Differences between bipolar disorder type I and II

The Bipolar disorder is an important mental health problem, characterized by the appearance of acute episodes of sadness and of mood expansion clinically relevant, but whose expression may be different depending on the subtype diagnosed.

The differences between the types are remarkable, and to determine precisely which of the two is suffered by It is necessary to make an in-depth review of both the symptoms present and the history of the themselves.

In addition, there is a third type: cyclothymia. In this specific case, the symptoms are of less intensity for each of its poles, although it also generates a substantial impact on different areas of life.

In this article we will discuss 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 your clinic and forecast.

General characteristics of the subtypes of bipolar disorder

Before delving into the differences between type I and type II bipolar disorder,

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, in the event that depression occurs in this period, it can be understood as one of the risk factors for bipolarity in the future (although never in a decisive way).

Type I bipolar disorder has, as a hallmark, a history of at least one manic episode in the past or present (expansion mood, irritability and excess activity), which may 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).

Type II bipolar disorder is characterized by the presence of at least one hypomanic phase (less impact than the manic but with a similar expression) and another depressive, which are interspersed without an order apparent. 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, as mania can go unnoticed.

The cyclothymia would be equivalent to dysthymia, but from the bipolar prism. Along the same lines, there would be acute phases of mild depression and hypomania, 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 with symptoms of a bipolar disorder but that do not satisfy any of the diagnoses described with anteriority.

Differences between bipolar disorder type I and II

Type I and type II bipolar disorder, together with cyclothymia and undifferentiated, are the conditions included in the category of bipolarity (formerly known as manic-depressive). Although they belong to the same family, there are important differences between them that it is necessary to consider, since a Proper diagnosis is essential to provide a treatment tailored to the care needs of each case.

In this article we will deal with the possible differences in variables related to the epidemiological, such as gender distribution and prevalence; as well as other clinical factors, such as depressive, manic and psychotic symptoms. Finally, the specific form of presentation (number of episodes) and the severity of each of the cases will be addressed. Eventually, in addition, the particularity of cyclothymia will be discussed.

1. Distribution by sex

There is evidence to suggest that major depression, the most common of the problems that fall under the category of mood disorders, it is more common in women than in men. The same is true of other psychopathologies, such as those included in the clinical spectrum of anxiety.

However, in the case of bipolar disorder there are slight differences with respect to this trend: Data suggest that men and women suffer from type I with the same frequency, but the same does not occur in the type II.

In this case, women are the population at greatest risk, as is the case 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

Type I bipolar disorder is slightly more common than type II, with a prevalence of 0.6% versus 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 can suffer from it, being a data similar to that observed in other mental health problems different from this one (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 one and the other that must be taken into account. The first one is that in type I bipolar disorder 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 sometime (more than 90%). In principle, only one manic episode is needed to corroborate this disorder.

In type II bipolar disorder, on the other hand, its presence is mandatory. The person who suffers from it must have experienced it at least once. In general, it tends to appear recurrently, interspersed with periods in which the mood takes on a different sign: hypomania. In addition, it has been observed that depression in type II tends to last longer than in type I, this being another of its differential features.

In the case of cyclothymia, the intensity of depressive symptoms never reaches the threshold of clinical relevance, contrary to what happens in type I and II bipolar disorders. In fact, this is one of the main differences between cyclothymia and type II.

4. Manic symptoms

Expansive mood, occasionally irritable, is a phenomenon common to bipolar disorder in any of its subtypes. It is not an exultant joy, nor is it associated with a state of euphoria congruent with an objective fact, but rather acquires an invalidating intensity and does not correspond to precipitating events that can be identified as its cause.

In the case of type I bipolar disorder, mania is a necessary symptom for diagnosis. It is characterized by a state of extreme expansiveness and omnipotence, which is translated 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 eating, and engaging in acts that involve a potential risk or that can lead to serious consequences.

In type II bipolar disorder the symptom exists, but it does not present with the same intensity. In this case there is a great expansion, in contrast to the mood that is usually shown, occasionally acting in an expansive and irritable way. Despite this, the symptom does not have the same impact on life as the manic episode, so it is considered a milder version of it. As was the case in type I bipolar disorder with respect to mania, hypomania is also necessary for the diagnosis of type II.

5. Psychotic symptoms

Most of the psychotic phenomena associated with 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, in such a way that the person forges delusional content beliefs regarding his abilities or personal relevance to him (considering himself as someone as important as others They must address her in a special way, or ensure that they have a relationship with well-known figures of 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 type II bipolar disorder, they would be suggestive that what is actually is suffering is a manic episode, so the diagnosis should be changed to a bipolar disorder type I.

6. Number of episodes

It is estimated that the average number of episodes of mania, hypomania or depression that the person will suffer throughout his 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 turns clinical conditions in their mood, as well as those with poor adherence to pharmacological treatment and / or psychological. 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 is appreciated., as much of mania as of hypomania or of depression. These are fast cyclers, which present up to four clinically relevant turns 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 conclude that type I of bipolar disorder is more serious than type II, since in that the intensity of the manic symptoms is greater. The truth is that this is not exactly the case, and that subtype II should never be considered a mild form of bipolar disorder. In both cases, there are significant difficulties 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 serious, in type II depression is mandatory and its duration is longer than that of type I. On the other hand, in type I psychotic episodes can arise during the manic phases, which imply complementary perspectives of intervention.

As can be seen, each of the types has its peculiarities, so it is key to articulate a effective and personalized therapeutic procedure that respects the individuality of the person suffers. In any case, the selection of a psychological approach and a drug should be adjusted to the care needs (although the mood stabilizers or anticonvulsants are necessary), influencing the way in which the person lives with their problem of mental health.

Bibliographic references:

• Hilty, D.M., Leamon, M.H., Lim, R.F., Kelly, R.H. and Hales, R.E. (2006). A Review of Bipolar Disorder in Adults. Psychiatry (Edgmont), 3 (9), 43-55.
• Phillips, M.L. and Kupfer, D.J. (2013). Bipolar Disorder Diagnosis: Challenges and Future Directions. Lancet, 381 (9878), 1663-1671.