Bipolar spectrum disorder involves a wide range of signs and symptoms that can vary in severity. These symptoms may include mood swings, changes in energy levels and ways of thinking, and sleep disruption. Some mental health experts have described bipolar disorder as a spectrum disorder. This is because it can involve moods at both ends of the spectrum with individuals experiencing both very high and very low moods. The very high moods are known as mania, and the very low moods are classified as depression. However, it is possible to experience both of these ends of the spectrum simultaneously, known as a mixed episode.
A manic period may involve:
- Heightened mood, exaggerated optimism, and inflated self-esteem
- Excessive irritability or aggressive behavior
- Decreased need for sleep
- Racing speech or thoughts
- Impulsiveness or poor judgment
- Reckless behavior
- In severe cases, psychosis, involving delusions and hallucinations
A depressive period may include:
- A low mood
- Prolonged sadness or unexpected, unexplained crying
- Significant changes in appetite and sleep patterns
- Irritability, anger, worry, agitation, and anxiety
- Loss of energy
- Feelings of guilt or worthlessness
- Inability to concentrate
- Unexplained aches and pains
- Recurring thoughts of death or suicide
- A sense of doom or fear of having done something terrible
- Psychosis, in some cases
The bipolar spectrum
Bipolar disorder is traditionally defined by four primary forms known as bipolar I, bipolar II, bipolar not otherwise specified, cyclothymic disorder, and mixed features.
Bipolar type I is a manic episode that can last at least one week in duration or episodes. This can lead to hospitalization or other significant impairments in occupational or social functioning. Depressive episodes must also be present as well; however, in most cases of bipolar disorder type 1, manic episodes are the mainstay of the presentation.
Bipolar disorder type II is the milder form of the two types of manic depression and is often misdiagnosed as depression. This disorder is characterized by depression with alternating episodes of hypomania. Hypomania is a less severe form of mania and if often mistaken for ordinary happiness or normal behavior. As a result, bipolar disorder type II is often mistaken for unipolar depression, and when antidepressants are given, it can further trigger the mania episodes, worsening the disorder.
A mixed episode is characterized by the occurrence of simultaneous symptoms of opposite mood polarities during manic, hypomanic or depressive episodes. It’s marked by high energy, sleeplessness, and racing thoughts. At the same time, individuals may feel hopeless, despairing, irritable, and suicidal.
Cyclothymic disorder (sometimes unofficially called bipolar III) is characterized by episodes of hypomanias (as in bipolar II disorder). This disorder can frequently alternate with brief periods of depression. However, the periods of depression do not last long enough nor involve enough symptoms to define the major depressive disorder.
Overlapping conditions associated with bipolar spectrum disorders
Several mental health conditions other than bipolar affective disorder share symptoms that overlap across disorders. For example, many individuals with borderline personality disorder experience depression, along with severe mood swings and problems with impulse control. Individuals with some substance abuse disorders may also experience symptoms that may mimic mania and depression. Individuals with ADHD and bipolar affective disorder may similarly experience distractibility and problems with attention. Therefore it is common for both children and adolescents to be misdiagnosed for ADHD when instead, they are suffering from a bipolar affective disorder. Symptoms that may overlap with the bipolar spectrum and other mental health disorders include the following:
- Depression with very sudden or frequent mood swings (seen in many personality disorders and substance abuse disorders.)
- Prolonged irritability (often seen in ADHD)
- Impulsivity (commonly seen in substance abuse disorders and impulse control disorders)
- Euphoria and high energy (which can sometimes occur in substance abusers even when they are not intoxicated or “high” from the effects of drugs)
Kristen Fuller, M.D., is a clinical content writer and enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine. She is a family medicine physician and author, who also teaches and contributes to medicine board education. Her passion lies within educating the public on preventable diseases, including mental health disorders and the stigma associated with them. She is also an outdoor activist and spends most of her free time empowering other women to get outside into the backcountry.