Early in 2018, my psychiatrist was moving to a new diagnosis for my mental illness. He was leaning toward one of the Bipolar Disorders.
I wasn’t aware of this so, from my point of view, the prevalent condition affecting me remained depression. Yes, I did experience periods of lighter mood, joyous mood, but I thought that they were welcome breaks in the gloom. It never occurred to me that they might represent something more.
Events in 2018 and 2019 caused me to rethink this. I began to see my moods in a different light. Additionally, I looked at earlier events with a fresh understanding. I could see how sometimes the lighter mood differed from that same mood at other times. Sometimes, the lighter mood had an air, a self-confidence, that was atypical of me.
This new understanding propelled me to research Bipolar Disorder. In this post and the next two, I’ll share with you the insights I’ve gained. As I did with Major Depressive Disorder, I begin by presenting you with the definition of Bipolar II Disorder as it appears in DSM-5. My follow-up posts will explore bipolar II as I experienced it.
For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode.
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to a medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A-C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss. (*)
Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode (Criteria A-F under “Hypomanic Episode” above and at least one major depressive episode (Criteria A-C under “Major Depressive Episode” above).
B. There has never been a manic episode.
B. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The most important observation is that you must have at least one hypomanic episode AND one major depressive episode to be considered bipolar II.
The next key observation is that there is implicit recognition that of the two, depressive episodes are the more serious affect. Gone are the days of bipolar II being considered the “soft” or “lesser” bipolar, primarily because of the prevalence of depression in the person’s life.
Finally, the hypomanic and depressive episodes may alternate frequently causing significant distress and impairment. The hypomania falls just short of impairment causing hospitalization. If that happens, it’s considered to be mania.
Please remember that I’m not a mental health professional. I live with Bipolar II Disorder. I experience hypomanic and depressive episodes. The most severe depressive episode resulted in a suicide attempt. This prompted my reaching out for help. My own research, the guidance and lessons shared by fellow sufferers, the compassion of therapists, and so much more, have all inspired me to share what I’ve learned with you. It’s information, not a diagnosis.
If you believe that you’re in need of help, I urge you to speak to your family doctor. If you’re experiencing suicidal thoughts, SEEK HELP IMMEDIATELY BY DIALING 911 OR VISITING YOUR LOCAL HOSPITAL EMERGENCY ROOM.
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