I’ve been wanting to write about evidence that bipolar disorder type II really is bipolar disorder and really does exist. Why? Because some very vocal people have attacked me on this point. There is this ridiculous notion that bipolar disorder type II is made up just to sell more drugs and that I am pushing this evil agenda. But, well, I just haven’t had time to get the facts and evidence together for you. So today I just want to speak from my own experience — I have bipolar disorder type II and yes, it is real bipolar disorder.
What Is Bipolar Disorder Type II?
Many people don’t know the difference between bipolar disorder type I and type II. For more on this, please see this article. In short, people with bipolar disorder type I experience mania — a more severely elevated state than people with bipolar disorder type II. People with bipolar type II experience hypomania, which has all the same symptoms but it less severe.
It should also be noted that psychosis (the presence of delusions and/or hallucinations) can be present in bipolar type I and not in type II and those with type I do tend to require more hospitalizations in their elevated periods due to the severity of their manias.
So, I’d like to reiterate that: people with bipolar disorder type I and type II have all the same diagnostic symptoms with a difference in severity of mania (psychosis isn’t a diagnostic symptom either way).
Bipolar Disorder Type I Is the ‘Real’ Bipolar Disorder
Look, bipolar disorder type I can be considered “classic” bipolar disorder (or manic depression, if you really prefer). But that doesn’t make it more “real.” People with bipolar disorder type I have very real experiences and in some ways, they can be different from those with type II but in most ways, they are actually the same. More links bipolar disorder type I and II than separates them, certainly.
Why Does Bipolar Disorder Type II Even Exist?
There’s a reason why bipolar disorder type II exists — and no, it isn’t to sell more drugs. It exists because people with bipolar disorder type II have an illness that clearly contains major depressive disorder but responds differently to treatment than major depressive disorder alone does. When you have a person with major depressive disorder and you give them an antidepressant, they tend to improve. When you give an antidepressant to a person with bipolar disorder (type I or II) they will often get worse in that they will flip to mania/hypomania, a mixed state, cycle or even become psychotic. Antidepressants can worsen the course of bipolar disorder over time whereas for major depressive disorder, they improve it.
Treatment wise it is extremely important to understand these differences and understand these differences do warrant another diagnosis. Bipolar disorder type II is like major depressive disorder plus. Bipolar disorder type I is like major depressive disorder plus too. In the case of bipolar I, it’s plus mania. In the case of type II, it’s plus hypomania. That makes them awfully, awfully similar.
So the diagnosis of bipolar disorder type II is important because not only does it characterize the experience of the illness but it also indicates proper treatment. (And while treatment for bipolar disorder is nuanced, it can simply be put that bipolar disorder type I and bipolar disorder type II are treated almost identically.)
Bipolar Disorder Type II Is ‘Real’ Bipolar Disorder
Look, I have bipolar disorder type II and I know how similar my experience is to those with bipolar disorder type I and I know that we do, in fact, have very similar illnesses. But you don’t have to believe me.
What you should believe, though, is that people with bipolar disorder type II, like me, clearly have a serious mental illness no matter what you call it. And from my perspective, you could call it “Fred.” I don’t care. That doesn’t change the illness and it doesn’t change the treatment necessary. If that makes you feel better and that makes you feel like I’m not encroaching upon your precious bipolar disorder diagnosis then, sure, I’ll say I have Fred. Sure, you have the “real” bipolar disorder and I have Fred. Feel better?
For all the scientific details on bipolar disorder type I and type II, see this Medscape section.
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Hi. My name is Kev. For clarity I was diagnosed with OCD firstly with major depressive disorder that was later changed to OCD and BP2. Setting OCD aside (fyi, I thought I knew what OCD was and didn’t identify with it while suffering terribly from it – it’s a horrible affliction that literally drove me round the bend until I totally opened up to a professional who absolutely nailed it). Now regarding the BP2, I would suffer mostly depressive episodes and was put on AD’s to then flip almost unknowingly to a hyper manic state which included high energy, over confidence, arrogance to the point I believed I was special (almost god like). I would even see colours differently, I felt unstoppable and beyond any reprieve. I was sharp as a razor. Now all this seems great (and sometimes I wish I was back there) but if I were to describe how these misconceptions actually manifested in terms of physical behaviour you would be shocked. I’m lucky to be alive tbh with the things I have done. But I was able to fly just below the radar of total unacceptability and avoided medical intervention for the large part that almost destroyed my career and did destroy my marriage (c/w 2 kids) of nearly two decades. The only difference I see is that my mania is slightly less obvious and thus in some respects more destructive as its right on the fringes of acceptable behaviour. My depressive episodes are dangerous; the thought of suicide is a constant for me. I’ve tried various AD’s, AP and stabilisers and I’m so far away from what I could describe as happy. That’s what other have. Whatever BP2 is; it’s miserable.
Hmmm… a psychiatry lecturer at our local medical school would disagree with you. Bipolar 2 is contested. Seriously, how bad can hypomania be when by definition it does not markedly impair functioning? You are aware that Alan Frances, who oversaw the DSM-IV committee that introduced bipolar II as a diagnosis, now regrets its inclusion? As you’ve made a career out of bipolar 2 your attitude is expected – it would be very hard for you to seriously consider viewing much of so-called bipolar 2 as recurrent depression.
Hi Eleanor,
Bipolar II may be contested by some, maybe, but accepted by most. Scientific consensus is what I go by, but that’s me.
That said, if my psychiatrist turned around tomorrow and said my diagnosis was major depressive disorder with hypomanic episodes, that would be fine. Diagnoses are only useful in that they describe what is happening for a person. They allow us to talk to each other and know what others are talking about. If mine were called “Fred” it really wouldn’t matter to me. What matters is that we agree what “Fred” means.”
– Natasha Tracy
Hey everybody. Carli here. I have BP1, and sure enough, it really sucks. I’m just here to mention that I think a lot about my friends out there with BP2. I think each has its extreme challenges. I know that I go for long periods with low to no problems, while a lot of my BP2 friends rarely get “a break,” meaning a few days without the highs or lows. That must be very exhausting. So I just want to send some love to Natasha and everybody out there dealing with BP2. It’s real, it’s a serious challenge, and we all do better with support. Much love to all.
I was diagnosed Bipolar II when I planned to commit suicide in 2011. I got diagnosed in my 30’s. it would have been earlier but there was a stigma as I would have been diagnosed with manic depression.
Bipolar II according to what I heard and read is a lot more dangerous than Bipolar I to the sufferer because you are more prone to self harm.
F-ck yes!! Finally! This feels like someone just spoke my mind for me -once again #thankyou!!!
In my humble opinion, bipolar disorder type II is a legitimate disorder simply becoz it’s documented in the DSM5. Treatment of this type of disorder may vary from person to person, so in short I really don’t understand what the fuzz is all about.
If you reckon documenting in the DSM is what matters, then you need to recognise that bipolar 2 was unreal up until the 1990s, and the psychiatrist who oversaw it’s inclusion in the DSM now regrets that inclusion
When I was first officially diagnosed with Bipolar. (2006).. I was told that I had all the symptoms of Bipolar I (including psychosis) but that because my mood history had me with longer, harder, deeper and stronger depressive episodes.. that I was predominately Bipolar II with Mixed Features.
I have been hospitalized with high flying mania and I’ve been hospitalized for psychotic mixed… thing that the pros said made the difference was the meds and IF they helped. So, Lithium and Seroquel add in Lexapro and some Klonopin… knocked me on my arse, slept likened to a coma, gained 35 lbs in 6 months and the vehicles passing me on the interstate were screaming at me one afternoon (Lexapro caused this). The Lithium however, kept me from killing myself.
I’ve been told by pros to not have those with Bipolar on Anti-Depressants. I’ve never had a positive response to any anti-depressant and I’ve taken every classification since the early 80s. I’ve also been told by the pros that it doesn’t matter and quite often ADs are prescribed to those diagnosed with Bipolar.
I’ve been diagnosed continually with Bipolar since my last psych IP (2006) for I’ve had several in my lifetime… I truly believe that I have it. When I was officially diagnosed; a click occurred way down deep and a feeling of relief swept through me… it fit and I and my spirit knew it fit. Regardless of whether I have I or II… for I’ve had pros argue to and fro… either/or is REAL and either/or is deadly and either/or is disabling and even to the point of crippling at times.
It’s all mental illness, irregardless of the can’s label…
call me an old fogey, but i’m just not a fan of blurring diagnoses to include as many people as possible, even if the rationale for doing so is good. autism sounds nicer than mental retardation, let’s put everyone on the spectrum. addiction once had a specific medical definition: substance use which requires increasing amounts for the same effect and involves physical withdrawal symptoms upon cessation. now tiger woods is a sex addict, teenagers are addicted to their iphones.
so too with bipolar disorder — because it’s often portrayed positively (beethoven was bipolar!), it’s become far more popular than various other neurotic / psychotic “brands.” and if it feels good, why should anyone care? if it’s the difference between insurance coverage and poverty, what monster would complain? well, there’s this quaint idea that psychiatry is actually a medical discipline. some people actually believe that mental illnesses are no different from other diseases, that they can be treated scientifically, that it’s not all a matter slapping meaningless names onto sufferers,
rule of thumb: if they tell you you’re bipolar but put you on a steady diet of antipsychotics and nothing but, well, they’re either kidding you, incompetent or both.
I have been diagnosed with Bipolar 1 and Seasonal Bipolar, its funny how they just change.
I also change more that once in 1 day, just when I think I got this another new symptom surfaces, Mainly will be hospitalised for both conditions at least 3 times in year.
Its confusing as I will get mania and depressed in a matter of hours, recently have been very psychotic
I have type 2 and I dare someone to tell me it’s not real. I suffer just as much as anyone else with type 1 but maybe not quite as long in between mood changes. It feels just as bad to me.
When I was a teen, my counselor had me repeatedly take the either test for manic depression. I always failed. The psychiatrist would not diagnose me with manic depression. These days I would’ve been diagnosed with Bipolar 2. Instead I got worse and worse and was diagnosed 10 yrs later with Bipolar 1 Disorder.
Oh, my God, the EXACT same thing happened to me! I failed the bipolar test because it asked all the stereotypical questions like if I went on major gambling sprees, engaged in risky behavior, did things like travel abroad and max out my credit cards on a whim, etc. I didn’t have the money to do these things anyway, so the questions were kind of biased to people with a certain level of privilege, but I didn’t get full blown mania and do those types of things anyway. So just based on a few questions, I was deemed not bipolar, and I’d get worse and worse until I’d attempt suicide, and years later I got my diagnosis.
My last pDoc doesn’t like the Types labels because she maintains symptoms cross over. That’s to say someone who has previously been diagnosed as Type 2 may occasionally present classic Type 1 symptoms, particularly psychosis. Indeed, I note that some labelled Type 2 may be prescribed antipsychotics in addition to the usual mood containments where there may be persistent depression. I’m not saying she’s right not that she’s wrong, just that some hold that view.
Hi Harry,
Well, I’ve been prescribed antipsychotics (and some with unipolar depression are too). It’s not about psychosis (I’ve never been psychotic), it’s just about what works.
– Natasha Tracy
I am diagnosed officially Type 2, but I’ve have a few completely dilutional experiences. It is scary, and it is real. They were life changing in that what I “saw / did” was so outside of reality. Luckily I was hospitalized both times, but for folks who don’t understand – it’s a real thing and having that mental break from reality is not something any of us would sign up for.