The 2 Types of Bipolar Disorder (DSM-5)

Know the differences between Bipolar Disorder Types I and Type II and Depressive Disorder.

Hello friends!

Many people don’t know, but there are two types of Bipolar Disorder. In this text, we are going to talk about the history of Bipolar Disorder, the confusion that can exist in the diagnosis with Depressive Disorder and about the difference between Bipolar I Disorder and Bipolar II Disorder.

Manic Depressive Psychosis

Many people criticize the DSM (Diagnostic and Statistical Manual of Mental Disorders) – myself included – for the way it was and is created and for the extension of diagnoses without necessarily proving the need for the distinction or a reasonable empirical foundation (as is the case of ADHD).

But, like it or not, the DSM has remained the reference in the Diagnosis of Mental Disorders, for psychologists and psychiatrists. Although we must always have a critical eye and vision, we must also study it before criticizing it. Also because this last version, the 5th, was significantly reformulated and heard the main criticisms of professionals in the area.

Learn more – DSM-5 Course: Main Changes in relation to DSM-IV

In the case of Bipolar Disorder, it is important to know that, until the DSM-III, it did not exist. Patients with similar symptoms were diagnosed as a Psychotic Manic-Depressive patient. This nomenclature is quite old and has existed since the beginning of the 20th century, with the works of the famous Kraepelin.

Therefore, it was only from the 1980s that we saw the appearance of the name Bipolar Disorder or, more precisely, Bipolar Affective Disorder.

To understand Bipolar Disorder well, then, we must understand that it is a Disorder that involves psychosis and, equally, mania and depression. In the DSM-5, we have in the very structure of the chapters an order that goes from the extreme of psychosis to the other extreme of depression.

– Schizophrenia Spectrum and Other Psychotic Disorders

– Bipolar Disorder and Related Disorders

– Depressive Disorders

Thus, we see that the former (schizophrenia) are the extreme of psychosis and represent the conditions with the worst prognosis, that is, there is a greater tendency for the patient not to improve. And the prognosis improves in Bipolar Disorder, and the outlook is even better when there is only one Depressive Disorder, and no symptoms of mania or hypomania are involved.

This does not mean, of course, that a schizophrenic patient cannot improve and live with quality, but, in the group in which he is inserted, the probabilities are lower if we compare with other groups. And, at the other end, this also does not mean that a Depressive Disorder, “only”, cannot be devastating. When we say that there is a better prognosis in depression, a little worse in Bipolar Disorder and worse in Schizophrenia Spectrum Disorders, we are only talking about the average – and according to our knowledge to date and the treatment resources available.

That said, it is easier to understand that Bipolar Disorder has characteristics of the schizophrenia group and characteristics of the depression group. Therefore, its former name was manic-depressive psychosis.

Let’s go to the diagnostic criteria in the DSM-5 for Bipolar I Disorder and Bipolar II Disorder

Bipolar I Disorder

Diagnostic Criteria

To diagnose bipolar I disorder, the following criteria must be met for a manic episode. The manic episode may have been preceded or followed by hypomanic or major depressive episodes.

manic episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration, if hospitalization is necessary).

B. During the period of the mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is just irritable) are present to a significant degree and represent a marked change from usual behavior:

1. Inflated self-esteem or grandiosity;

2. Decreased need for sleep (eg, you feel rested on just three hours of sleep).

3. More talkative than usual or pressure to keep talking.

4. Flight of ideas or subjective experience that thoughts are racing.

5. Distractibility (ie, attention is too easily diverted by insignificant or irrelevant external stimuli), as reported or observed.

6. Increased goal-directed activity (whether socially, at work or school, or sexually) or psychomotor agitation (ie, non-purposeful, non-goal-directed activity).

7. Excessive involvement in activities with a high potential for painful consequences (eg, engaging in reckless buying sprees, sexual indiscretions, or foolish financial investments).

C. The mood disturbance is severe enough to cause marked impairment in social or occupational functioning or to require hospitalization to prevent harm to self or others, or psychotic features exist.

D. The mood disturbance is not attributable to the physiological effects of a substance (eg, drug of abuse, medication, other treatment) or another medical condition.

Note: A full manic episode arising during antidepressant treatment (eg, medication, electroconvulsive therapy) but persisting at a level of signs and symptoms beyond the physiological effect of that treatment is sufficient evidence for a manic episode and therefore for a diagnosis of bipolar I disorder.

Note: AD Criteria represent a manic episode. At least one lifetime manic episode is required for a diagnosis of bipolar I disorder.

Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is just irritable) persist, represent a marked change from usual behavior, and are present to a significant degree :

1. Inflated self-esteem or grandiosity.

2. Decreased need for sleep (eg, you feel rested on just three hours of sleep).

3. More talkative than usual or pressure to keep talking.

4. Flight of ideas or subjective experience that thoughts are racing.

5. Distractibility (ie, attention is too easily diverted by insignificant or irrelevant external stimuli), as reported or observed.

6. Increased goal-directed activity (whether socially, at work or school, or sexually) or psychomotor agitation.

7. Excessive involvement in activities with a high potential for painful consequences (eg, engaging in reckless buying sprees, sexual indiscretions, or foolish financial investments).

C. The episode is associated with a clear change in functioning that is uncharacteristic of the asymptomatic individual.

D. The mood disturbance and change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization. If psychotic features exist, by definition, the episode is manic.

F. The episode is not attributable to the physiological effects of a substance (eg, drug of abuse, medication, other treatment).

Note: A full-blown hypomanic episode arising during antidepressant treatment but persisting at a level of signs and symptoms beyond the physiological effect of that treatment is sufficient evidence for a diagnosis of a hypomanic episode. However, caution is recommended so that 1 or 2 symptoms (mainly increased irritability, nervousness or agitation after antidepressant use) are not considered sufficient for the diagnosis of a hypomanic episode or indicative of a bipolar diathesis.

Major Depressive Episode

A. Five (or more) of the following symptoms were present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by subjective report (e.g., feels sad, empty, or hopeless) or observation made by another person (e.g., feels tearful). (Note: In children and adolescents, it can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or nearly all, activities most of the day, nearly every day (as indicated by subjective report or observation by another person).

3. Significant weight loss or gain when not dieting (eg, change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day. (Note: In children, consider failure to achieve expected weight gain)

4. Almost daily insomnia or hypersomnia.

5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8. Decreased ability to think or concentrate, or indecisiveness nearly every day (by – subjective account or observation made by another person).

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, attempted suicide or a specific plan for committing suicide.

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The episode is not attributable to the physiological effects of a substance or another medical condition.

Bipolar II Disorder

To diagnose bipolar II disorder, criteria for a current or past hypomanic episode and criteria for a current or past major depressive episode must be met.

Differential diagnosis

The diagnosis of bipolar I disorder differs from that of bipolar II disorder by the presence of a previous episode of mania🇧🇷 Other specified bipolar and related disorders or unspecified bipolar and related disorders must be distinguished from bipolar I and type II disorders by considering whether episodes with manic or hypomanic symptoms or episodes with symptoms…