Bipolar 1 or 2? Cyclothymia? Mania or HypoMania?
Your moods have been swinging back and forth, driving you (pardon the expression) crazy. You go to the doctor seeking answers. After lots of questions and possibly tests for other illnesses you are diagnosed with Bipolar Disorder. While having a name for the way you’ve been feeling may be a bit of a relief, the reality of having a “mental illness” can be frightening.
So, take a deep breath and relax. Lots of us have BP Disorder, you are not alone. You will have questions and this should be one of the first: which BP Disorder do you have? There are several types of Bipolar Disorder which are characterized by the length, frequency and pattern of the manic and depressive episodes. Proper diagnosis is essential for effective treatment.
I have had the unique experience of originally being diagnosed as BP 2 and then upgraded to BP 1 ten years later.
Bipolar 1 Disorder
Those with BP 1 experience extreme manic episodes or mixed episodes (mania and depression occurring nearly every day for at least one week) and one or more major depressive episodes. BP 1 is the most severe form of the illness. Psychosis, paranoia and hospitalization are all associated with BP1. Episodic depression does not have to be experienced for a diagnosis of BP1 but it usually exists.
My own experience with BP1has included a trip to the psych ward, paranoia and the inability to work for months. Mixed episodes and suicidal thoughts were also present during my last relapse.
Bipolar 2 Disorder
Since depression is what normally sends us to the doctor, BP 2 is typically misdiagnosed as major depression. Basically, once the depression slips into hypomania, you feel so much better that it doesn’t occur to you to call the doctor or to stay on your meds. Frankly, you feel just fine—maybe even better than fine, that’s because the hypomania has taken over. The elevated moods associated with hypomania are welcomed warmly after a deep depression. Most of the time friends and family simply believe that the depression has lifted and you are back to being the life of the party. The problem is that “what goes up, must come down” and usually it’s not a level mood that shows up.
My diagnosis of BP2 came during a deep depression that followed a wild hypomanic summer which was kicked off by anti-depressants meant to help me quick smoking. That’s right, I was given an anti-depressant to help me quit smoking and to relieve the slight depression caused by frequent migraines. It took only a couple of months and I was swinging high on Hypomania Mountain. I was running on all cylinders at work, I opened my own home business, never slept and spent a lot of time drinking (a form of self-medication that the hospital will consider abuse).
Not Otherwise Specified (NOS)
Bipolar Disorder NOS, sometimes called “sub-threshold” Bipolar Disorder, is a “catch-all” diagnosis that is used to indicate bipolar illness that does not fit into any of the formal DSM-IV bipolar diagnostic categories (BP1, BP 2, or Cyclothymia-see below). If an individual seems to be suffering from some bipolar manic and depressive symptoms but does not meet the criteria for BP1, 2 or Cyclothymia a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified) is given.
Honestly, I think we’re all sort of BP NOS because I’ve never met two people with BP Disorder that have classically met all requirements of one or the other types. It seems to me that BP is really as unique as its owner. And by the way, you are the owner of the BP, it is not the owner of you.
Cyclothymia is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.
Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more manic, hypomanic, or depressive episodes in any twelve-month period. Rapid cycling can occur with any type of bipolar disorder, and may be a temporary condition for some people.
Confusing, isn’t it?
Be sure to discuss your diagnosis with your psychiatrist. Do your own research and write down any questions you may have and then ask them. Remember, YOU own BP and it is as unique as you are, therefore, you have to write your own owner’s manual because the best anyone else can do is give you the general information. You have the specifics and you must become self-aware to find them.