Bipolar 2 disorder is a class of mood disorder characterized by at least one major depressive episode and at least one hypomanic episode. Bipolar 2 is distinguished from the other mood disorders bipolar 1 (manic depression) and cyclothymic disorder by hypomania, which is a period of elevated mood that doesn’t reach the criteria of mania. Bipolar 2 disorder is frequently misdiagnosed as major depression if hypomanic episodes aren’t recognized. Bipolar 2 is a long-term, chronic mental health condition that can be successfully treated and managed.

DSM 5 Bipolar 2 Criteria

Someone experiencing bipolar 2 hypomania experiences at least four days of elevated mood change, which might include feelings of increased energy, irritability, and expansiveness. Their daily life is clinically impaired by the hypomanic episode, but not as seriously as manic symptoms like delusions and/or hallucinations that could cause a manic person to seek inpatient treatment. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, someone who has experienced a manic episode cannot be diagnosed with type 2 bipolar disorder. 

Bipolar 2 Symptoms of Hypomania

Someone with bipolar 2 disorder can experience rapid cycling of symptoms, or extended periods between hypomanic and depressed mood episodes. Symptom severity can be classified as mild, moderate, or severe. According to the DSM-5, the following symptoms may indicate bipolar 2:

  • Abnormally upbeat, jumpy, or wired feelings
  • Increased activity, energy, or agitation
  • Decreased need for sleep
  • Irritable mood
  • Unusual talkativeness
  • Exaggerated sense of wellbeing and self-confidence (euphoria)
  • Rushed/scattered thinking
  • Attention/focus issues
  • Increase in activity toward goals
  • Psychomotor agitation, which is an increase in purposeless physical activity. Symptoms are restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, rapidly talking, and moving items around without meaning.
  • Poor decision-making, such as taking risks sexually or making unwise investments

Bipolar 2 Symptoms of Major Depression

A major depressive episode involves depressive symptoms that are severe enough to cause noticeable difficulty in daily tasks like work, school, and activities, as well as in relationships. An episode of depression consists of five or more of the following symptoms which persist for at least two weeks:

  • Depressed mood—feeling sad, empty, hopeless or teary. In children and adolescents, this can manifest as irritability.
  • Significant loss of interest or feeling of no pleasure in all or most activities
  • Weight loss when not dieting, weight gain, or abnormal increase/decrease in appetite
  • Insomnia or oversleeping
  • Restlessness or slowed behavior
  • Loss of energy
  • Feeling worthless
  • Feeling inappropriate guilt
  • Decreased ability to think or concentrate
  • Indecisiveness
  • Thinking about, planning, or attempting suicide.

Bipolar 1 Vs Bipolar 2

The most prevalent contrast between bipolar 1 and bipolar 2 is complete mania (great excitement, euphoria, delusions, and overactivity) that lasts at least a week compared to hypomania that persists throughout most of the day for at least four days. When a person experiences a manic episode, a qualified psychiatrist might diagnose them with bipolar 1, aka manic depression. 

Impact of Bipolar 2 Disorder 

People with an untreated bipolar disorder may have serious problems in many features of their lives. The various depressive, hypomanic, or manic episodes may seriously impair functioning. The average age of onset is mid-20s, which is later than type 1 bipolar but earlier than major depressive disorder (MDD). People with untreated bipolar 2 may have a lower socioeconomic status due to a lag in occupational recovery after episodes. But early intervention for the disorder can help prevent negative functional consequences. 

Treatments for DSM-5 Bipolar 2 Disorder 

  • Prescription medications like mood stabilizers and antidepressants
  • Adaptation strategies like regulating daily exercise and sleeping routines. Some types of therapy can successfully treat the interruption of circadian rhythms (chronodisruption) related to bipolar 2 disorder.
  • Psychotherapy and behavioral therapy approaches like cognitive behavioral therapy (CBT)
  • Family-focused therapy
  • Interpersonal and social rhythm therapy (IPSRT) 
  • Support groups
  • Substance use therapy 

Individuals with bipolar disorder 1 and 2 can benefit greatly from high-quality mental health treatment. A professional diagnosis of a mental illness can help explain your distress, which is often a huge relief, but it does not define who you are. 

*A previous version of this blog post did not mention the efficacy of medication, which is a front-line, evidence-based treatment for bipolar disorder.

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