4 Types of Bipolar Disorder

People with bipolar disorder struggle daily with the unpredictable and often confounding features of this complex mental health disorder. There is still no known cause of the disorder, despite ongoing research. Some factors associated with bipolar disorder include family history of bipolar or other mental illness, unique brain structure features, highly stressful events, brain chemistry imbalance that affects mood regulation, and a history of abuse or trauma. 

There are four different types of bipolar disorder, each having unique features. The prevailing characteristics involve intense mood swings, shifting from manic episodes to depressive episodes, often without warning. Resulting changes in sleep patterns, eating habits, emotions, and behaviors accompany the mood swings.

What is Bipolar Disorder?

Bipolar disorder, once known as manic-depressive disorder, is a mental health condition that causes extreme shifts between manic and depressive emotional states. It typically appears during the teen or early adult years. According to the National Institute of Mental Health, approximately 4.4 percent of U.S. adults will experience bipolar disorder at some point in their lives.

Living with bipolar disorder can be profoundly disruptive. The mood changes can arrive without warning, shifting rapidly or lingering for days. During a manic phase, a person may feel intensely energized, focused, and capable. When the depressive episode follows, that same person may feel exhausted, hopeless, and unable to function.

While there is no cure for bipolar disorder, the condition responds well to treatment. Medication, psychotherapy, and structured care help most people manage symptoms and maintain stability over time.

Symptoms of Manic Episodes

Bipolar disorder symptoms during manic phases can range from mild to severe. In bipolar 1, manic episodes are intense enough to require hospitalization. In bipolar 2, the manic phase is less severe and is referred to as hypomania.

Symptoms include:

• Euphoria
• Racing thoughts and difficulty staying focused, easily distracted
• Rapid speech
• Excessive energy, hyperactivity
• Aggressive behavior
• Irritability or agitation
• Very little sleep
• Impulsive behaviors, using poor judgment
• Risky behaviors, such as substance use or sexual promiscuity
• Psychosis (hallucinations or delusions)

Symptoms of Depressive Episodes

Depressive episodes are a consistent feature across all four types of bipolar disorder, though their severity and duration vary. These episodes carry a heightened risk of suicidal behavior and should always be monitored by a clinical professional. 

Symptoms include:

• Persistent sadness
• Feelings of despair and hopelessness
• Intense fatigue
• Anxiety
• Sleep disturbances
• Loss of interest in activities once enjoyed
• Chronic pain with no known medical cause
• Trouble concentrating
• Irritability
• Suicidal thoughts

4 Types of Bipolar Disorder

Using the DSM-5, patient interviews, and diagnostic assessment tools, clinicians can identify which type of bipolar disorder is present. The National Institute of Mental Health recognizes four types of bipolar disorder, each defined by the pattern and intensity of manic and depressive episodes. 

• Bipolar I: Bipolar I disorder is the most common of the four types. Bipolar I involves one or more manic episodes, with or without depressive episodes occurring. The mania must be severe enough that hospitalization is required and lasts a week or longer.
• Bipolar II: Bipolar II disorder is characterized by the shifting between the less severe hypomanic episodes and depressive episodes.
  • Bipolar 1 vs bipolar 2 is one of the most common points of confusion for families. The key distinction is severity: bipolar 1 involves full manic episodes that often require hospitalization, while bipolar 2 involves hypomanic episodes that are less intense but still significantly disruptive. Both types carry substantial risk during depressive phases.
• Cyclothymic disorder: Cyclothymic disorder, or cyclothymia, involves repeated mood shifts between depressive and hypomanic that persist for more than two years. The depressive and mania episodes do not meet the diagnostic criteria for bipolar disorder episodes. There may be periods of normal mood as well, but those periods last less than eight weeks.

Unspecified bipolar disorder. Bipolar disorder not otherwise specified is present when the symptoms do not fit the other three categories, but still involve episodes of unusual manic mood.

Bipolar disorder is a difficult mental health condition to treat and manage. However, by charting thoughts, feelings, trigger exposures, work and family issues, and health conditions, it is possible to better predict and manage pre-relapse situations. This allows you to be proactive in taking steps to prevent a bipolar relapse, thereby enjoying a better quality of life.

Bipolar Disorder and Addiction

Bipolar disorder and addiction frequently occur together. Research from the Journal of Clinical Psychiatry indicates that people with bipolar disorder have among the highest rates of co-occurring substance use disorder of any psychiatric condition. Alcohol and stimulants are the substances most commonly misused by people with bipolar disorder, often as a way to manage the extremes of manic or depressive episodes.

The relationship runs in both directions. Substance use can trigger or worsen manic and depressive episodes, making bipolar disorder harder to manage. At the same time, the instability of bipolar disorder increases the risk of turning to substances for relief.

Treating bipolar disorder and addiction together, rather than sequentially, produces better outcomes for both conditions. Ashley Addiction Treatment’s dual diagnosis program addresses both conditions simultaneously, with psychiatric care integrated into the addiction treatment plan from the start.

If you or someone you love is experiencing symptoms of bipolar disorder alongside substance use, Ashley’s clinical team can help clarify what level of care is appropriate. Reach out through the admissions inquiry form or the contact page to start that conversation.