Problems related to mood can appear in the population due to excess or defect, that is, either due to the presence of a low mood or due to the experience of a high mood.
While it is true that our mood can fluctuate based on numerous circumstances (even throughout the day), this fluctuation is often within normality. Sometimes, these fluctuations can be much more exaggerated and even interfere with the patient’s daily life and cause discomfort to the sufferer, and this is what happens in bipolar disorders. If you want to know more, continue reading this Psychology-Online article in which we explain the types of bipolarity and their symptoms.
Episodes of bipolar disorders and their symptoms
Bipolar disorders are characterized by the appearance of hypomanic, manic and/or major depressive episodes. These episodes can alternate more or less quickly over time.
major depressive episode
A major depressive episode lasts at least two weeks. During this time, following the DSM-5 (American Psychiatric Association) diagnostic classification, the following symptoms may appear.
- Experiencing depressed mood.
- Absence of pleasure and/or interest in all or almost all activities.
- Increase or decrease in body weight and/or loss of appetite.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Fatigue or loss of energy.
- Feeling of excessive guilt and/or worthlessness.
- Decreased ability to concentrate and/or make decisions.
- Recurrent suicidal ideas and/or thoughts of death.
hypomanic episode
If in the major depressive episode the mood is abnormally low, in this episode and in the manic episode it is abnormally high, expansive or irritable. The person is energetic and increases their activity. The duration in this case is shorter than for the major depressive episode, since they are only necessary four days in a row.
The symptoms proposed by the DSM-5 classification for the hypomanic episode are the following:
- Increased self-esteem or feeling of greatness.
- Disminution of necesity of sleep.
- He is more talkative than normal.
- He presents a flight of ideas or, where appropriate, a subjective experience that his thoughts are going too fast.
- He is easily distracted.
- Psychomotor agitation or increased goal-directed activity.
- Excessively participates in activities that may have negative consequences (such as compulsive shopping, risky sexual behavior, etc.).
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manic episode
As we indicated previously, in this episode the mood is also abnormally high. In this case, the episode must be present, at least, one week. The episode, unlike the hypomanic episode, is severe enough to cause an alteration in social or work functioning or even require hospitalization.
Finally, if the episode presents psychotic characteristics, hypomania will be ruled out and it will be considered, directly, manic.
The classification of bipolar disorders
How many types of bipolarity are there? Bipolar disorders are included in the DSM-5 and ICD-11 (World Health Organization) classifications. In both classifications we find five types:
- Bipolar disorder type I.
- Bipolar disorder type II.
- Cyclothymic disorder.
- Other specified bipolar disorders or related disorders.
- Other unspecified bipolar disorders or related disorders.
- Bipolar disorder and related substance/medication-induced disorder.
- Bipolar disorder and related disorder due to another medical condition.
The first three are set out below.
The following two include those patients who present bipolar symptoms but who, for some reason (which the professional may or may not specify), do not meet all the criteria for their diagnosis.
In the case of the DSM-5, two other categories are added: substance-induced bipolar disorder and bipolar disorder due to another medical condition, depending on whether the symptoms are caused by the use of a substance or medication or if the condition It is caused by some disease.
Bipolar disorder type I
Bipolar disorder type I is characterized by the appearance of a manic episode and, before or after this, both hypomanic episodes and episodes of major depression may have been present.
This type of disorder, in turn, is classified depending on the current or most recent episode that has appeared:
- Most recent hypomanic episode.
- Most recent manic episode.
- Most recent depressive episode.
- Most recent unspecified episode (when criteria are met for any of the above except duration).
Bipolar disorder type II
For the diagnosis of this type of bipolarity there must be a history of one or more major depressive episodes and presence or history of a hypomanic episode. In this type of bipolar disorder, manic episodes do not appear. In the same way as in bipolar disorder type I, the most recent episode can be specified: hypomanic or major depressive in this case.
Cyclothymia
Cyclothymic disorder functions similarly to bipolar disorder, with the occurrence of episodes of abnormally high and abnormally low mood. In this case, they appear hypomanic and depressive symptoms but they don’t meet the criteria for the episode. Symptoms are present two years, at least half the time and have not been absent for more than two months in a row. Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
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Bipolar disorder type III
Regardless of the disorders proposed in the diagnostic classifications, there seems to be some consensus regarding the existence of a third type of bipolar disorder. Bipolar disorder type III would encompass those patients who have a family history of bipolar disorder and present hypomania and/or depression only during treatment with antidepressants (González Parra, D. et al, 2007), therefore, the episodes would be caused by the drugs themselves.
Rapid cycling
Along with the diagnosis, a “fast cycles” specifier when at least four mood episodes have appeared in the last twelve months, spaced by at least two months or with a change in polarity, of those previously mentioned: major depressive episode, hypomanic episode and manic episode.
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
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References
- American Psychiatric Association (2014). DSM-5. Reference guide to the diagnostic criteria of the DSM-5-Breviary. Madrid: Panamericana Medical Editorial.
- World Health Organization (WHO) (2018) International Classification of Diseases, 11th revision. Recovered from https://icd.who.int/es
- González Parra, D., González de María, V., Leal Sánchez, C., Sánchez Iglesias, S. (2007) Bipolar illness. Medicine, 9 (85) 5461-5468
Bibliography
- Sevillá, J., Pastor, C. and Ruiz, L. (2014). Bipolar disorder and related disorders. En Caballo, VE, Salazar, IC and Carrobles, JA (2014) Manual of Psychopathology and Psychological Disorders. Madrid. Pyramid.