table etiquette. They may also no longer know when to stop eating, drinking alcohol, or smoking.
- It is common for a person with behavioural variant FTD to struggle with planning, organising, and making decisions. These difficulties may first appear at work or with managing finances.
In contrast to those with Alzheimer’s disease, people in the early stages of behavioural variant FTD tend not to have problems with day-to-day memory or with visuospatial skills (judging relationships and distances between objects). Someone with FTD may go walking without obvious purpose but, unlike a person with Alzheimer’s, will often find their way home without getting lost.
Recent research shows that FTD can also affect the sensitivity of people with dementia to physical or environmental stimulation such as temperature, sounds and even pain. It is unusual for a person with behavioural variant FTD to be aware of the extent of their problems. Even early on, people generally lack control over their behaviour or insight into what is happening to them. Their symptoms are more often noticed by the people close to them.
By Rick Klink
Linkedin: Just Rick