Differences between type I and II bipolar disorder

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

The differences between the types are notable, and to determine precisely which of the two suffers it is necessary to make an in-depth review of both the present symptoms and their history.

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

In this article, we will address the differences between bipolar disorder type I and II, in order to shed light on the issue and contribute to the precision of the diagnosis or treatment process, which are key to influence its clinical and prognosis.

General characteristics of the bipolar disorder subtypes

Before delving into the differences between type I and 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 during this period, it can be understood as one of the risk factors for bipolarity in the future (although never decisively).

Type I bipolar disorder has, as a distinctive element, the history of at least one manic episode in the past or present (expansion of mood, irritability and excess activity), and may alternate with stages of depression (sadness and difficulty in experiencing pleasure) . Both extremes reach a very high severity, so that they can even provoke psychotic symptoms (especially in the context of mania).

Type II bipolar disorder is characterized by the presence of at least one hypomanic phase (of less impact than the manic but with similar expression) and another depressive phase, which are interspersed in no apparent order. For this diagnosis, it is necessary that a manic episode has never been presented previously, otherwise it would be a subtype I. Making this nuance requires a deep analysis of past experiences, since mania may go unnoticed.

The ciclotimia amount to dysthymia , but from the perspective bipolar. Along these 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 who have symptoms of bipolar disorder but who fail to satisfy any of the diagnoses previously described.

Differences between type I and II bipolar disorder

Type I and type II bipolar disorder, together with cyclothymia and undifferentiated, are the conditions included in the category of bipolarity (previously known as manic-depressive). Although they belong to the same family, there are important differences between them that must be considered, since an adequate diagnosis is essential to provide treatment tailored to the healthcare needs of each case.

In this article we will discuss possible differences in variables related to epidemiology , 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 case will be emphasized. Eventually, in addition, the peculiarity of cyclothymia will be discussed.

1. Distribution by sex

There is suggestive data that major depression, the most common of the problems included in the category of mood disorders , 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: the data suggests that men and women suffer type I with the same frequency, but the same does not occur in type II.

In this case, women are the population most at risk, the same thing that happens with regard to 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 frequent than type II, with a prevalence of 0.6% compared to 0.4% , according to meta-analysis. 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 may suffer from it, being a similar figure to that observed in other mental health problems other than this (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 them that must be taken into account . The first of these is that in type I bipolar disorder this symptom is not necessary for 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 a manic episode is required to corroborate this disorder.

In type II bipolar disorder, on the other hand, its presence is mandatory. The person suffering from it must have experienced it at least once. In general, it tends to appear recurrently, interspersed with periods in which the mood acquires a different sign: hypomania. Furthermore, it has been observed that depression in type II is usually more lasting 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, occasionally irritable mood 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 it acquires a disabling 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 translate into impulsive acts based on disinhibition and the feeling of invulnerability. The person is excessively active, engaged in an activity to the point of forgetting to sleep or eat, and engaging in acts that involve a potential risk or that can have serious consequences.

In type II bipolar disorder the symptom exists, but it does not present with the same intensity. In this case a great expansion is shown, 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 compared to mania, hypomania is also necessary for the diagnosis of type II.

5. Psychotic symptoms

Most of the psychotic phenomena that are linked to a 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, such that the person forges delusional content beliefs regarding his abilities or personal relevance (consider himself someone so important that others should go to her in a special way, or ensure that she has a relationship with well-known figures in art or politics, for example).

In hypomanic episodes, associated with type II, sufficient severity is never observed for such symptoms to express themselves. In fact, if they appeared in a person with type II bipolar disorder, they would be suggestive that what is actually being suffered is a manic episode, so the diagnosis should be changed to a type I bipolar disorder.

6. Number of episodes

It is estimated that the average 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 higher risk of experiencing clinical changes in their mood, as well as those with poor adherence to pharmacological and / or psychological treatment. 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 , both mania and hypomania or depression, can be seen. These are the fast cyclists, who 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 severe than type II, since in that type the intensity of manic symptoms is greater. The truth is that this is not exactly the case, and that subtype II should never be considered the 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 manic episodes are more severe in type II depression is mandatory presence and its duration is higher than that of type I . On the other hand, in type I psychotic episodes may arise during the manic phases, which imply complementary perspectives of intervention.

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

by Abdullah Sam
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