Everyone experiences emotional highs where they are upbeat and happy, and emotional lows where they are sad and depressed. Yet, for some people, these highs and lows can become cyclical and involve very extreme moods on both ends of the emotional spectrum. Oftentimes, this indicates the person could have bipolar disorder.
However, there are differences between bipolar 1 and bipolar 2, which are essential to know to help decide when to seek professional bipolar disorder treatment.
Bipolar 1 vs. Bipolar 2
Bipolar disorder is a mental health condition that involves changes in behavior, moods, and energy levels. People with this condition can experience episodes of mania (highs) and depression (lows). The two most common types of bipolar disorder are bipolar I and bipolar II. However, there are some key differences between bipolar 1 and bipolar 2, regarding mania and depression episodes.
Bipolar I
Individuals with bipolar I experience intense episodes of mania but may or may not experience depressive episodes. Some people may return to a normal state in between episodes, while others could rapidly cycle from one mood state to the next without any type of baseline in between. It is important to remember that everyone’s cycle, whether they have bipolar I or bipolar II, will be different.
- Mania: The mania episodes can be very intense and usually last at least a week, but can last longer. Bipolar I mania can make some people almost invincible, which can cause them to engage in risky behaviors, make snap decisions, and over-indulge. Some people’s mania episodes can become dangerous and life-threatening, requiring inpatient care and hospitalization. They can also get into injury-causing accidents.
- Depression: People with bipolar I may or may not experience depressive episodes. For those who do, their depression tends only to last about two weeks at most, but can sometimes last longer.
Bipolar II
People with bipolar II will experience depressive episodes but generally do not have full mania episodes, but have less intense hypomania episodes. People with bipolar II can also cycle between the different mood states and have a baseline state in between.
- Hypomania: Hypomania is a period of elevated mood, increased energy, and happiness. However, hypomania is not as intense as mania episodes. During hypomania episodes, people can still make snap decisions and take risks, but they are not usually as dangerous or extreme as bipolar I mania episodes. For instance, they might go on a spending spree, reorganize their entire home, or decide to take a last-minute vacation.
- Depression: People with bipolar II will experience a depressive episode that usually lasts for two weeks, but can last much longer. They can also experience major depressive episodes.
Symptoms and Diagnosis of Bipolar 1
Symptoms of bipolar 1 will vary depending on whether the individual is experiencing a manic or depressive episode. Common symptoms associated with manic episodes include:
- Racing thoughts
- Elevated mood
- Extreme happiness
- Irritability
- Restlessness
- Energetic
- Elevated self-esteem
- Rapid speech
- Easily distracted
- Problems concentrating and focusing
- Engaging in risky behaviors
- Getting injured from accidents
- Need less sleep or not sleeping at all
- May experience hallucinations or delusions
Common symptoms associated with bipolar I depressive episodes include:
- Hopelessness
- Persistent sadness
- Sleeping excessively
- Changes in eating habits (eating for comfort or not eating)
- Lack of energy
- Loss of interest in hobbies and activities
- Feeling worthless
- Difficulty concentrating, focusing, and making decisions
- May experience thoughts of self-harm or suicide
The diagnosis of bipolar 1 usually involves an assessment performed by a mental health professional to evaluate one’s mood, behavior patterns, and energy levels during mania and depressive episodes. The psychiatrist will inquire about one’s medical and family histories, as well. A comprehensive physical exam is also conducted to rule out other potential medical conditions.
A formal diagnosis will require mania episodes lasting at least one week or longer. A depressive episode is not required for a bipolar 1 diagnosis. However, when they do occur, they generally last about two weeks.
Symptoms and Diagnosis of Bipolar 2
The symptoms of bipolar 2 will also vary depending on whether the person is having a hypomania or depressive episode. Common symptoms associated with hypomania include:
- Elevate mood
- Increased energy levels
- Irritability
- Sleeping less than normal
- Racing thoughts
- Rapid speech
- Taking risks
- Making snap decisions
- Lowered inhibitions
- Boosted confidence and self-esteem
- Problems staying focused
People with bipolar II do not have psychotic symptoms during hypomania and do not experience delusions or hallucinations.
Some of the common symptoms associated with bipolar II and depressive episodes are:
- Lack of energy
- Persistent low mood that lasts at least two weeks but generally longer
- Sadness
- A sense of emptiness
- Feeling hopeless
- Loss of interest in hobbies, activities, and socializing
- Sleep disturbances
- Fatigue
- Thoughts of self-harm and suicide
- Agitation
- Feelings of guilt
- Feeling worthless
- Changes in eating habits
- Changes in weight
- Problems focusing, concentrating, and making decisions
Just like bipolar I, a mental health professional will perform a comprehensive examination, physical exam, and tests to rule out other medical conditions. A formal diagnosis requires at least one hypomanic episode that lasts for at least four days and one major depressive episode lasting for at least two weeks or longer.
How Do Bipolar I and Bipolar II Differ?
The primary difference between bipolar 1 and bipolar 2 is in the “high” episodes. With bipolar 1, individuals will experience very intense mania and could also experience psychotic symptoms, such as delusions and hallucinations. Some individuals also require hospitalization or inpatient mental health care. People with bipolar 1 may or may not experience depressive episodes and usually do not experience major depression.
With bipolar 2, individuals will only experience hypomania, a much less intense “high” episode. However, depressive episodes can last much longer than with bipolar 1. Individuals may also experience major depression during a “low” episode.
How Do Doctors Diagnose Bipolar Disorder I and II?
Doctors diagnose bipolar disorder I and II by performing a comprehensive evaluation, which includes:
- Mental health assessment
- Family and medical history review
- Physical exam and lab tests to rule out other medical conditions
After the exam, the DSM-5 diagnostic criteria are used to determine what, if any, mental health disorder the person may have after other medical conditions have been ruled out.
What Is the Treatment for Bipolar Disorder I and II?
Both bipolar I and II are treated using a combination of evidence-based and holistic therapeutic modalities and medications, such as:
- Psychotherapy (talk therapy)
- CBT (Cognitive Behavioral Therapy)
- Group Therapy
- Holistic Therapies (yoga, mindfulness, exercise, nutritional counseling)
- Family Therapy
- DBT (Dialectical Behavior Therapy)
Additionally, there are different care levels available, including:
- Inpatient programs
- Intensive outpatient programs
- Partial hospitalization programs
- Outpatient programs
- Telehealth programs
- Aftercare and alumni programs
Comprehensive treatment plans are developed to reflect the personalized needs of the individual, which include the appropriate care level and treatments to help them effectively manage their bipolar I or II diagnosis.
Contact Montare Behavioral Health to Treat Bipolar Disorder
If you or a loved one are experiencing the symptoms of bipolar I or II, help is available at Montare Behavioral Health at our mental health treatment centers in California and Arizona. Regardless of the differences between bipolar 1 and bipolar 2, our caring and supportive team provides comprehensive care tailored to your specific needs. Contact us today to schedule an initial consultation or to start the admissions process.
Published: 4/16/2025
