man holding up a graphic illustrating bipolar 1 and bipolar 2

The Differences Between Bipolar I and Bipolar II

Being diagnosed with a type of bipolar disorder can cause a lot of uncertainty in an individual. They wonder what it will mean for them and their family, and how it will affect their life. One of the most common concerns is how bipolar type I differs from bipolar type II and how the treatments will vary.

Some individuals who don’t tend to experience deep depressive episodes may even question if they received an accurate diagnosis in the first place. To help you better understand what a diagnosis of bipolar means, we’re going to look at bipolar I and bipolar II. We’ll take a deep look at how they are similar and what the important differences are.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition marked by significant periods of mood swings, which will include either hypomanic or manic episodes, and frequently involves some degree of depression. While having family members with preexisting diagnoses of bipolar disorder doesn’t mean that other family members will also have it, there has been shown to be a strong genetic predisposition that can be carried through hereditary lines.

Being diagnosed with bipolar disorder doesn’t mean that you have to deal with it without help, and there are a variety of treatments available. Those diagnosed with bipolar may benefit from different therapies and medications that can help minimize or control symptoms while also enhancing their quality of life. Understanding the differences between bipolar I and bipolar II can help diagnosed individuals be informed about available treatment options.

Understanding Bipolar I

One of the most integral criteria for being diagnosed with bipolar I, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (also known as the DSM-V), is the presence of at least one manic episode in their history. The manic episode must be at least a week in length and will involve three or more of the following conditions:

  • Decreased need for sleep
  • Elevated self-esteem or feelings of grandiosity
  • Racing thoughts or ideas
  • Increased talkativeness
  • High potential for distraction
  • Increase in goal-oriented activity
  • Engaging in risky and potentially dangerous behavior such as reckless spending, risky sexual encounters, or physically dangerous activities

The manic episode may be severe enough to warrant hospitalization as a result of the risky or dangerous behavior. Manic episodes as a result of bipolar I may also involve delusions or hallucinations, though they aren’t required for diagnosis. Mania brought on by bipolar I must also not be the result of schizoaffective disorder, and may not be coincident with schizophrenia, delusional disorder, or other similar psychotic disorders.

Understanding Bipolar II

The primary feature that can lead to a diagnosis of bipolar II is the occurrence of a major depressive episode and at least one hypomanic episode. The DSM-V states that a hypomanic episode is identified by having three or more characteristics of a manic episode that lasts for four days or more. The depressive symptoms experienced during a major depressive episode will include at least five of the following criteria and will last for two weeks or more:

  • Depressed mood lasting most of the day, each day of the episode
  • Interest in activities will be lowered or even absent
  • Reduced appetite or significant reduction in weight
  • Restlessness
  • Disruption in the sleep cycle, either sleeping more than usual or not being able to sleep
  • Low energy or fatigue
  • Feeling guilty or worthless
  • Challenges maintaining concentration
  • Problems with decision making
  • Self-harm or suicidal ideation

For a bipolar II diagnosis to be accurate, the depressive and hypomanic episodes must be unrelated and unexplainable by schizoaffective disorder or similar psychotic disorders. The episodes must also not occur in conjunction with any psychotic disorder, including any schizophreniform or schizophrenia spectrum condition.

Hypomanic episodes are considered less severe than a full manic episode and will not include any hallucinations or delusions. They will often cause less impairment than manic episodes, although both will lead to difficulty with functioning normally in the individual’s daily life.

What is the difference between Bipolar I and Bipolar II?

There are a few primary differences between bipolar I and bipolar II. Bipolar I and II have similar symptoms and symptom patterns. However, people who have bipolar II will experience less severe mania, called hypomania. Hypomania is not considered an indicator if the sole cause of the episode was drugs or alcohol use.


Bipolar I may involve depressive episodes, while bipolar II must involve a major depressive episode. Additionally, bipolar I may include psychotic features, such as delusions or hallucinations, while there will be no psychosis involved in bipolar II. 

Coping with Bipolar Disorder

There are many people that feel a sense of loss for the perceived “benefits” brought on by manic episodes or hypomania, such as the increased goal-driven activity or enhanced creativity. This sense of loss can occur even when the individual only experiences one or two “cycles” in a 12-month period.

This means that daily life post-stabilization can be challenging and may require continued treatment, such as long-term therapy. This continued therapy can help minimize or prevent depression, which can significantly reduce both activity and creativity.

Treatments for Bipolar Disorder

The most common treatments for bipolar I and bipolar II include medication and psychotherapy. Rare instances can require hospitalization if either the depressive or manic episodes trigger suicidal ideation or action, but this is generally only used to help ensure safety during stabilization.

Medication used is frequently various types of mood stabilizers and other drugs that help normalize neurotransmitter levels. Psychotherapy is used in both group settings and individual sessions to help the individual learn more effective coping mechanisms and to help them better understand how their bipolar disorder affects them.

How to find the best treatment plan 

If you think you may be living with undiagnosed bipolar disorder, the best thing you can do is talk to a professional. Not only will you be able to get a firm diagnosis, but you’ll also be able to begin creating a treatment plan with your healthcare professional. Reach out to Absolute Awakenings and start discussing your needs in a comfortable and confidential environment.

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