Bipolar II Disorder: Three Things You Should Know

If you are wondering whether you or someone you know has bipolar, it is important to get a diagnosis from a mental health professional. Having said that, what follows is a look at some of the symptoms you can look for if you are on the fence about seeking a diagnosis.

What is Bipolar II Disorder?

Bipolar disorder is typically characterized by an emotional cycle of highs and lows, or manic and depressive states, over a period of days or weeks with a broad range of symptoms.

According to the DSM-5:

For a diagnosis of Bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode:

Hypomanic Episode

1. A distinct period of abnormally and persistently elevated, expansive, or irritable moods and abnormally and persistently increased activity or energy lasting at least four consecutive days and present most of the day, nearly every day.

2. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represents a noticeable change from usual behavior, and has been present to a significant degree:

• Inflated self-esteem or grandiosity.
• Decreased need for sleep (e.g., feels rested after only three hours of sleep).
• More talkative than usual or pressure to keep talking.
• Flight of ideas; for subjective experience, the thoughts are racing.
• Distractibility (i.e. attention easily drawn to unimportant or irrelevant to external stimuli) as reported or observed.
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
• Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual and not symptomatic.

4. The disturbance in mood and this change in functioning are observable by others.

5. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is by definition, manic (and hence more likely to fall under Bipolar I).

6. The episode is not attributable to the physiological effects of a substance (e.g., a drug abuse, and medication or other treatment).

Major Depressive Episode

Any five (or more) of the following symptoms have been present during the same two-week period and represent the change from previous functioning (1) depressed mood or (2) loss of interest or pleasure:

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears cheerful). (Note: In children and adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly everyday (as indicated by either subjective account or observation).

3. Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month or decrease or increase in appetite nearly everyday). (Note: In children, considered failure to make unexpected weight gain).

4. Insomnia or hypersomnia nearly everyday.

5. Psychomotor agitation or retardation nearly everyday (observable by others; and not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or loss of energy nearly everyday.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly everyday (not merely self-reproach or guilt about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or specific plan for committing suicide.

10. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

11. The episode is not attributable to the physiological effects of a substance or another medical condition.

Differences Between Bipolar I and Bipolar II Disorder

The main difference between Bipolar I and Bipolar II Disorder is the requirement of a manic episode (more severe than the hypomanic episode described above).

A person with bipolar in a hypomanic episode may experience feelings of euphoria, less need for sleep, an increase in sexual desire, delusions or hallucinations, or significant increase in energy, but it will be in a lesser degree to a manic episode, and not significantly impairing to normal functioning. This does not mean it is inconsequential and should be ignored.

A professional diagnosis is still an important first step toward finding treatment. A mental health professional may add a specifier to the diagnosis (e.g. with anxious distress, with mixed features, with rapid cycling, with mood-congruent psychotic features, etc.) but these are beyond the scope of this overview.

Most Common Symptoms of Bipolar II Disorder

If you are concerned that you or someone you love may have Bipolar II Disorder, it may be useful to see some of the most common symptoms in a bullet list for clarity.

Please remember it is important not to self-diagnose. If some of these symptoms seem like they are on the money, the next step is to see a professional mental health counselor for a diagnosis. Remember, you need more than one of these for a specific period of time for there to be an actual diagnosis:

Common Manic and Hypomanic Symptoms

Talking Excessively

In the old days, someone who spoke quickly and used a lot of words might be called a “chatterbox.” Some people are wired this way – energetic, busy thoughts, able to communicate them in quick succession.

Taken by itself, this is not necessarily a symptom of bipolar disorder. If the person is unable to stop it and settle down and the energetic presentation seems to alternate with a low-energy, depressed kind of presentation and it seems to happen on a cycle coupled with other symptoms in this list, it might be worth being curious about with a therapist.

Racing Thoughts

Most of us have had the experience of racing thoughts, especially when faced with some kind of crisis. It can be very hard to set aside thoughts about a future that is facing threats of some sort.

If the person often struggles with that and is unable to quiet their mind, and especially if it seems to oscillate with a state where it’s difficult to think clearly, again coupled with other symptoms in this list, this might be worth being curious about with a therapist.

Decreased Need for Sleep

Difficulty sleeping is a common occurrence for many people, but this is something different. If the person doesn’t feel they need sleep and can work long hours – some might say he or she is “a machine” – especially on multiple projects, and if that state seems to shift to a low-energy state where they need more sleep and can’t keep up with that energetic pace, coupled with other symptoms in this list, this might be worth a check in with a therapist.

Grandiosity or Inappropriate Behavior 

The rush of a manic or hypomanic episode can make a person giddy and “full of themselves” for no apparent reason, and in this state they may act out in aggressive or narcissistic ways that may or may not seem out of character.

Increased Sexual Desire

This would be sexual desire which is noticeably greater than the person’s typical baseline, and as before, coupled with other symptoms.

Physical Agitation and Relentless Movement

An inability to sit still, pacing, feeling like they have to do something, again in conjunction with other symptoms.

Impulsive Risky Behaviors (i.e. gambling, spending, sexual)

These are some of the more dangerous symptoms because of the danger of ruining financial or physical health. As mentioned below, and as with each of these symptoms, your mental health professional would have to rule out other disorders based on actual symptoms.

Irritability, Hostility, or Aggression

This is just what it sounds like, and if coupled with other symptoms in this list, may be worth a visit to a professional therapist or psychiatrist.

Delusions or Hallucinations

Delusions are beliefs about oneself or situation that are not true, and hallucinations are actually sensing (sight, sound, touch, taste) things that are not true. Here again, the specific collection of symptoms will help your mental health professional give you a diagnosis.

Common Depressive Symptoms

Loss of interest in enjoyable activities

Nothing sounds good. It’s easier to just sit around and do nothing or watch T.V.

Persistent feelings of hopelessness or guilt 

The person may make up a narrative where they are the bad guy, or nothing ever goes right, and cycle on these thoughts on a downward spiral. This is one of the symptoms that makes a professional diagnosis imperative.

Crying without an obvious reason or extended times of sadness

The important part of this is the “without an obvious reason” part. If the person keeps dredging up the same old wounds, that would also qualify, but would require other symptoms for a diagnosis.

Significant fatigue or inability to get out of bed

A symptom found in most inclusive symptoms of depressive disorders, so context with other symptoms is important.

Excessive sleep or difficulty sleeping

Also common to most depressive disorders.

Not caring about your physical appearance or health

Also common to most depressive disorders.

Suicidal thoughts or desire to harm self

This is another of the more important symptoms that make a professional diagnosis imperative.

Both ends of these cycles can include difficulty concentrating — in the manic phase because the thoughts are racing, in the depressive phase because interest and desire are so low.

If you or someone you love are showing multiple symptoms on these lists in any kind of cycle, talk to a therapist.

A Complex Diagnosis

Some disorders are harder to diagnose than others, and this is one of the hard ones. Bipolar Disorder shares symptoms with a number of other disorders and they can look very similar in the short term.

Some of the disorders a therapist will have to rule out are Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder, Delusional Disorder, Major Depressive Disorder, Panic Disorder, Schizophrenia, Schizoaffective disorder, eating disorders, and symptoms related to use of substances. The good news is, you don’t have to figure out the diagnosis. That’s why you set up an appointment with a psychiatrist or therapist.

Three Things to Know About Bipolar II Disorder

There are a few things to know if you end up with a diagnosis of Bipolar II Disorder:

It’s not curable, but it is treatable

A person with Bipolar Disorder (I or II) will not usually improve with counseling alone. The right medication in conjunction with therapy can be an effective way to manage symptoms. Finding the right medication in the right dosage for you might take some time, so it is important to be patient as you work with your psychiatrist to find something that works.

It shouldn’t be ignored

Depending on the severity of the symptoms, some people can function for years unmedicated. The problem is, left untreated, if the symptoms are bad or get worse overtime, the risk to health and life, either through behaviors like gambling or risky sexual activity, or thrashing between manic and depressive phases or suicidal thoughts and self-harm can be significant. So much better to see a professional and pursue treatment.

Don’t lose hope

Don’t let the complexity of the diagnosis throw you. Try to make peace with the idea that it may take time to refine the treatment for your specific symptoms. Make use of your support system, friends, family, church, and don’t use a diagnosis as a reason to isolate yourself, unless that is prescribed for a time as part of treatment. As with most of the illnesses that come our way, the path to health leads through diagnosis and treatment, whatever that turns out to be.

Closing Thoughts

Mental illness can be frightening for patients and loved ones alike. It is important to get the help you need and not allow the stigma (which seems to get less every year as people become more educated about it) or the temptation to retreat into denial to prevent you from moving forward toward growth and health with the help of whatever professional or professionals you need.