Reviewed by Dawn Brown, LPC, NCC
Long ago, scientists and mental health professionals used the term manic depression to describe a mental illness identified by distinct, cycling moods. Today, the accepted name is bipolar disorder. While most people have heard both these phrases, many people don't realize that bipolar disorder is an umbrella term that includes two similar conditions labeled one and two. So, what's the difference between bipolar 1 and 2? Read on for a description of each and some of the key factors that set them apart.
The most apparent difference between the two disorders is in the types of phases people with these disorders have. There are three distinct phases in bipolar disorder, and each comes with its own unique challenges.
The manic phase is characterized by a high, elated, or irritable mood. During this phase, people have trouble with work-related tasks, social functioning, and may even be hospitalized. Other symptoms of the manic phase include grandiose ideas, racing thoughts, flights of ideas, and pressured speech. People who are manic tend to take on more than they can possibly do. They are often impulsive and engage in risky or dangerous behavior. Because your mood is so intense, this phase can cause significant impairment in all aspects of your life.
The hypomanic phase is much like the manic phase, but it is not as intense. Many people can do their work, often becoming highly productive. Social situations may become more comfortable for some people during a hypomanic phase. The increased energy helps them get things done and engage in life more.
During the depressed phase, people experience an overwhelmingly sad or despairing mood. They may even attempt suicide or other forms of self-harm. It's challenging to get things done during the depression because of negative thoughts, low self-esteem, and a lack of energy. You lose interest in your favorite activities and may sleep too much or too little. You may gain or lose weight as your appetite changes. Self-isolation is common during depression, and social situations may feel unbearable.
Phases in Bipolar 1
If you have a manic episode, your diagnosis will likely be bipolar I. You might or might not have hypomanic episodes. However, people with bipolar I do have depressive episodes. Depending on your condition's severity, you may have problems functioning during both manic and depressive phases.
Phases in Bipolar 2
People with bipolar 2 have not had a manic episode, and you might never have one. However, it's possible that it just hasn't happened yet and will in the future. Also, if you don't practice good self-care habits, you may be more likely to trigger a manic episode. If you do, your diagnosis will change to bipolar I. Depression is the greatest disabler for people with bipolar 2. The sad mood, slow speech and movements, indecisiveness, and loss of interest can bring your life to a screeching halt. Add to that the negativity and possibility of self-harm, and you can see that this phase is just as difficult for people with bipolar 2 as it is for those with bipolar 1.
Who Gets Bipolar I and II?
Little research has been done comparing the prevalence of bipolar 1 and bipolar 2. However, a 2011 study found that 0.6% of the population had bipolar type 1 during their lifetime, while 0.44 had bipolar type 2 in their lifetime. The same study found that the mean age of onset for bipolar I was 18.4 years of age, while bipolar II had a slightly higher onset of 20.
Bipolar 1 vs. 2: Which Is Worse?
Your condition's severity is far more significant than whether you have type 1 or type 2 bipolar disorder. There are a few small differences in the way each is likely to affect your life.
When bipolar I or bipolar II disorder is severe, they both are about equally disabling. Role impairment is an inability to perform well at a job or in everyday tasks. The study referred to above explored how disabling the phases of bipolar were depending on the severity of the illness and the type of bipolar.
During the manic phase, about the same percentage of people with bipolar 1 and people with bipolar II have role impairment. However, the difference becomes more significant at lower levels of severity. In bipolar with moderate severity, more people with bipolar 1 had impairment during the manic phase than people with bipolar 2 do during the hypomanic phase.
For those in the depressive phase, the disability is more significant. More people with bipolar I people than people with bipolar II have role impairment if the episode is severe. For moderate episodes, that's reversed, with more bipolar II people having impairment than bipolar I people.
Suicide and Self-Harm
People with both types may become depressed enough to attempt suicide. According to the above 2011 study, 25% of people with bipolar I, and 20% of bipolar II people reported suicide attempts. The difference is significant, but no matter which type of bipolar disorder you have, it's critical that you seek help in your local area immediately if you're considering or planning to commit suicide.
How to Know If You Have Bipolar 1 or 2
While reading about bipolar 1 and 2, you may recognize symptoms that seem familiar to you. You may have noticed them in yourself or members of your family. Or, you may still wonder if they're severe enough to warrant a diagnosis. So, what can you do? How can you assess your condition as well as your need for mental health care?
You can start with a simple screening test to determine if you might have bipolar disorder. The confidential screening test is meant to ease your mind if you have no symptoms or give you the information in case you do show signs of bipolar disorder. The test is easy to take, and you get quick, accurate results. If your test shows a good chance that you have this disorder, you can take your results with you when seeking help from a mental health professional.
Getting a Diagnosis
Of course, the best way to know for sure if you have bipolar 1 or bipolar 2 is to talk to a psychiatrist or therapist. They can spot the difference between bipolar 1 and 2 very well. They use the DSM-5 diagnostic manual to ensure you get an accurate diagnosis based on the symptoms you're experiencing.
But here's another difference. Many people with bipolar 2 don't seek treatment until they have a major depressive phase. They don't have manic phases at all, and their hypomanic phases might not be very disruptive or uncomfortable. Friends and family might not realize that they're even having a problem. So, diagnosis often gets put off until later. Then, when the depression hits, their condition can be quite severe.
For someone in the manic phase of bipolar I, the picture is quite different. They may feel like their life has turned upside down. Their friends and family will almost certainly notice that something is seriously wrong. They may destroy their relationships without ever understanding why it happened. If they don't seek help during a manic phase, their loved ones might step in to convince them it's time.
Treatments for Bipolar I Disorder and Bipolar II
Similar treatments are used for bipolar I and II. People in both groups will likely need a mood stabilizer medication. Lithium was once the preferred medication of this type. However, now several different mood-stabilizing medications are available, including a few anti-seizure medicines that have a mood-leveling effect.
Antidepressants are used for bipolar I and II, both during depressive episodes and between episodes, to decrease the likelihood of the depression returning. However, some antidepressants aren't safe for bipolar I disorder people who tend to have severe manic episodes. The problem is that the wrong antidepressant can trigger a manic episode in some people.
Therapy can be beneficial for people with both bipolar I and bipolar II disorders. Your therapist can help you gain a more realistic, balanced perspective. They can teach you techniques to assess your thoughts and stabilize your behaviors.
Knowing the difference between bipolar I and bipolar II can help you in several ways. If you have bipolar disorder, it can help you understand what to expect. If someone you care about has one of these conditions, you can understand their behavior better. However, it's important to remember that no matter which category you or they fall into, each person's mental health issues are unique.
The first step is to find out about the possibility you might have bipolar disorder at all. Taking a screening test can help you find out about that. If a loved one seems to be having bipolar symptoms, you might suggest that they take the test. If your test shows you might have bipolar, you can bring your results with you as you seek diagnosis and treatment.