Bipolar Is One Disorder With Many Faces

Although the symptoms of bipolar disorder can vary significantly from person to person, mental health professionals have identified four main subtypes of the illness that are sometimes referred to as bipolar spectrum disorders: bipolar I, bipolar II, bipolar not otherwise specified, and cyclothymia.

Factors that differentiate the types of bipolar include the duration and intensity of the mood swings. Knowing which type you have can help doctors choose the right course of treatment, according to Gabrielle Carlson, MD, professor of psychiatry and pediatrics at Stony Brook University Medical Center in New York.

Bipolar I
People who have bipolar I—the “classic” bipolar disorder—have experienced one or more manic episodes lasting at least a week and almost always one or more major depressive episodes.

Manic episodes bring an abnormally elevated mood. A person may be agitated, have grandiose ideas, need less sleep, be easily distracted, and act impulsively.

Depressive episodes bring feelings of sadness, hopelessness, guilt, worthlessness, and pessimism; patients may experience difficulty concentrating, a loss of interest in normal daily activities, and changes in eating and sleeping habits. It’s considered a depressive episode if the person experiences several of these symptoms for most of the day for more than two weeks.

Bipolar disorder can also cause psychosis, which may include hallucinations (seeing things that aren’t there) or delusions (strongly held beliefs not based in reality and not influenced by rational thinking).

Men and women are equally likely to have bipolar disorder, although a 2005 study in the American Journal of Psychiatry found that men are more likely to have their first manic episode at a younger age.The disease is also evenly distributed among ethnicities, says S. Nassir Ghaemi, MD, the director of the Mood Disorders Program at Tufts Medical Center in Boston.

In bipolar disorder, periods of depression typically last longer than manic episodes. Depression can last for a year or longer, while manic episodes rarely go on for longer than a few months. If treatment is successful, bipolar patients may experience months or years of mood stability between episodes, although one-third have some residual symptoms, according to the National Institute of Mental Health (NIMH).