What Are the Differences Between Bipolar 1 and 2?

The differences between bipolar 1 and bipolar 2 primarily lie in the mania state of bipolar disorder, a mental health condition characterized by fluctuations in mood and energy levels. Manic episodes, with deeper changes in mood and energy, occur with a bipolar 1 condition.

The bipolar 2 state is typically associated with less severe, hypomanic symptoms. Keep in mind that each person diagnosed with a bipolar disorder is affected differently. However, the length and intensity of manic, hypomanic, or depressive episodes will determine the type of bipolar diagnosis.

This article explains the types of bipolar disorder and the differences between bipolar 1 and bipolar 2. It will help you to know more about how bipolar disorders are treated and offers tips on coping with a diagnosis.

Types of Bipolar Disorder

Types of bipolar disorder are differentiated by their symptoms and the duration of those symptoms. There are a few types of bipolar disorder, including:

• Bipolar 1 disorder: One episode of mania must occur and last for at least one week. Mania is characterized by an extreme elevation of mood and energy. An episode of hypomania or depression may precede or occur after the manic episode.
• Bipolar 2 disorder: There is at least one episode in which symptoms of hypomania (a less-intense form of mania) persist for at least four days, as well as the occurrence of one major depressive episode.
• Cyclothymic disorder: Over the course of two years, symptoms of hypomania and depression persist, but do not meet the criteria for a full-blown episode.

Regardless of the type, bipolar disorder can significantly impact a person's daily life.

What Are the Differences Between Bipolar 1 and 2?

Bipolar 1 and 2 are similar in that periods of elevated mood and symptoms of depression can occur in both types of the condition.

The main difference between the two types is the degree to which mania presents.

In bipolar 1 disorder, a person experiences a full manic episode, which causes extreme changes in mood and energy. Symptoms are severe enough that they may interfere with a person's functioning at home, school, or work.

Less severe symptoms occur during a hypomanic episode, which are present in bipolar 2 disorder. In hypomania, a person experiences an elevated mood, but it isn't as intense and doesn't last as long as a manic episode.

Ultimately, these types share similar symptoms, but the way in which they are experienced can be different.

What Are the Differences Between Hypomanic and Mania?

The symptoms of bipolar 1 disorder can be more severe than bipolar 2 due to the mania associated with bipolar 1 disorder. In some cases, people may require inpatient care (hospitalization) because of extreme manic episodes, which may be associated with:

• Paranoia
• Delusions
• Hallucinations

With bipolar 2, hypomania (a less intense and shorter duration of symptoms) occurs.

It's not clear whether bipolar 1 or bipolar 2 is more common. Overall bipolar disorder prevalence is low, with only 2.8% of U.S. adults having the condition. Limited research on this question has noted the prevalence of each bipolar type as being slightly over 1%.

What Are the Symptoms of Mania and Hypomania?

During a manic episode, a person can experience the following symptoms for at least a week:

• Euphoria/elevated mood or irritability
• Decreased need for sleep
• Distractibility (e.g., poor focus and multitasking)
• Excessive talking 
• Participation in risky activities (e.g., excessive spending, sexual encounters, and substance use)
• Racing thoughts
• Inflated sense of self
• Psychosis (hallucinations, delusions, and disorganized thinking)
  

Symptoms of hypomania mirror those of mania, except they last for a shorter period, at least four days, and are less severe. 

Depression in bipolar disorder might look like:

• Sadness or low mood
• Low energy
• Feelings of hopelessness, powerlessness, and worthlessness
• Changes in sleeping patterns (typically a need for more sleep)
• Lack of interest or joy in daily activities
  
• Decreased appetite
• Isolation and withdrawal
• Feelings of guilt
• Psychomotor agitation (movements without purpose such as pacing and toe tapping)
• Thoughts of death or suicidal thoughts
  

What Causes Bipolar Disorder?

While the cause of bipolar disorder is not entirely understood, genetics and environmental factors may contribute to the onset of the condition.

The risk of developing bipolar disorder is higher in people with a first-degree relative (a parent or sibling). Bipolar disorder also is a common diagnosis that co-occurs in people with autism, with the possibility of a genetic link, although the reasons for why remain unclear.

Environmental factors such as maltreatment during childhood, trauma, or experiencing significant life events may also influence the onset of the disorder, as stress may be a trigger. Lack of sleep can trigger a manic or hypomanic episode, though there's some evidence that occurs more often in people with a bipolar 1 diagnosis.

Further research is needed to enhance understanding and expand on the potential causes of bipolar disorder.

How Is Bipolar Disorder Diagnosed?

There is no definitive test a person can take to determine if they have bipolar disorder. However, getting a mental health evaluation with a psychiatrist or licensed psychologist is the first step toward getting a diagnosis.

During an assessment, a licensed mental health professional gathers information about a patient’s psychological health, including the intensity and severity of symptoms. This process allows them to get a complete picture of a patient’s history and current concerns to make an accurate diagnosis.

To specifically diagnose bipolar 1 vs. bipolar 2, a mental health professional will need to review any manic, hypomanic, and depressive episodes that have occurred.

They may also recommend that patients seek a physical evaluation so a healthcare provider can rule out potential medical conditions that could be causing symptoms.

Upon diagnosing a patient with bipolar disorder, conversations about treatment will begin. 

How Is Bipolar Disorder Treated?

Though they are different types, treatments for bipolar 1 and bipolar 2 are very similar.

Medications are used to help stabilize the mood of patients with bipolar disorder:

• Mood stabilizers, such as lithium, valproic acid, and lamotrigine, may be used to combat mania and depression.
• Antipsychotics can treat mania and psychosis.
• Alpha-2 adrenergic agonists, such as Igalmi (dexmedetomidine) may be used to treat agitation associated with bipolar 1 or 2. 
• Antidepressants are an option, but they may not be prescribed to treat bipolar 1 disorder, as they can trigger episodes of mania.

Talk therapy is also effective for treating bipolar disorder, especially in conjunction with medication. Patients can learn more about a diagnosis, identify triggers and patterns, and establish coping and safety plans as needed.

Various therapy methods can be used in the treatment of bipolar disorder, including cognitive behavioral therapy and family-focused therapy. A cognitive approach helps clients to develop healthy thoughts and behaviors, and cope with difficult feelings. Family-focused strategies can provide education and understanding for family members and a person’s support system.

Additionally, treatment interventions that focus on creating a routine and healthy habits can benefit people with the condition.

How to Cope With Bipolar Disorder

Being diagnosed with bipolar disorder can be overwhelming.

On one hand, it may be a relief for some to have a diagnosis, which can help patients learn more about the condition and provide context for their experiences. On the other hand, a diagnosis can stir up feelings of anxiety or fear about prognosis.

Part of living with and receiving treatment for bipolar disorder is learning to accept the condition and take care of yourself. Helpful coping strategies might include:

• Working consistently with a mental health care team (psychiatrist and therapist)
• Establishing a support system
• Getting consistent sleep
• Identifying and engaging in self-care activities like exercising, which can help alleviate depressive symptoms
  
• Being compassionate toward yourself
• Joining a mental health support group
  

Summary

Bipolar disorder is a mood disorder characterized by extreme changes in a person's mood and energy. Types of bipolar disorder include bipolar 1 and bipolar 2. Differences between bipolar 1 and bipolar 2 involve the degree of mania, which is heightened in bipolar 1, while people with bipolar 2 may experience hypomanic episodes.

The symptoms of bipolar disorder can vary from mild to extreme impacts that interfere with your life. The best way to determine if you have bipolar 1 or bipolar 2 is to speak with a psychiatrist or licensed mental health professional.

Understanding which type of the disorder you have can help you live with the condition. Your provider can create an individualized treatment plan using medication, therapy, and self-care strategies to help manage symptoms and improve your quality of life.