What's the Difference Between Bipolar I and Bipolar II Disorder?

Table of ContentsView AllTable of ContentsUnderstanding Bipolar I vs. Bipolar II DisorderDepressive Symptoms and Bipolar DisorderTreatment for Bipolar DisordersCyclothymic DisorderCoping With Bipolar DisorderFinal Thoughts

Table of ContentsView All

View All

Table of Contents

Understanding Bipolar I vs. Bipolar II Disorder

Depressive Symptoms and Bipolar Disorder

Treatment for Bipolar Disorders

Cyclothymic Disorder

Coping With Bipolar Disorder

Final Thoughts

Close

Bipolar disorder is a treatable condition, and some therapies and medications can reduce symptoms and improve quality of life. However, being diagnosed with bipolar disorder can be scary and confusing. Understanding the different types can help in determining the best treatment path for you.

This article covers the differences between bipolar I and bipolar II disorder and discusses the treatment options available for each.

Let’s take a look at some of the major differences between bipolar I and bipolar II disorder. While each can be debilitating, they have unique symptoms. More details about these symptoms are explained further in this article.

Bipolar I DisorderIncludes a history of at least one fullmanic episodeIs often associated with a depressive episode, but not alwaysMay include psychotic features in the context of mood episodesBipolar II DisorderIncludes a history of at least onehypomanic episodeand no history of full manic episodesIs always associated with a depressive episodePsychosisis absent

Bipolar I DisorderIncludes a history of at least one fullmanic episodeIs often associated with a depressive episode, but not alwaysMay include psychotic features in the context of mood episodes

Includes a history of at least one fullmanic episode

Is often associated with a depressive episode, but not always

May include psychotic features in the context of mood episodes

Bipolar II DisorderIncludes a history of at least onehypomanic episodeand no history of full manic episodesIs always associated with a depressive episodePsychosisis absent

Includes a history of at least onehypomanic episodeand no history of full manic episodes

Is always associated with a depressive episode

Psychosisis absent

What Is Bipolar I Disorder?

According to theDiagnostic and Statistical Manual of Mental Disorders(DSM-5-TR), for someone to be diagnosed with bipolar I disorder, they must have a history of at least one manic episode.

Amanic episodeconsists of a period ofat least one weekand involves three or more of the following symptoms:

The episode must cause significant impairment in daily functioning andmightrequire hospitalization due to unsafe behavior or psychotic symptoms such ashallucinationsordelusions.

In addition, the manic episode must not be superimposed onschizophrenia,schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.

What Is Bipolar II Disorder?

Bipolar II disorder is associated with amajor depressive episodeas well as at least onehypomanicepisode. According to the DSM-5-TR, a hypomanic episode consists of three or more symptoms of a manic episode lasting at leastfour consecutive days.

A hypomanic episode is less severe than a manic episode in that its duration is shorter. Hypomanic episodes do not include psychotic symptoms such as delusions or hallucinations.

A hypomanic episode is generally less intense and causes less impairment than a manic episode.However, both bipolar I and bipolar II cause difficulty with functioning. Both conditions are treatable and have options for evidence-based interventions.

Although most individuals with a bipolar disorder diagnosis experience depressive symptoms, a history of major depressive episodes is not necessary to diagnose bipolar I disorder if an individual has experienced a full manic episode. On the other hand, a diagnosis of bipolar II disorder requires a history of at least one depressive episode.

A major depressive episode consists of five or more symptoms lastingtwo weeks or longer, including either depressed mood orloss of interest:

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

What is Rapid Cycling?Typically, individuals with bipolar disorder will experience one to two episodes per year, but those who experience “rapid cycling” will have four or more episodes in a twelve-month period.

What is Rapid Cycling?

Typically, individuals with bipolar disorder will experience one to two episodes per year, but those who experience “rapid cycling” will have four or more episodes in a twelve-month period.

Although there are some differences in recommendations for bipolar I and bipolar II disorder, recommendations are similar for the two diagnoses. Treatment options include:

It is essential that clients bring any concerns related to ongoing medication or therapy to a treatment team and not change or stop a medication without supervision from the prescribing physician.

RecapTherapy ismost productivewhen the client isnotundergoing an immediate crisis. Therapy services provided when an individual is stable are important for long-term improvement. Consistent medication management can reduce the risk of future manic, hypomanic, or depressive episodes.

Recap

Therapy ismost productivewhen the client isnotundergoing an immediate crisis. Therapy services provided when an individual is stable are important for long-term improvement. Consistent medication management can reduce the risk of future manic, hypomanic, or depressive episodes.

In addition to bipolar I and bipolar II disorders,cyclothymic disordercan consist of hypomanic and depressive symptoms. Colloquially, cyclothymic disorder is sometimes referred to as “bipolar III disorder,” but bipolar III isn’t an official diagnosis.

Cyclothymic disorder consists of ongoing hypomanic and depressive symptoms that lastat least two yearsbut do not meet the full diagnostic criteria for a hypomanic or major depressive episode.

Being in tune with your feelings and recognizing if symptoms are increasing is an important part of living with bipolar disorder. Noticing that an episode might be coming,managing stress levels, and identifying and avoiding things that trigger episodes can help manage symptoms and maintain stability.

Triggers may include things like excess stress, not getting enough sleep, lacking routine, drinking alcohol or using other substances, and being in loud, chaotic environments. Changing medications and certainneurotherapiescan trigger manic episodes as well.

Having a treatment team made up of professionals that you trust is important for managing symptoms. Open, honest communication about your symptoms and stressors is an essential part of treatment.

There are many stigmas that people with bipolar I and bipolar II disorder face. But stigmas are often the result of a lack of knowledge on a particular subject. Both bipolar I and bipolar II are highly treatable.Individuals with these disorders can receive effective treatment, stabilize, and lead fulfilling lives.

What to Know About Coming Out of a Manic Episode

12 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kerner B.Genetics of bipolar disorder.Appl Clin Genet. 2014;7:33-42. doi:10.2147/tacg.s39297American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR); 2022. doi:10.1176/appi.books.9780890425787Solé E, Garriga M, Valentí M, Vieta E.Mixed features in bipolar disorder.CNS Spectrums. 2017;22(2):134-140. doi:10.1017/s1092852916000869Smith L, Johns L, Mitchell R.Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review.Bipolar Disorders. 2017;19(6):417-433. doi:10.1111/bdi.12520Green E, Toma S, Collins J, et al.Similarities and differences across bipolar disorder subtypes among adolescents.J Child Adolescent Psychopharmacol. 2020;30(4):215-221. doi:10.1089/cap.2019.0031Carvalho AF, Firth J, Vieta E.Bipolar disorder. Ropper AH, ed.New Engl J Med. 2020;383(1):58-66. doi:10.1056/nejmra1906193Chiang KJ, Tsai JC, Liu D, Lin CH, Chiu HL, Chou KR.Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. Mazza M, ed.PLOS ONE. 2017;12(5). doi:10.1371/journal.pone.0176849Inder ML, Crowe MT, Luty SE, et al.Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder.Bipolar Disorders. 2014;17(2):128-138. doi:10.1111/bdi.12273Wang X, Luo Q, Tian F, et al.Brain grey-matter volume alteration in adult patients with bipolar disorder under different conditions: A voxel-based meta-analysis.J Psychiatry Neurosci. 2019;44(2):89-101. doi:10.1503/jpn.180002Terao T, Ishida A, Kimura T, Yarita M, Hara T.Preventive effects of lamotrigine in bipolar II versus bipolar I disorder.J Clin Psychiatry. 2017;78(8). doi:10.4088/JCP.16m11404Van Meter AR, Youngstrom EA, Findling RL.Cyclothymic disorder: A critical review.Clinical Psychology Review. 2012;32(4):229-243. doi:10.1016/j.cpr.2012.02.001Hawke LD, Parikh SV, Michalak EE.Stigma and bipolar disorder: A review of the literature.J Affect Disord. 2013;150(2):181-191. doi:10.1016/j.jad.2013.05.030

12 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kerner B.Genetics of bipolar disorder.Appl Clin Genet. 2014;7:33-42. doi:10.2147/tacg.s39297American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR); 2022. doi:10.1176/appi.books.9780890425787Solé E, Garriga M, Valentí M, Vieta E.Mixed features in bipolar disorder.CNS Spectrums. 2017;22(2):134-140. doi:10.1017/s1092852916000869Smith L, Johns L, Mitchell R.Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review.Bipolar Disorders. 2017;19(6):417-433. doi:10.1111/bdi.12520Green E, Toma S, Collins J, et al.Similarities and differences across bipolar disorder subtypes among adolescents.J Child Adolescent Psychopharmacol. 2020;30(4):215-221. doi:10.1089/cap.2019.0031Carvalho AF, Firth J, Vieta E.Bipolar disorder. Ropper AH, ed.New Engl J Med. 2020;383(1):58-66. doi:10.1056/nejmra1906193Chiang KJ, Tsai JC, Liu D, Lin CH, Chiu HL, Chou KR.Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. Mazza M, ed.PLOS ONE. 2017;12(5). doi:10.1371/journal.pone.0176849Inder ML, Crowe MT, Luty SE, et al.Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder.Bipolar Disorders. 2014;17(2):128-138. doi:10.1111/bdi.12273Wang X, Luo Q, Tian F, et al.Brain grey-matter volume alteration in adult patients with bipolar disorder under different conditions: A voxel-based meta-analysis.J Psychiatry Neurosci. 2019;44(2):89-101. doi:10.1503/jpn.180002Terao T, Ishida A, Kimura T, Yarita M, Hara T.Preventive effects of lamotrigine in bipolar II versus bipolar I disorder.J Clin Psychiatry. 2017;78(8). doi:10.4088/JCP.16m11404Van Meter AR, Youngstrom EA, Findling RL.Cyclothymic disorder: A critical review.Clinical Psychology Review. 2012;32(4):229-243. doi:10.1016/j.cpr.2012.02.001Hawke LD, Parikh SV, Michalak EE.Stigma and bipolar disorder: A review of the literature.J Affect Disord. 2013;150(2):181-191. doi:10.1016/j.jad.2013.05.030

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Kerner B.Genetics of bipolar disorder.Appl Clin Genet. 2014;7:33-42. doi:10.2147/tacg.s39297American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR); 2022. doi:10.1176/appi.books.9780890425787Solé E, Garriga M, Valentí M, Vieta E.Mixed features in bipolar disorder.CNS Spectrums. 2017;22(2):134-140. doi:10.1017/s1092852916000869Smith L, Johns L, Mitchell R.Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review.Bipolar Disorders. 2017;19(6):417-433. doi:10.1111/bdi.12520Green E, Toma S, Collins J, et al.Similarities and differences across bipolar disorder subtypes among adolescents.J Child Adolescent Psychopharmacol. 2020;30(4):215-221. doi:10.1089/cap.2019.0031Carvalho AF, Firth J, Vieta E.Bipolar disorder. Ropper AH, ed.New Engl J Med. 2020;383(1):58-66. doi:10.1056/nejmra1906193Chiang KJ, Tsai JC, Liu D, Lin CH, Chiu HL, Chou KR.Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. Mazza M, ed.PLOS ONE. 2017;12(5). doi:10.1371/journal.pone.0176849Inder ML, Crowe MT, Luty SE, et al.Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder.Bipolar Disorders. 2014;17(2):128-138. doi:10.1111/bdi.12273Wang X, Luo Q, Tian F, et al.Brain grey-matter volume alteration in adult patients with bipolar disorder under different conditions: A voxel-based meta-analysis.J Psychiatry Neurosci. 2019;44(2):89-101. doi:10.1503/jpn.180002Terao T, Ishida A, Kimura T, Yarita M, Hara T.Preventive effects of lamotrigine in bipolar II versus bipolar I disorder.J Clin Psychiatry. 2017;78(8). doi:10.4088/JCP.16m11404Van Meter AR, Youngstrom EA, Findling RL.Cyclothymic disorder: A critical review.Clinical Psychology Review. 2012;32(4):229-243. doi:10.1016/j.cpr.2012.02.001Hawke LD, Parikh SV, Michalak EE.Stigma and bipolar disorder: A review of the literature.J Affect Disord. 2013;150(2):181-191. doi:10.1016/j.jad.2013.05.030

Kerner B.Genetics of bipolar disorder.Appl Clin Genet. 2014;7:33-42. doi:10.2147/tacg.s39297

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR); 2022. doi:10.1176/appi.books.9780890425787

Solé E, Garriga M, Valentí M, Vieta E.Mixed features in bipolar disorder.CNS Spectrums. 2017;22(2):134-140. doi:10.1017/s1092852916000869

Smith L, Johns L, Mitchell R.Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review.Bipolar Disorders. 2017;19(6):417-433. doi:10.1111/bdi.12520

Green E, Toma S, Collins J, et al.Similarities and differences across bipolar disorder subtypes among adolescents.J Child Adolescent Psychopharmacol. 2020;30(4):215-221. doi:10.1089/cap.2019.0031

Carvalho AF, Firth J, Vieta E.Bipolar disorder. Ropper AH, ed.New Engl J Med. 2020;383(1):58-66. doi:10.1056/nejmra1906193

Chiang KJ, Tsai JC, Liu D, Lin CH, Chiu HL, Chou KR.Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. Mazza M, ed.PLOS ONE. 2017;12(5). doi:10.1371/journal.pone.0176849

Inder ML, Crowe MT, Luty SE, et al.Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder.Bipolar Disorders. 2014;17(2):128-138. doi:10.1111/bdi.12273

Wang X, Luo Q, Tian F, et al.Brain grey-matter volume alteration in adult patients with bipolar disorder under different conditions: A voxel-based meta-analysis.J Psychiatry Neurosci. 2019;44(2):89-101. doi:10.1503/jpn.180002

Terao T, Ishida A, Kimura T, Yarita M, Hara T.Preventive effects of lamotrigine in bipolar II versus bipolar I disorder.J Clin Psychiatry. 2017;78(8). doi:10.4088/JCP.16m11404

Van Meter AR, Youngstrom EA, Findling RL.Cyclothymic disorder: A critical review.Clinical Psychology Review. 2012;32(4):229-243. doi:10.1016/j.cpr.2012.02.001

Hawke LD, Parikh SV, Michalak EE.Stigma and bipolar disorder: A review of the literature.J Affect Disord. 2013;150(2):181-191. doi:10.1016/j.jad.2013.05.030

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