Bipolar II Disorder (Type 2)

What is Bipolar II Disorder?

With moods changing between euphoric hypomania (hypomanic episodes) and crippling major depression, individuals with bipolar II disorder (type 2) can experience a huge range of positive and negative symptoms.

The condition is often confused with bipolar I disorder, which causes manic episodes rather than hypomanic episodes. While the less extreme highs of bipolar II might make it seem like a less severe condition, it can be an incredibly debilitating condition due to the lengthy periods of major depression that are experienced. Plus, it’s often much harder to diagnose, which can leave people suffering without appropriate treatment. However, once a successful treatment plan is in place, the outlook for bipolar II disorder is positive.

Overview of Bipolar II Disorder

Bipolar II is a mood disorder which causes dramatic swings between high and low moods. In order to make a formal diagnosis of the condition, DSM-IV-TR diagnostic criteria states than an individual must have experienced at least one episode of hypomania and at least one episode of major depression. However, individuals must not have experienced an episode of mania.

Hypomania is different to mania in that it is a less extreme version of the elevated mood. Mania causes extremely reckless, often dangerous behavior which can be harmful to sufferers and those around them. With hypomania, the symptoms can be more positive; individuals can feel more productive, creative and outgoing without necessarily taking any major risks which could be dangerous to themselves or others. For this reason, many bipolar II suffers do not see their hypomanic episodes as problematic and tend to enjoy the elevated mood in contrast to the long periods of depression that they also face.

Another key difference is that while someone with mania usually lacks awareness that their behavior is unusual or out of control, someone experiencing hypomania is usually fully aware of their euphoric state and of the changes in their behavior. Individuals who have experienced mania as well as at least one episode of major depression are diagnosed with type I bipolar, and these people may also experience hypomanic episodes. However, those who have experienced only hypomania with episodes of major depression are diagnosed with bipolar II disorder.

Since individuals with bipolar II tend not to find their hypomanic episodes problematic or detrimental to their wellbeing, it can be much more difficult to recognize and diagnose the condition. Typically, individuals only seek help during major depressive episodes since it is these which cause the most disruption to their quality of life. It is at this stage that a doctor may recognize hypomanic episodes within the patient and make a diagnosis of bipolar II.

Symptoms of Bipolar II

The clearest symptom of bipolar II disorder is experiencing extreme high and low moods. However, in order to recognize these moods, it’s important to know the symptoms of hypomania and major depression.

Major depression is a period of persistent depressed mood, during which time individuals may report feeling empty, worthless, hopeless, guilty and with little energy or motivation. In some instances, major depression can cause individuals to have thoughts of suicide or self harm.

Other symptoms of major depression include:

  • Low energy and fatigue, even with plenty of sleep
  • Difficulty getting to sleep, or sleeping far too much
  • Unusual change in appetite, such as overeating or eating too little, and subsequent rapid changes in weight
  • Lack of interest in things that would usually be pleasurable
  • Having trouble remembering things, concentrating or making decisions
  • Recurring thoughts of death

Hypomania, as discussed above, is a highly elevated mood, during which time individuals often experience racing thoughts and grand ideas. They may make plans or come up with ideas that they would not have done when in a stable mood.

Other symptoms of hypomania include:

  • Heightened self-esteem
  • More confidence and feeling more sociable
  • Being incredibly talkative
  • Getting irritated when others can’t keep up with the same train of thought
  • Increased productivity and taking part in goal-oriented activities
  • Making brash decisions without fully weighing up the consequences
  • Getting easily distracted
  • Heightened creativity

An individual must experience symptoms of hypomania for most of the day, nearly every day, for at least four consecutive days in order for the experience to be diagnosed as a hypomanic episode. For a bipolar II diagnosis, they must also experience an episode of major depression which lasts for at least two weeks.

Typically, the periods of depression tend to last much longer than periods of hypomania in patients with bipolar II, and compared to those with type I bipolar, the periods of depression are usually much more frequent. For this reason, many people with bipolar II are often misdiagnosed with major depressive disorder since they experience very many depressive episodes and don’t necessarily always acknowledge that their hypomanic episodes are not “normal”.

Bipolar II Causes

It is thought that bipolar occurs as a result of a combination of different factors. First and foremost, it is understood that the dramatic changes in mood occur as a result of chemical imbalances in the brain. Chemicals known as neurotransmitters are responsible for how our brains function, and if the levels of these neurotransmitters changes, it can lead to extreme moods.

However, it is believed that the cause of these chemical imbalances is influenced by a number of things. Genetics play some part in it; those with a family history of bipolar II are more likely to develop the condition than those who don’t. If you have a parent, grandparent or other close family member with the condition, you are more at risk of developing bipolar II in the future.

That doesn’t necessarily mean that everyone who has a family history of the disorder will develop it. It is believed that certain environmental factors can trigger the condition too. Stressful life events such as the death of a loved one, the ending of a relationship or financial hardship can trigger bipolar II disorder. Severe emotional trauma, particularly when experienced as a child, can also trigger the condition.

In some instances, the abuse of alcohol or illicit drugs may cause symptoms which seem like hypomania and depression, but the use of these substances doesn’t necessarily cause bipolar II. In these instances, individuals are advised to cease drug or alcohol use and see if their symptoms subside before a diagnosis of bipolar II can be made.

Treatments for Bipolar II

Medication

Medication and psychotherapy are usually used in combination to treat the symptoms of bipolar II, since there is no definitive cure for the disorder. Mood stabilizers may be used to help reduce the severity or frequency of the extreme highs and lows, but since bipolar II only causes hypomania and not mania, it may not be necessary to regulate the heightened moods. Instead, treating episodes of major depression, as and when they occur, may be more effective.

In these cases, antidepressants are usually prescribed. These medications work to adjust the chemicals in the brain to a more normal state in order to alleviate depressive symptoms. There are many different types of antidepressants available, each with unique effects on the body and potential side effects. For many patients it can take some trial and error with different types of antidepressants and dosages before they find a solution which improves their mood with minimal side effects. Usually, it takes a few weeks before the effects of antidepressants kick in, which is why psychotherapy is often recommended alongside the medication.

Psychotherapy

Psychotherapy can help patients to understand the causes of their depressed state and talk over the particular negative thoughts that they experience during depressive episodes. Therapies such as CBT (cognitive behavioral therapy) can be particularly effective in changing negative thought patterns and establishing more positive behaviors in order for patients to better manage the symptoms of depression.

When it comes to hypomania, psychotherapy may also be useful for helping individuals to recognize the signs and triggers of their elevated mood. For many, hypomania may be a positive state of mind, and a therapist or counselor could help them to use the periods of elevated mood to their advantage, without taking risks or making decisions that have detrimental consequences to their life.

For many people with bipolar II, the effects of their condition can be harmful not only to them, but to those around them. During hypomanic episodes, they may become angry or irritated with those around them, and when in a depressed state they may isolate themselves from others and neglect their relationships. Psychotherapy may offer an opportunity for them to reflect on how their actions impact others, and find ways to improve their relationships with others.

Lifestyle changes

Since bipolar II is usually a lifelong condition, it’s important for individuals to find coping mechanisms or make lifestyle changes that will manage their symptoms. Psychotherapy may allow them to identify triggers or warning signs of hypomanic or depressive episodes, and take necessary precautions to stabilize their moods or better cope with their extreme moods.

Bipolar II Disorder Prevention

Individuals who have been given a diagnosis of bipolar II disorder may find ways to prevent future episodes of mania, or at least reduce the frequency of them. Since stress can be a big triggering factor, it might be helpful to make lifestyle changes to reduce stress, such as changing jobs, finding a better work-life balance, or taking up hobbies or activities that help to relax you. Exercise can be incredibly helpful in alleviating stress and maintaining a stable mood.

Some may find it helpful to keep a diary or journal in which they note down their thoughts, feelings and moods. This can help them to pick out patterns in their moods or behavior and identify triggering factors. With this knowledge, it may be possible to pinpoint episodes of hypomania or depression before they occur, and seek advice from a doctor or psychotherapist to prevent the episode from escalating.

For those who do not have a bipolar II diagnosis but know they are at risk of developing the condition due to having a family member with the disorder, it can be helpful to speak to a doctor or psychotherapist. They will help you to recognize symptoms in yourself which may be of concern. Since stress is a trigger, it may be wise to avoid stressful scenarios wherever possible, or to seek out psychotherapy or counseling to help you cope with stressful periods in your life. If you have experienced emotional trauma in the past and have a family history of bipolar II disorder, it may also be very beneficial for you to seek out professional talking therapies in order to come to terms with the trauma and find some closure. This may not necessarily prevent you from developing bipolar II disorder in the future, but it will no doubt be of huge benefit to your well-being.

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Last Reviewed:
September 25, 2017
Last Updated:
November 16, 2017
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