Differences Between Bipolar Disorder Type I And II
Bipolar disorder is an important mental health problem, which is characterized by the appearance of acute episodes of sadness and clinically relevant mood expansion, but whose expression may be different depending on the subtype diagnosed.
The differences between the types are notable, and to determine precisely which of the two you suffer from, it is necessary to do an in-depth review of both the symptoms present and their history.
In addition, there is a third type: cyclothymia. In this specific case, the symptoms are less intense for each of its poles, although it also generates a substantial impact on different areas of life.
In this article we will address the differences between bipolar disorder type I and II, in order to shed light on the issue and contribute to precision in the diagnosis or treatment process, which are key to influencing its clinical symptoms and prognosis.
General characteristics of bipolar disorder subtypes
Before delving into the differences between bipolar disorder type I and II, It is important to know the main characteristics of each of the disorders that make up the category In general, these are problems that can debut in adolescence. In fact, if depression occurs during this period, it can be understood as one of the risk factors for bipolarity in the future (although never decisive).
Bipolar disorder type I has, as a distinctive element, the history of at least one manic episode in the past or present (expansion of mood, irritability and excess activity), which can alternate with stages of depression (sadness and difficulty experiencing pleasure). . Both extremes reach a very high severity, so that they can even cause psychotic symptoms (especially in the context of mania).
Bipolar disorder type II is characterized by the presence of at least one hypomanic phase (less impactful than the manic phase but with similar expression) and another depressive phase, which are interspersed in no apparent order. For this diagnosis, it is necessary that a manic episode has never previously occurred, otherwise it would be a subtype I. Making this nuance requires an in-depth analysis of past experiences, since mania can go unnoticed.
Cyclothymia would be equivalent to dysthymia, but from the bipolar perspective. Along these lines, acute phases of mild depression and hypomania would occur, the intensity and/or impact of which would not allow the diagnosis of any of them separately (subclinical symptoms). The situation would continue for at least two years, generating disturbances in the quality of life and/or participation in significant activities.
Finally, there is an undifferentiated type, which would include people who present symptoms of bipolar disorder but who do not satisfy any of the diagnoses described above.
Differences between bipolar disorder type I and II
Bipolar disorder type I and type II, along with cyclothymia and undifferentiated disorder, are the conditions included in the category of bipolarity (previously known as manic-depressive). Although they belong to the same family, there are important differences between them that must be considered, since an adequate diagnosis is essential to provide treatment tailored to the healthcare needs of each case.
In this article we will discuss possible differences in variables related to epidemiology, such as sex distribution and prevalence; as well as in other clinical factors, such as depressive, manic and psychotic symptoms. Finally, the specific form of presentation (number of episodes) and the severity of each case will be influenced. Eventually, the particularity of cyclothymia will also be discussed.
1. Distribution by sex
There is suggestive data that major depression, the most common of the problems included in the category of mood disorders, is more common in women than in men. The same occurs with other psychopathologies, such as those included in the clinical spectrum of anxiety.
However, in the case of bipolar disorder, slight differences can be seen with respect to this trend: the data suggest that men and women suffer from type I with the same frequency, but the same does not occur in type II.
In this case, women are the population at highest risk, the same as happens with cyclothymia. They are also more prone to changes in mood associated with the time of year (seasonal sensitivity). Such findings are subject to discrepancies depending on the country in which the study is conducted.
2. Prevalence
Bipolar disorder type I is slightly more common than type II, with a prevalence of 0.6% compared to 0.4%, according to meta-analysis works. It is, therefore, a relatively common health problem. In general (if both modalities are considered at the same time), it is estimated that up to 1% of the population may suffer from it, a figure similar to that observed in other mental health problems other than this (such as schizophrenia).
3. Depressive symptoms
Depressive symptoms can occur in both type I and type II bipolar disorder, but there are important differences between them that must be taken into consideration The first of them is that in bipolar disorder type I this symptom is not necessary for the diagnosis, despite the fact that a very high percentage of people who suffer from it end up experiencing it at some point (more than 90%). In principle, only one manic episode is needed to corroborate this disorder.
In bipolar disorder type II, however, its presence is mandatory. The person who suffers from it must have experienced it at least once. In general, it tends to arise recurrently, interspersed with periods in which the mood takes on a different sign: hypomania. Furthermore, it has been observed that depression in type II tends to last longer than in type I, this being another of its differentiating features.
In the case of cyclothymia, the intensity of depressive symptoms never reaches the threshold of clinical relevance, contrary to what happens in bipolar disorders type I and II. In fact, this is one of the main differences between cyclothymia and type II.
4. Manic symptoms
Expansive, occasionally irritable mood is a common phenomenon in bipolar disorder in any of its subtypes It is not an exultant joy, nor is it associated with a state of euphoria consistent with an objective fact, but rather it acquires a disabling intensity and does not correspond to precipitating events that can be identified as its cause.
In the case of bipolar I disorder, mania is a necessary symptom for diagnosis. It is characterized by a state of extreme expansiveness and omnipotence, which translate into impulsive acts based on disinhibition and the feeling of invulnerability. The person is excessively active, engrossed in an activity to the point of forgetting to sleep or eat, and engaging in acts that involve potential risk or that may have serious consequences.
In bipolar disorder type II the symptom exists, but it does not present with the same intensity. In this case he shows great expansion, in contrast to the mood he usually shows, occasionally acting in an expansive and irritable way. Despite this, the symptom does not have the same impact on life as the manic episode, which is why it is considered a milder version of it. As occurred in bipolar disorder type I with respect to mania, hypomania is also necessary for the diagnosis of type II.
5. Psychotic symptoms
Most of the psychotic phenomena linked to bipolar disorder are triggered in the context of manic episodes In this case, the severity of the symptom can reach the point of breaking the perception of reality, such that the person forms delusional beliefs regarding their abilities or their personal relevance (considering themselves someone so important that others should turn to them). her in a special way, or ensure that you have a relationship with well-known figures in art or politics, for example).
In hypomanic episodes, associated with type II, sufficient severity is never observed for such symptoms to be expressed. In fact, if they appeared in a person with bipolar disorder type II, they would be suggestive that what they are really suffering from is a manic episode, so the diagnosis should be changed to bipolar disorder type I.
6. Number of episodes
It is estimated that the average number of episodes of mania, hypomania or depression that a person will suffer throughout their life is nine. However, there are obvious differences between those who suffer from this diagnosis, which are due to both their physiology and their habits. Thus, for example, those who use illegal drugs have a greater risk of experiencing clinical changes in their mood, as do those with poor adherence to pharmacological and/or psychological treatment. In this sense, there are no differences between subtypes I and II.
In some cases, certain people may express a peculiar course for their bipolar disorder, in which a very high number of acute episodes are seen, both mania and hypomania or depression. These are rapid cyclers, who present up to four clinically relevant changes in each year of their lives. This form of presentation can be associated with both type I and type II bipolar disorder.
7. Severity
It is possible that, after reading this article, many people will conclude that type I of bipolar disorder is more serious than type II, since in the former the intensity of manic symptoms is greater. The really true thing is that this is not exactly the case, and that subtype II should never be considered the mild form of bipolar disorder. In both cases, significant difficulties occur in daily life, and therefore there is a general consensus on their equivalence in terms of severity.
While in subtype I the episodes of mania are more severe, in type II depression is a mandatory presence and its duration is longer than that of type I On the other hand, in type I, psychotic episodes may arise during manic phases, which imply complementary perspectives of intervention.
As can be seen, each of the types has its particularities, so it is key to articulate an effective and personalized therapeutic procedure that respects the individuality of the person who suffers from them. In any case, the selection of a psychological approach and a drug must be adjusted to the care needs (although mood stabilizers or anticonvulsants are necessary), influencing the way in which the person lives with their mental health problem.
