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The Diagnosis of Combination Bipolar Disorder 1 & 2

The diagnosis of bipolar disorders can be evaluated by a trained mental health professional. A comprehensive evaluation would include questions about the patient's current symptoms, history (including family data) and mood patterns. It is not likely that a patient would present with both bipolar I disorder and bipolar II disorder as there are some distinct differences between the types of mania found in each. Usually, patients are diagnosed with one or the other rather than a combination of bipolar disorder 1 and 2. However, during the course of bipolar illness it is possible that bipolar II disorder could eventually develop into bipolar I disorder if treatment is delayed.

  1. Manic Episode

    • Evaluation of mania includes looking for symptoms such as an inflated sense of self-esteem, rapid and pressured speech, subjective experience of racing thoughts, elevated energy levels, decreased need for sleep and engagement in high risk activities such as excessive gambling, sexual activity or increased spending. These symptoms are severe enough to interfere in the individual's level of functioning and/or causes significant distress or problems in social relationships or family life.These symptoms are reported as abnormal, unusual and are easily identifiable for at least one week or less if hospitalization is necessary to ensure the patient's safety.

    Hypomanic Episode

    • Identification of hypomanic symptoms includes recognizing inflated self-esteem, elevated mood, decreased need for sleep, racing thoughts and pressured speech. However, hypomanic symptoms are less severe in nature and can be identified if present for at least four days. Hypomanic symptoms usually do not cause the level of impairment that is typical of a full-blown manic episode. Hypomanic symptoms are resolved quicker and with less intervention than manic symptoms.

    Major Depressive Episode

    • Recognition of major depression can result from symptoms such as chronically sad and empty mood, isolation from family and friends, sleeping too much or too little, appetite/weight gain or loss, excessive feelings of guilt and/or suicidal thoughts. A major depressive episode can cause significant dysfunction and safety concerns. These episodes can be particularly risky in bipolar disorders when patients come down from a manic or hypomanic mood swing.

    Bipolar I Disorder

    • Diagnosing bipolar I disorder requires that a trained professional evaluate presenting symptoms, mental health history and pattern of mood episodes. Bipolar I disorder is diagnosed when there is an occurrence of at least one manic episode. Mania includes symptoms of inflated self-esteem, grandiosity, little to no sleep, irritability, agitation, high risk behavior and may include psychotic symptoms such as auditory or visual hallucinations. At least one inpatient hospitalization is likely during the lifetime of an individual with bipolar I disorder.

    Bipolar II Disorder

    • Diagnosing bipolar II disorder requires that a trained professional distinguish between a hypomania and mania including whether or not a person has suffered a major depressive episode. Bipolar II disorder occurs when recurrent major depressive episodes are present with hypomanic episodes. The mood shifts cycle more rapidly and are typically less severe than those experienced with bipolar I disorder. Symptoms can usually be managed on an outpatient basis.

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