What Is Bipolar II Disorder? - Symptoms, Diagnosis & Treatment

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Devin Kowalczyk

Devin has taught Psychology and has a master's degree in Clinical Forensic Psychology, and will earn a PhD in 2015.

What is the difference between Bipolar I Disorder and Bipolar II Disorder? The symptoms, while similar, manifest with a different intensity, kind of like the difference between a party popper and a firework.

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Bipolar I Disorder is very similar to Bipolar II, but possesses subtle differences to make it a different diagnosis. The main difference, as will be explored below, is the different levels of mania the two endure.

Mood Disorder

Bipolar II Disorder is considered a mood disorder. Mood disorders obviously have to do with a person's mood. One of the most well-known mood disorders is Major Depression, sometimes called unipolar depression. Bipolar disorder is like having two opposite mood disorders rolled into one. They just swing back and forth.

II vs. I

Bipolar I Disorder is when a person has depression and mania. Think of it like a long pole, and at one side is super sad (depression) and the other side is super excited (mania).

Bipolar II Disorder is when a person cycles between relatively normal moods, suffering from major depressive episodes, and experiencing hypomanic episodes. The term episodes is used here to mean that the individual suffers a full range of emotions, but it is not a constant state of being. Someone can be extremely depressed, and then they can have an episode of depression. The only difference between the two versions is the level of mania. Those afflicted with Bipolar I have full mania, while those with Bipolar II have hypomania. What this means will be explored below.

Hypomanic Episode

Full mania, part of the Bipolar I Disorder, is described as being excessively filled with energy, inflated self-esteem, distractibility, and decreased need for sleep. Think of giving someone a Big Gulp filled with an energy drink, a cup of coffee, a caffeine pill, and a little amphetamine. They could be described as overflowing with energy.

Extreme Happiness

A hypomanic episode is a period of elevated, expansive, or irritable mood lasting at least four days. During this time the person must be different enough that those close to them notice. He or she must have three or more of the following symptoms which are markedly different than his or her 'normal' day-to-day mood:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than normal
  • Quickly changing ideas or thoughts seem to race ahead
  • Distractibility
  • Increase in goal-directed activities
  • Excessive focus on pleasurable activities (excessive gambling, poor investments bought in the moment, sexual promiscuity)

The main difference between hypomania and mania is hypomania does not cause a marked impairment in functioning. The person has this feeling of being full of energy for several days, without the need for medical treatment. Also, the symptoms cannot be caused by an outside source like amphetamines.

Major Depressive Episode

A depressive episode is a mood of sadness or negativity that is powerful enough to keep you from your life. This is when the person effectively shuts down and withdraws from the world.

Extreme Sadness

A person must have most of the following symptoms to some degree for two weeks, or if it was so severe it required hospitalization:

  • Depressed or sad mood, with feelings of emptiness, hopelessness, guilt, tearfulness, or occasionally irritability or physical pain
  • Inability to think clearly or concentrate
  • Loss of interest or feeling of pleasure in activities once enjoyed
  • Increase of decrease in eating, appetite, or weight
  • Change in sleep patterns, including insomnia and hypersomnia, as well as constant feelings of fatigue
  • Lethargy or slowed physical movements
  • Decreased feelings of self-worth, often paired with suicidal thoughts and actions


A licensed psychologist or psychiatrist is required to diagnose someone. The requirements, however, would be a presence of:

  • One or more major depressive episodes
  • One or more hypomanic episodes
  • The person has not had a full manic episode
  • Symptoms are not better accounted for by another disorder
  • Symptoms cause distress or impairment in the person's life

Bipolar II can also be diagnosed with Rapid Cycling, but this is a rarer add on. This is where the individual's mood bounces between hypomanic and depressive mood quickly, sometime in the matter of days or weeks. TV often depicts Bipolar disorder like this, with the person's mood jumping between happiness and sadness extremely quickly. But only about 10%-20% of people diagnosed with Bipolar disorder have this, and rarely as severe as TV shows.


One of the best treatments for Bipolar II Disorder is psychotherapy. Psychotherapy that focuses on learning how to identify and control behaviors during hypomanic phases is effective. Depression is best treated with psychotherapy both in the behavioral and the cognitive domain. Basically, the person needs to learn how to handle his or her fluctuating mood in a way that is beneficial.

Another treatment that can work well with psychotherapy is a prescription treatment. One of the most common is lithium treatment. It is currently unknown why lithium, often lithium carbonate, effectively treats Bipolar disorder. However, lithium has been linked to liver damage and requires careful monitoring. Other medicines, including antidepressants and antipsychotics, have been shown to have some positive effect.


Bipolar II Disorder is when a person's mood cycles between Major Depression and Hypomania. The difference between Bipolar I and II is I=Mania, while II=Hypomania. Major Depression is an extreme form of sadness and low self-worth, while Hypomania is a heightened level of energy and mood but not to the point of mania. Treatment is often focused on educating the person on how to deal with his or her mood changes, and prescription medication has also been found to be helpful in leveling out someone's mood.

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