Bipolar Disorder type 2: characteristics, symptoms and treatments

In this type of Bipolar Disorder, the depressive phase is more intense than the euphoric phase.

Bipolar disorder is characterized by the intermittent presence of manic episodes and depressive episodes. For this reason it is called 'bipolar' disorder and is also known as manic-depressive disorder (because the manifestations oscillate from one pole to the other).

Within this broad spectrum, manic episodes may be more intense than depressive episodes, or vice versa. For this reason, two types of bipolar disorder are currently recognized two types of bipolar disorder: Bipolar Disorder type I and Bipolar Disorder type II..

What is Bipolar Disorder type 2?

Bipolar Disorder Type II, also written including Roman numerals (Bipolar Disorder Type II) is a mood pattern characterized by major depressive episodes alternating with hypomanic episodes. In other words, depression manifests itself with greater intensity than mania.

Currently, Bipolar Disorder type 2 is one of the clinical sub-categories found within the category of "Bipolar Disorder and Related Disorders" in the fifth version of the Diagnostic and Statistical Manuals of Mental Disorders (DSM-V).

Diagnostic Criteria for Bipolar Disorder Type II (according to DSM-V)

As we have said, Bipolar Disorder Type 2 can be diagnosed in the presence of two major and complex phenomena: a hypomanic episode and a major depressive episode.. In turn, these phenomena must have a number of specific characteristics (in order to differentiate Bipolar Disorder Type I from Type II).

In addition, during their diagnosis it must be specified which of the episodes has been more recent, and how it has been, for example, if it has occurred in rapid cycles, if there are psychotic features, if it is accompanied by other elements, if it has been accompanied by other elements.The hypomanic episode, whether it is accompanied by other elements such as anxiety, whether there is a seasonal pattern, and whether the severity is mild, moderate or severe.

The hypomanic episode

This refers to a period of overly elevated mood, e.g., more expansive or more irritable than normal, characterized by a visible and persistent increase in energy. For diagnosis, this period must have lasted at least four days in a row and must occur for most of the day.

This visible and persistent increase of energy must have caused a significant change in habitual behavior, but that is not seriously interfering with the fulfillment of responsibilities that are considered socially appropriate for the age, gender, social position, etc. of the person.

This increase in energy is characterized by the presence of at least three of the following phenomena, provided they cannot be explained by the physiological effects of any substance or treatment:

• There is an increase in self-esteem and a feeling of greatness..
• Even if there is fatigue, there is little or low need for sleep.
• There is an increased need to talk or carry on conversation.
• There is a feeling that thoughts are running at a high speed or that there is a kind of flight of ideas
• There is a special facility to be distracted.
• The activity is exacerbated, what can be seen in a psychomotor agitation.
• Excessive interest in activities that are very likely to cause discomfort (e.g., sudden, reckless and unrestrained shopping).

If all this is accompanied by psychotic features, then the episode is not hypomanic, but manic, which requires a different intervention. Likewise, all of the above should be sufficiently noticeable and visible to those closest to the patient.

Major depressive episode

As its name implies, the major depressive episode is the presence of a depressive mood that is experienced most of the day and almost every day, which significantly influences the person's daily activities.

Clinically this episode can be diagnosed when the mood has at least five of the following characteristics, and also it has produced clinically significant distressThe mood has caused the person to be unable to fulfill the responsibilities that are considered socially accepted for his or her age, gender, social status, etc. (e.g., work, school, family):

• The mood has lasted almost every day.The mood has lasted almost every day, which can be known from what the person expresses, as well as corroborated by what other people have seen.
• Important diminution of the interest and the sensation of pleasure for practically all the activities of day to day.
• Important and rapid Weight loss or gain (without having gone on a diet).
• Insomnia almost every day.
• Sensation of restlessness and constant psychomotor agitation and observable by others.
• Fatigue and constant loss of energy.
• Excessive or inappropriate sense of guilt, may even be delusional.
• Lack of concentration and decision making.
• Constant ideation of death and suicide.

None of the above phenomena can be explained by the effects of a substance or medical treatment. For its diagnosis, it is important not only to consider the list, but also the clinical criteria of the specialist based on the clinical history of the person and the cultural norms that make it be considered a significant malaise.

Therapies and treatments

Bipolar Disorder type 2 is not so much a disease as a condition of life, however, there are several options for help the person gain more control over their emotions and the swings of their and mood swings.

The most effective options are those that combine appropriate pharmacological therapy with long-term psychotherapy. As for medicationsthose most frequently included are mood stabilizers, antipsychotics and antidepressants. The most common psychotherapies are cognitive behavioral therapy, systemic therapy and psychoeducation.

Currently, many studies and researches (and even civil associations and critical models) are being carried out to better understand Bipolar Disorder Type 2, with which, more and more options are being developed so that people who have had this diagnosis, and their families, can have good living conditions.

Bibliographic references:

• National Institute of Mental Health (2018). Bipolar Disorder. Retrieved May 02, 2018. Available at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
• American Psychiatric Association (2014). DSM-5 diagnostic criteria reference guide. Washington, D.C: USA.