Bipolar Classifications.

Discussion in 'General Parenting Archives' started by Fran, Jun 30, 2005.

  1. Fran

    Fran Former Site Owner

    Presently, there are 4 classified types of Bipolar Disorder, with many variations of each. The four types are:

    Bipolar I
    Bipolar II
    Bipolar III-Medicated Mania
    Finally, there is what is called "Mixed States". This is not a classification, but rather, a description.

    The following is a brief condensation of each of the classifications:


    Bipolar I is the one we hear most about, although it is not the most common. During manic episodes, people with this form of the illness do outrageous, outlandish things. They feel invincible, see no consequences for their behavior, and, in fact, believe they can conquer the world. In the grip of extreme mania, people's energy becomes misdirected and their judgment vanishes. They spend money extravagantly, drive recklessly, become sexually promiscuous, conceive grandiose schemes, make outrageous business investments, gamble away the house. They may also become irritable, quickly outraged, and intolerant of the needs of others.

    In full-blown psychotic manias, a person loses all touch with reality. He has delusions and hallucinations, is extremely impulsive, impatient, becomes hypersexual and has a total lack of insight and judgment. Energy is boundless and the Bipolar can get along on amazingly little sleep. They may reach a level of destruction so severe-to themselves or to others-that they need to be hospitalized. Note: Some people experience a lifetime of recurrent depressions, punctuated by one or two episodes of mania.

    People with milder forms of the illness-which have different names and mean different things-are often erroneously labeled neurotic or personality-disordered.
    The have recurrent depressions, but without the psychotic manic episodes. Instead, they experience brief "hypomania" (less than manic) periods, during which they feel mildly euphoric and have lots of self-confidence and energy. These hypomanic episodes may last from 2-10 days, and they don't require hospitalization.

    How can hypomania be distinguished from just plain happiness? How does a doctor know it is a condition that needs to be treated? Dr. Hagop S. Akiskal, senior adviser of affective and related disorders at the National Institute of Mental Health, says that "hypomania is a recurrent condition; happiness is not." It is especially significant if the high-spirited time has been preceded or followed by depression.

    BIPOLAR III--Medicated into Mania

    Throw into the pot Bipolar III, and the water gets murkier. For people in this group, a manic episode can be precipitated by a drug or by electroconvulsive treatment prescribed for depression. In some cases, the drug may be a steroid such as cortisone. Sometimes it is an antidepressant prescribed because the patient was mistakenly believed to have clinical depression. It is not unusual for someone being treated for such a depression to spring into a manic episode; it may mean that he or she is really a misdiagnosed manic-depressive.

    CYLOTHYMES: Mild Ups and Downs

    The most uneven group of manic-depressives are called Cylothymes. Their highs and lows only last a few days or weeks. They start something with great enthusiasm but don't complete it. They move from place to place. They attach themselves to various movements, then become disillusioned. They may get great poetic inspirations, then dry up for weeks. They have an uneven work record, but during their productive times, they can achieve remarkable things. This group represents a vast group of people whose deviations in temperament are often thought, mistakenly, to be personality or character disorders. Their fluctuations are different from the normal shifts in mood that most people have, in that they are more intense and more frequent. "Most people don't go that deep or that high from day to day, or week to week," says Dr. Akiskal. "And they don't lose their judgment." The most extreme cyclothymes are called "rapid cyclers," with mood changes colliding with each other, from month to month, from day to day, or sometimes even within the same day. They might bounce from euphoria to despair and back again within hours. While many people are rapid cyclers from the start, others, over time, "mature" into that form of the disorder.


    Patients often show a smorgasbord of symptoms that are at odds with each other. They alternate their elation and ecstasy with irritability and anger that may explode into destructive rage. They are hypercritical and complaining, manipulative and often obnoxious. Momentary tearfulness and even suicide threats or attempts are not uncommon.
    Some mental health experts describe these mixed bipolar episodes as a "despairing anxiety"--a form of depression--coupled with flight of ideas and distractibility--a form of mania.This mixture of behavior reflects both extremes of the illness coming out at one time. So the mood in mania, far from always being pleasant and fun, is often antagonistic and merciless.

    Research shows that the milder forms of the illness are far more common than the classic Bipolar I type. But those who have them seldom get diagnosed accurately. 3 to 4 percent of the general population account for the milder forms of the illness. Full-blown manic-depressive illness has a lifetime risk of one percent; by the time it is diagnosed, it has already caused a great deal of grief and suffering to the patient and his family.

    ~Dr. Hagop Akiskal: A Brilliant Madness-Living With Manic Depressive Illness~
  2. Sara PA

    Sara PA New Member

    Dr. Akiskal is truly an expert on bipolar disorder.
  3. SunnyFlorida

    SunnyFlorida Active Member

    Thanks. That sort of puts it into an easier format to read. I would place my difficult child 1 into the mixed states kind. Maybe that means his type is not the most serious! That's great news. I just hope he doesn't morph into another :panic:
  4. tiredmommy

    tiredmommy Site Moderator

    My Mom morphed. The good news is she morphed from Bipolar I to now being a cyclothyme. The change finally cemented after menopause. Now we can say she's the "eccentric" one in the family, LOL. Seriously though, it's now like getting my Mom back after all these years.
  5. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Hmmm...I dont know really where I fall on that scale because I have pieces of everything but the truly psychotic behavior. I havent ever felt like I was anyone but who I am for example but I do alot of the other stuff when manic but maybe not as completely extreme.

    I think I fall more under the mixed states category. But when I cycle its ultra rapidly. So who knows.
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Actually, mixed states happen in all bipolar. They are pretty yukky. You feel happy and sad at the same time, very energized, yet angry. Don't miss those at all. Since I only get hypomanic, although it is very obvious, I do get depressed more so I have always been classified as Bipolar II. It was debilitating for me when depressed, so I guess I don't think it's not so serious. I had times I had to be hospitalized and couldn't function. Unmedicated, I can't either. I think my 21 year old daughter who once used drugs may be the cyclo. type of bipolar, which may be why she used drugs. However, she won't take any medication and seems to be doing well right now.
  7. susiestar

    susiestar Roll With It

    This and a talk with our therapist today make me wonder again if B is either bipoar III or a cyclothyme. He is stuck in a mixed state much of the time if he is. It will also be tough gettingour current psychiatrist to trial any medications for it.

    But if the neuro findings are all normal later this month, then I WILL prevail in running htis to the ground. I was never truly satisfied that we had answered this question for him!

  8. Hound dog

    Hound dog Nana's are Beautiful

    I'm going to talk to my psychiatrist about this today.

    I am beginning to suspect that at the very least, I have a mood disorder. But I am wondering about bipolar.

    My family has been more open since I started going to the psychiatrist and have been on medications. They also believe my problem is a mood disorder. And say before the medications I was really bad. :eek:

    I know that I have been plagued with depression (severe) for years now, but I honestly don't know if I have symptoms of mania or not.

    Is that normal for someone with a mood disorder?

    I am a bit tempted to have husband come in with me..... maybe he'll be honest about it there??.... Sadly I think they are still leery of being fully honest with me about it.

    I also need to talk with him about my medications. The effexor, trazodone, and seroquel aren't working worth a darn. The depression has become worse. Waaaaay worse. It helped for a while, but hasn't for a long time.
    This is the first descriptions I've really been able to understand. Thanks Fran!
  9. Sara PA

    Sara PA New Member

    Few people complain about hypomania (the low level form of mania described in Bipolar II). Most just identify it as "feeling good." In fact, a lot of Bipolar II is misdiagnosed as major depression because paitents don't recognize hypomanic phases and doctors, who often don't either, don't ask enough questions to figure it out.

    So yeah, that's pretty normal.
  10. Fran

    Fran Former Site Owner

    Daisylover,I thought it was easy to read and is a good refresher for all of us.

    I'm a big fan of "if it ain't working, get an expert opinion and get it fixed". I really hate playing into our society's' fear of labels and mental illness. Too many people have suffered needlessly and had children who have suffered so they could maintain the facade.

    If you suffer from mental illness or your child does and you help yourself to function better, you are a hero. in my humble opinion. :Warrior:
  11. Jemma1028

    Jemma1028 New Member

    Well, I have never been told by my doctor what I am specifically, other than I am a Bipolar "rapid cycler" but I do think I can relate to the Mixed state category too. I am well aware that I cycle very rapidly and I have been diagnosis'ed with Borderline Personality Disorder since I was 23. I think that I am stable with the Borderline Personality Disorder (BPD) these days but I have a harder time with the Bipolar symptoms on a daily basis.

    TYLERFAN New Member

    Hi Fran:

    Thank You once again for providing invaluable information to us.
    My difficult child seems to fall into the 'Mixed" category....
    Very Interesting stuff.....

    God Bless,
  13. SassyGirl

    SassyGirl Active Member


    You mention that hardly anyone complains when they are hypomanic. However, my son, when hypomanic, is extremely irritable and defensive. He doesn't like this at all, which is one of the reasons he is so medication compliant. He never seems to get to the euphoric state (maybe talking too fast, but certainly not euphoric). He gets restless. I, for one, would love to see him just happy...even too happy.

  14. Sara PA

    Sara PA New Member

    I stand corrected. I fell into the old pitfall of referring to just the mildly euphoric, a-btt-too-happy version of hypomaina.

    My penance is to post the symptoms of hypomania:
    (Source: )

    Also keep in mind that by DSM definition, rapid cycling is 4 mood switches per year. Children tend to be ultra rapid cyclers or even ultra-ultra rapid cyclers.
  15. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    When I'm hypomanic I just feel on top of the world and happy, but am not irritable and I can sleep (of course I'm on medications). Some people with bipolar are NOT that severe and I'm not sure how I'd handle that if it were me. In my case, I would become incapacitated and have been in the hospital three times. There was no doubt in my mind that something was wrong and it was mood related. There is a cold, and there is pneumonia. I'm puzzled when Bipolar II is seen as less severe because it certainly has been quite severe at times for me, but maybe even the different classifications have variations to them. I am defintely not Bipolar I. Just a few thoughts
  16. SassyGirl

    SassyGirl Active Member

    I honestly don't think that Bipolar II is "less severe" than Bipolar I. It may appear that way because the outward manifestation is so dramatic in BiPolar (BP) I (not sleeping, unlimited energy, etc.) I wish the psychiatrists would stop talking about a "spectrum" for bipolar which implies that specific types are worse than others. In fact, I think that some EPISODES are worse than others.

    I liken my son to an unstable diabetic, only his imbalance is in his mind. The medications work most of the time, sort of a blanket coverage. There are breakthroughs, though. I wish there were a blood test, or some type of test, to measure the chemical imbalance and more precisely target the medications esp. in dosage.

    Maybe in the future...

  17. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Bipolar II is actually more common than the classic Bipolar I, and I can guarantee that my parents and my first hub thought I acted very bizarre at times, although I never did get psychotic. I do think some bipolar is more severe than others---not sure if "type" matters. If you find you can't work or get out of bed or not rage because of it, then it's affecting your life and the lives of those you love. Although some people cycle to "normal" between highs and lows (be they huge highs or hypomania, which feels very good), I never did cycle to "normal." It was either deep, debilitating depression or my hypomania. I used to think "I'm actually two different people" and worried about DID, but it was just the "Hypomanic me" and the "depressed me." I didn't lose any time or have thought disorders, but I sure could swing with the best of them! Thank God for!
  18. Jemma1028

    Jemma1028 New Member

    I really do depend on my medications as well, but I have to say that they don't always help me. I do have days where I am up and feeling great and within hours I am crying and laying in bed. Stress adds to my cycling and My P-doctor says that I tend to try to induce my manic states by drinking too much coffee etc.... He says that oftentimes we chase our highs because they feel so good, but the downside is that you crash and burn into an angry state or a depression.

    I always referred to myself as "free-spirited" but my husband knows that it is actually manic. I love my highs and hate my lows. It does keep me from working at my old teaching job but I am pretty good at taking care of the house and kids because for the most part it is a low stress job. Until you add in the difficult child part.
  19. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Jemma, I've tried to induce hypomania with the coffee I don't know if you do it on purpose, but I used to. The truth is, I love hypomania. Now I'm off all caffeine, since the induced hypomania would cause a mild depression to follow. In my case, the medications were miraculous, but that was after many years of trying medications t hat never really worked more than 50%. Hang in there. Sometimes it takes years (and, yes, I know first hand what a pain it is!)
  20. dreamer

    dreamer New Member

    I have to say, I LOVE my hypomania and I think without it I could not have met the challenges my life threw at me. For nearly 20 years I worked 16-20 hours a day - waiting tables and nursing- and never slept more than 3 hours at a time or per day.
    Dang RA and Lupus hit me, and totally derailed that. UG.
    Yes, my hypomania was pleasant. I know now I perpetuated it with my lifestyle. THankfully my crashes were few and far between. I terribly miss hypomania.