I have received quite a few questions since I began The Diary of Hypomaniac in regards to what Bipolar Disorder actually is, and more specifically around Bipolar II and hypomania. Well my friends, I am NO medical expert, and I am still researching and learning every single day, almost two years after my diagnosis. I do however, love that people reading are interested enough to reach out. Keep the questions coming!
To honour those who would like more information, and those that are just curious, I have decided to dedicate the next couple of blog posts to explaining what Bipolar Disorder is (with the help of actual medical experts of course).
In both self exploration and in advocacy, it is important that you are willing to drill down to the roots and know your story inside and out. Teaching others, only helps me learn more myself. And, the key to empathy and kindness is understanding, which I am more than happy to attempt to give.
“Bipolar Disorder is the great stew of mental illness: a little ADHD, a little bit of OCD, a dash of eccentricity, a sliver of paranoia, a splash of impulsivity, a touch of random neurosis, a tad of grandiosity, and a stroke of genius.” ~ Unknown
What is Bipolar?
According to the Canadian Association of Mental Health (CAMH) Bipolar Disorder, formerly called manic depression, is a medical condition that causes a person to cycle through periods of depression and elevated mood. Bipolar disorder typically consists of three states:
- A high state, called mania
- A low state, called depression
- A well state, during which a person feels healthy and functions well
The Phases
As per the Mayo Clinic, when attempting to diagnose a bipolar disorder, the individual must present some or all of the symptoms listed below. I have broken them out into phases that the information is easier to digest.
Mania Phase
Sometimes a person may seem continuously high, happy, euphoric, or irritable, angry, and aggressive for at least one week. If this change in mood is accompanied by at least three of the following symptoms, the person may be in the manic phase of bipolar:
- Exaggerated self-esteem or feeling of grandeur
- Decreased need for sleep
- More talkative than usual
- Racing thoughts
- Easily distracted
- Excessive energy for activities
- Engaging in risky behaviour or poor judgement
A less intense form of mania is hypomania. The symptoms of hypomania are less severe that those of mania. The person may feel happy and have a lot of energy, but his or her life is usually not seriously disrupted. Hypomania may progress to a full blown manic episode or a severe depression and therefore also requires treatment.
Depressive Phase
A person may be experiencing the depressive phase of bipolar disorder if at least five of the following symptoms are present for at least two weeks and experienced on most days:
- Depressed mood
- Loss of interest or pleasure in activities that used to be enjoyable
- Weight loss or gain
- Difficulty sleeping or sleeping too much
- Apathy or agitation
- Inability to concentrate
- Loss of energy
- Feelings of worthlessness or guilt
- Thoughts of suicide (which should always be taken seriously)
Mixed Episodes
Some people with bipolar disorder experience manic and depressive symptoms at the same time. This is called a mixed episode. For example, someone experiencing a mixed episode may think and speak very rapidly. At the same time, they may be very anxious and have suicidal thoughts. Mixed episodes are hard to diagnose and are very painful for the individual.
Types of Bipolar Disorder
As if the symptoms of bipolar aren’t confusing enough, the disorder presents itself in several different ways. Reclassification of the symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have caused there to be some differentiation in what a few of the types are called. I am going with the majority on this one, however, I am in no way limiting this list to what is below.
Bipolar 1
Bipolar I is sometimes referred to as manic depressive disorder or manic depression. It refers to a person who has suffered at least one manic episode in their life. Manic or mania is a period of abnormally elevated mood and high energy, accompanied by abnormal behaviour that disrupts life.
Manic episodes can be described in numerous ways. It is an “elevated mood” that manifests itself in feeling euphoric (high) or as irritability. The euphoric mood is accompanied by behavioural signs such as jumping from one idea to the next, increased energy, lack of sleep, rapid and loud speech, inflated self image, reckless behaviour like excessive spending, drinking, substance abuse or hypersensitivity.
On the opposite end of the spectrum, there are depressive episodes that look similar to clinical depression. This includes low energy and activity, sadness, feelings of guilt, worthlessness and thoughts of suicide.
These episodes of mania and depression can occur back and forth, thus creating a cycle… hence manic depression. There can be long periods between these episodes where someone with bipolar might experience zero symptoms at all.
Bipolar II
Those with Bipolar II (myself included) share a similar cycle of moods as those with Bipolar I. The major and defining factor that differentiates the two is that Bipolar II patients never reach full blown mania. Rather, they experience a less intense but still elevated mood called hypomania.
Like Bipolar I, II has depressive episodes following hypomania. In between the highs and the lows someone with Bipolar II may live a relatively normal life.
Hypomania may appear from the outside to be a very happy mood which will include rapid speech, a jumpy mentality that bounces from idea to idea, an exaggerated sense of self confidence, an increased energy with decreased need for sleep.
In hypomanic episodes, people might spend money the don’t have, seek out sex with people that the normally wouldn’t, and engage in other impulsive and risky behvaiour with potential dangerous consequences.
Unique to Bipolar II is that patients who suffer from it will experience longer or more depressive episodes after hypomania. These depressive episodes also present similar clinical depression with low energy, activity, feelings of guilt and worthlessness, as well as a loss of pleasure and overall sadness.
It is important to note that Bipolar II is not a milder form of Bipolar I disorder, but a separate diagnosis. While the manic episodes of Bipolar I can be severe and dangerous, bipolar II persons can be depressed for longer periods of time which can cause significant impairment.
Rapid Cycling Bipolar
If someone has experienced 4 or more mood swings within a 12 month period, it is considered to be Rapid Cycling Bipolar.
The episodes consist of depression, mania, hypomania or what is called a mixed state where mania and depression occur at the same time. These mood swings are unpredictable, and there is usually no rhyme or pattern behind them. Rapid cycling isn’t much different from Bipolar I, the significant difference being the speed in which the episodes occur.
Cyclothymia
Generally seen as a milder form of bipolar, those with Cyclothymia still experience episodes of highs and lows but the defining difference here is the intensity of which experiences each episode.
Cyclothymia is still a serious form of bipolar disorder, but is less noticeable as episodes feel like low grade depression or mild-hypomania.
As these depressive episodes never reach the levels of major depression and hypomania never becomes full blown mania, cyclothymia is incredibly hard to diagnose.
The Take Away
As you can see, Bipolar Disorder is complex. It affects each individual differently and it is one of the hardest mental illnesses to diagnose for those reasons. Add in social stigmas, lack of funding and/or access to treatment and it is estimated that 51% of people that have bipolar will go undiagnosed or without treatment. I am hoping this little bit of information will help to build greater understanding and appreciation for BP and those that manage the diagnosis every day.
Yours as a Bipolar II,
Heather Adele
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