Types of Bipolar Disorder
Updated 5/10/09
The DSM-IV, or Diagnostical and Statistical Manual of Mental Disorders, classifies bipolar disorder as a mood disorder. There are three categories under this disorder: bipolar disorder I, bipolar disorder II, and cyclothymic disorder. Specifiers (such as “with catatonic features” or “with psychotic features”) can be added to any of these disorders to further clarify the severity of the symptoms for each patient.
Bipolar I disorder is the most serious type of manic depression, and is identified by the individual displaying at least one mixed or manic episode along with episodes of major depression. What are the mixed episode symptoms of bipolar disorder? A mixed episode is one in which both depression and mania are displayed at the same time. For instance, an individual may show increased energy but be having dark, depressing thoughts. In a manic episode, the person may suffer from psychosis, which include symptoms such as delusions and hallucinations. In this case the diagnosis would be bipolar I with psychotic features. By definition, only bipolar I can include psychotic features. Having this type of bipolar disorder can impair daily functioning.
Bipolar II disorder is a less severe form of the disorder, and is identified by at least one major depressive episode and hypomanic episode. Bipolar II is different from bipolar I in that it displays hypomania instead of mania. Also, psychotic features do not occur with bipolar II. And according to diagnostic criteria, bipolar II does not require hospitalization or impair functioning like bipolar I.
Cyclothymia refers to a disorder in which chronic, fluctuating moods are present, including periods of hypomania and periods of depression. This is a condition in which the person’s moods cycle between depression and hypomania, ranging from mild to somewhat severe over a long period of time. Cyclothymia does not include psychotic features, impaired functioning or suicidal tendencies. With cyclothymia, there is no full-blown mania or major depression, and symptoms are fairly steady, never easing for longer than two months at a time. Also, there can’t be a mixed, manic, or depressive episode within the first two years of onset.
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) classifies bipolar disorder as a mood disorder in the “affective” family, and breaks up the types into additional categories more specific to the various symptoms displayed. The types disorders listed in the ICD-10 are manic episode, depressive episode, bipolar affective disorder, recurrent depressive disorder, and persistent mood disorders that include dysthymia and cyclothymia .
In addition to the above classification systems, researches have developed other models for classifying bipolar disorder. One of the most popular systems is the Young and Klerman Subtypes. This system categorizes the disorder into six subtypes, which are: bipolar I (mania and major depression), bipolar II (hypomania and major depression), bipolar III (cyclothymia), bipolar IV (antidepressant-induced mania or hypomania), bipolar V (major depression with family history of bipolar disorder), and bipolar VI (unipolar mania).
Unipolar mania refers to episodes of mania occurring without any episodes of depression. Since this condition is so rare, it is not included in the DSM-IV.
Other subtypes used to classify manic depression include rapid cycling, ultra-rapid cycling, seasonal pattern, and post-partum onset. Rapid cycling refers to four or more mood episodes per year. If you go from mania or hypomania to depression and back at least four times in one year, you are experiencing rapid cycling. Ultra-rapid cycling refers to mood cycles that occur more frequently, at least four or more times per week. Some people experience cycling as often as several times per day. I experience ultra-rapid cycling. Rapid cycling and ultra-rapid cycling are subtypes of bipolar II disorder. Seasonal pattern refers to mood changes that occur with the change in the weather. For instance, some people get depressed in the winter and manic during the summer. Post-partum onset occurs within one month of childbirth. Bipolar disorder with post-partum onset is usually a temporary condition.
