Bipolar disorder is characterized by the intermittent presence of manic episodes and episodes of depression. This is why it is called ‘bipolar’ disorder and is also known as manic-depressive disorder (because the manifestations oscillate from one pole to another).

Within this broad spectrum, manic episodes may be more intense than depressive ones, or vice versa. For this reason, two types of bipolar disorder are currently recognised : Bipolar Disorder Type I and Bipolar Disorder Type II .

What is Bipolar Disorder Type 2?

Bipolar Disorder Type II, also written including Roman numerals (Bipolar Disorder Type II) is a mood pattern that is characterized by major depressive episodes, alternating with hypomanic episodes. That is, depression manifests itself with greater intensity than mania.

Currently, Bipolar Disorder Type 2 is one of the clinical sub-categories that fall under the category of “Bipolar Disorder and Related Disorders” in the fifth version of the Diagnostic and Statistical Manuals of Mental Disorders (DSM-V).

Diagnostic Criteria for Bipolar Disorder Type II (according to DSM-V)

As we have said, Bipolar Disorder Type 2 can be diagnosed in the presence of two large and complex phenomena: a hypomanic episode and a major depressive episode . In turn, these phenomena must have a series of specific characteristics (in order to differentiate Type I from Type II Bipolar Disorder).

In addition, during the diagnosis, it should be specified which of the episodes has been more recent, and how it has been, for example, if it has occurred in rapid cycles, if there are psychotic characteristics , if it is accompanied by other elements such as anxiety, if there is a seasonal pattern, and if the severity is mild, moderate or severe.

The Hypomanic Episode

It refers to a period of too high mood, for example, more expansive or more irritable than normal, characterized by a visible and persistent increase in energy. To be diagnosed, this period must have lasted at least four days in a row and must be present for most of the day.

This visible and persistent increase in energy must have led to a significant change in usual behaviour, but which is not seriously interfering with the fulfilment of responsibilities that are considered socially appropriate for the person’s age, gender, social position, etc.

This increase in energy is characterized by the presence of at least three of the following phenomena, as long as they cannot be explained by the physiological effects of some substance or treatment

  • There is an increase in self-esteem and feeling of greatness .
  • Even if there is fatigue, there is a little or low need for sleep.
  • There’s a greater need to talk or to keep the conversation going.
  • You feel that thoughts are going at a great speed or that there is a kind of flight of ideas
  • There’s a special facility for distraction.
  • The activity is exacerbated, which can be seen in psychomotor agitation .
  • Excessive interest in activities that are likely to cause discomfort (e.g., sudden, reckless, and unbridled shopping)

If all this is accompanied by psychotic characteristics, then the episode is not hypomanic, but manic, which requires a different intervention. Likewise, all of the above must be sufficiently noticeable and visible by those closest to the person.

Episode of major depression

As the name implies, the major depression episode is the presence of a depressive mood that is experienced most of the day and almost every day, which has a major influence on the person’s daily activity.

Clinically this episode can be diagnosed when the mood has at least five of the following characteristics, and in addition has produced a clinically significant discomfort , that is, it has caused the person to be unable to fulfil the responsibilities that are considered socially accepted for his/her age, gender, social status, etc. (e.g. with work, studies, family):

  • The state of mind has lasted almost every day , which can be known through what the person expresses, as well as being corroborated by what other people have seen.
  • Significant decrease in interest and sense of pleasure in virtually all day-to-day activities.
  • Significant and rapid weight loss or gain (without dieting)
  • Insomnia almost every day.
  • Constant and observable feeling of restlessness and psychomotor agitation by others.
  • Fatigue and constant energy loss .
  • Excessive or inappropriate feelings of guilt, can even be delusional.
  • Lack of concentration and decision making
  • Constant idea of death and suicide.

None of the above phenomena can be explained by the effects of a substance or medical treatment. For its diagnosis, it is important to consider not only the list, but the clinical criteria of the specialist based on the person’s medical history and cultural norms that make it considered a significant discomfort.

Therapies and treatments

Bipolar disorder type 2 is not so much a disease as a living condition, however, there are several options to help the person gain more control over his or her emotions and over the oscillations in his or her mood.

The most effective options are those that combine appropriate drug therapy with long-term psychotherapy. As for medications , those most frequently included are mood stabilizers, antipsychotics and antidepressants. The most frequent psychotherapies are cognitive behavioural therapy, systemic therapy and psychoeducation.

Currently, many studies and researches are being carried out (and even civil associations and critical models) to better understand the Type 2 Bipolar Disorder, so that more and more options are developed for people who have had this diagnosis, and their families, to have good life conditions.

Bibliographic references:

  • National Institute of Mental Health (2018). Bipolar Disorder. Recovered May 2, 2018. Available at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
  • American Psychiatric Association (2014). DSM-5 Diagnostic Criteria Reference Guide. Washington, D.C: USA.