Bipolar II Disorder, Cyclothymia, And Bipolar Disorder, NOS

Bipolar II Disorder

This type of bipolar disorder is characterized by one or more major depressive episodes with at least one hypomanic episode in which hospitalization is not required. By definition, no actual manic episodes are present in Bipolar II.

Although in some respects Bipolar II is milder than Bipolar I, the condition is still very serious. As with Bipolar I, the rate of completed suicides in patients with Bipolar II Disorder is between 10-15%. The DSM lists school truancy, school failure, occupational failure, and divorce as social problems associated with Bipolar II Disorder. Also of note are other complications such as substance abuse and associated mental disorders such as, Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/ Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder.

Bipolar II symptoms tend to occur more frequently in women then men. When it does occur in males, the number of hypomanic episodes typically equals that of depressive episodes whereas depression tends to dominate in women. As in Bipolar I Disorder, rapid cycling bipolar disorder is most likely to occur in women. Complications of female biology such as hormones associated with pre-menstruation and postpartum are known to exacerbate already vulnerable moods.

Lifetime prevalence of Bipolar II Disorder is 0.5% in community samples. [DSM]

Cyclothymia

Cyclothymia is characterized by at least a two-year period characterized by numerous manic or depressive moods, none of which reach the severity necessary for a diagnosis of either full mania or major depression. Instead, hypomanic episodes may be experienced, in conjunction with sub-clinical severity depressive episodes. Individuals with Cyclothymia do not remain symptom-free for more than two months at a time, by definition.

The diagnosis of cyclothymia cannot be made casually. Two full years of documented bipolar symptoms of the proper intensity must have been observed prior to diagnosis. If the mood swings can be better accounted for by the criteria of schizoaffective disorder, then that diagnosis prevails. If mood swings are considered to be a part of a larger schizophrenic disorder, then Cyclothymia becomes an associated feature of a psychotic disorder. If one or more mood episodes reach clinical mood episode proportions, then a diagnosis of Bipolar I or II is appropriate. Additionally, medical conditions such as hypothyroidism must be eliminated as the cause of bipolar symptoms before this diagnosis may be made. Substance abuse may be associated with Cyclothymia, as well as sleep disorders.

Cyclothymic Disorder symptoms often begin early in life and are sometimes considered to reflect a temperamental predisposition to other mood disorders. The condition typically has a slow, gradual, and progressive onset and a chronic course once established. There is a 15-50% chance that cyclothymic individuals will go on to develop bipolar I or II disorders in later life. In community samples, cyclothymic disorder symptoms are apparently equally common in men and in women. As with all bipolar disorders, a general medical condition or substance abuse problem must be excluded in order for this diagnosis to stand.

Lifetime prevalence of Cyclothymia is 0.4% to 1% in community samples. [DSM]

Bipolar Disorder, NOS

This classification is included in the DSM to enable mental health professionals to diagnose disorders with bipolar symptoms that do not meet criteria for any of the defined bipolar disorder subtypes (as described above). For instance, a person who rapidly alternates (over days) between manic and depressive symptoms may be classified under this category. Recurring hypomanic episodes without intervening depression symptoms can lead to this diagnosis as well. A clinician may label a person with bipolar disorder, NOS when he or she suffers from manic or mixed mood episodes that appear to be part of a delusional disorder, residual schizophrenia, or psychotic disorder that is also difficult to classify.

The NOS diagnosis is also sometimes used provisionally, when doctors do not feel they have enough information yet to make a proper bipolar diagnosis, but wish to document their impression that a condition is an instance of bipolar disorder.

Comments
  • patrick j. stump

    I've been diagnosed with bpolar II and cyclothymia since 1989. There is a posiability that I developed these symtoms in early life. Even before 1st grade. I also have symtoms of ADHD. Thank You Very Much ! PJS

  • Anonymous-1

    With all due respect, how can you have bipolar II and cyclothymia when you have had to have had a depressive episode to be diagnosed with bipolar II but not with cyclothymia. Isn't it one of the other?

  • Gretta

    4/5 of my antie and uncles have bipolar 1 and bi polar 2 disorder, alcoholism and I was rared by all 5 through various foster placements.The best thing that 5 families gave me was a personality disorder and an inability to flourish in everyday life. I am now 20, I have a boyfriend at the end of his tether with my aggresiveness, hyperactiveness, inability to sit still, inability to be alone for more than a few hours, my moods change within hours from excessively happy to depressed. dont want to kill myself so they put me in the cyclothemia section. Is it possible to be rid of this? is there anyway to get away from it. I'm ready to explode especially since my psycho therapist told me to stop smoking dope because i am just repressing my emotions and memories that she needs to crack in order to "fix" me. Two days without the stuff and I am like a lunatic. It is the only thing that calms me down! It stops me being depressed, it stops me goin off the rails with emotion and all in all I am a much calmer person with it. However I know that this is just a quick fix and in the long run will do me no favours but for now it is what makes life bareable and i can stand to be around myself a bit more. Is it so bad to use this crutch?

  • Kay

    what medications do you take?

    do you take medication of adhd. How to you cope with bipolar and adhd?

    what type of job do you have?

  • Anonymous-2

    I am currently diagnosed with Major Depressive Disorder, Post Traumatic Disorder, and Anxiety Disorder. I am meeting with the doctors this week because they think I may have Bi Polar. I am 42 and the antidepressants are not working-this leads to the belief that I am Bi polar. I smoked marijuana for 20 years before I ever had antidepressants. After taking Prozac for 5 years, I just stopped smoking marijuana. I would not have believed I would or could have ever quit, but once properly medicated and receiving great therapy-I just didn't want it any longer. Hang in there-you are so young and your life could have a much better outcome without the marijuana. It is self-medication.

    Best of luck

  • C. Singleton

    Who even knows what the hell is wrong with me? I have had major depression since I was 12. (I'm 33 now) It was wlways the same until 3 yrs ago when I went through abuse, divorce, harrassment and major stress that brought out my bipolar II. I swear, I could feel my brain chemistry changing during that time. The major depression was morphing into a whole different animal. It was a time of acute stress for me for certain. I began to experience extreme anxiety and irritability which I never had before. I had a few "manic" moments I guess where I felt unreasonably optimistic and self assured that lasted for 5 mns or less. I had one that lasted all day. They felt good, but they were brief and not what I would call extreme. Anti depressants do not work at all for me. Never have. The Abilify and Celexa I'm on now don't work either. I really don't think doctors know what they are doing. Either that, or there's no hope for me. During manic times, I've had symptoms that I have never heard about anywhere. Such as, feeling as though I'm on a roller coaster while sitting still and feeling as though I'm shrinking as the room gets larger and just feeling as though I'm not "in" my body. Sound familiar to anyone at all? I hope so. I don't know what the f*ck it is! Very frustrating. I'm sad all the time, I hate myself, I believe I'm a waste of space, I think about suicide all the time, I wrap myself up in a cocoon so no one can get to me, I have lost hope that I will ever improve, I feel incapable of feeling good or ever realizing my potential if indeed there even is any. I have no enthusiasm for life at all. And I hate it. I have a husband and children and I feel like I can't give them what they need from me. This shit will surely ruin my life. It already is. What the hell do I do?

  • Anonymous-3

    I felt like i was reading my life story when reading your comment, i am now 35, single mom of 2 kids, one of them being 13 mnths ool. i am at my worst lately, i have alienated myself from almost everyone in my life and i can barely go to the store without freaking out or having a panic attack. i was never like this before. i'm on celexa, lamictal, buspar. i think thats it? i was just told last week that i am incapastated for the next yr.

  • Katie Latimer

    I honestly believe I was born with Bipolar disorder. I do not have Bipolar I, yet my psychiatrist does not want to "label" me, as I have cooccuring disorders. I suffered severe anxiety as a child, even broke a crib from rocking. I continued (rocking) until kindergarten. I had my first OCD attack at the age of about 8 years old. Rituals, no sleep,panic,seperation anxiety. I broke most of the severe rituals on my own, only to have them morph later into other disorders. Anorexia and bulemia by age 14, which lasted into my early twenties. I was put on Paxil and Xanax in 1999, and after a month, I was high on life. I believe it induced mania, because soon, I was in a deep depression, missing a lot of school (college) and work. I cut back the dose and soon, was just up and down. I have social anxiety and am obssessive about my skin. I often wonder how one person can have SO many mental problems! I am now on Effexor XR and Xanax, and life is more tolerable, but I still walk the line, the slippery slope. It never goes away completely, and I still hear the voice of suicide calling to tempt me sometimes. The monster,pack of wolves, The Long Boy, Demons. It's as if you never "feel" comfortable in your own skin, and somedays I want to turn myself inside out . I know there is no "normal", but I long for the sense of Freedom, I see in so many others.

  • Only_me

    Reading your words was so bizarre - it felt as though for the first time someone was understanding the way I've ben feeling. I've just been diagnosed with cyclothymia, and had a really miserable traumatic childhood. I was depressed for years and years and then in the last 5 years I hooked up with a narcissist and i beleive it brought out my bipolar tendencies. I have felt crazy and unmanageable and humiliated and as though I want to tear at my own skin (I've even self harmed for the first time). It's as though I feel uncomfortable in my own skin, like it's crawling with insects and i want to turn it inside out. And then I have felt as though I can LITERALLY feel some chemical change taking place in my brain. I've always explained it in terms of feeling as though my head is changing shape - like it's flattening out, becoming stretched. And my eyes don't feel right when that happens, and it's almost like an out of body expeirence. It doesn't happen so much since I've been taking valproate, but I'm sure that living with the narcissist is making me il.

  • dean Armstrong

    its a bit late for me. so I'm sorry if this is a bit rushed. I'm very tired.

    your words about how you feel are very powerful. good luck bro. bloody hell. I just want to hug every body in pain. its horrible. I'm learning meditation. found a good tutorial on youtube. well, its more explaining why and how, but its done me a bit of good.

    I don't want to be ill. I want to combat it and then help as many people I can. I know I'm a bit of everything when it comes to mental illness. my doctor (god bless her) gave me a letter for my Open University tutor. it wasn't what I expected it to say. it said more than I thought it would.

    Oh, why can't we just have badges that explain it all. I'm so fxxxd up most of the time, that because I'm on medication seems to mean that I have an obligation to explain how I'm fxxxxxg feeling.

    ohhhhhh, whatever. love you all. goodnight!!!!!!!!

  • cobain

    Hi there!

    I have Bipolar disorder NOS and GAD. Currently I am taking 1000mg Lithium, 30mg Abilify, 50mg Fluvoxamine

    I also have ultra ultra rapid cycling, which means I can go from psychotic mania to suicidal depression within only a few hours!

    But I am having a much better time since I started medication. I LOVE Abilify because it helps such a greeat deal with the psychotic moments and the manic moments.

  • Karina Rain

    Well hello all, I only thought I had an anger problem all my childhood and teen years, Yet I have learned that I have an explainion for how and why I do what I do and couldn't explain any of it, Im Bipoler 2, BPD, P.T.S.D ocd and code dependent, I found that as I lowerded my stress levels and most of the major triggers to all of that I can lead an almost normal life. I was on wellbutron xL, Trileptal for the BPD, aterax for the anzity. Well with reducing my trigers and stresses I was able to go into a sort of remission. I knew when or felt the syemptoms comming on and took care of it. But now they all are back full force with a vengance it seams, Reason I just lost my Father on 4/12/2011. In a motorcycal reck. Im the oldest so of course im the one having to deal with all the details. We dont know exactly what happend and theres too meany diff stories going that dont add up. SO dealing with all that also. pluse it happend in a another state. I can not funtion the way i did before all this and im so flusterated with that. I get so mad over nothing worth being mad about. To the point of wanting to become verbaly and physicaly vilant. This in its self scares the living hell out of me!!! So I am able to catch my self before i physacly hurt anybudy. Like today i recived some news that didnt make me happy one bit that has to do with my dad, and was lied to about it when I asked at the time. So i atempt to go to work, whare i find that most of the parking lot is taken up for a event tomarow. in less than 20 min, im in almost 4 diff acticednts im lucky that didnt happen thank the lord. the only spots open are a few handicaps, and i dont have a sticker for thoses. I think I found a spot when i see there are 3 other cars heading for that one not counting me. I give up im byound pissed ready to deack or punch anybudy that says anything to me. I go home, call work and leave mesage on michane telling them sorry couldnt find a parking spot and was done trying, going home for everybudys well being. One to keep from hurting anybuddy and 2 to not have to deal with the repercousions of my possable actions. Im best at home whare I dont have to deal with anybuddy that i dont want or need to. Mind you I called a mental health clinic when i relised the violent tendancs almost a month ago just after dad died. I called again asking if it can be moved up. was told no and if i get to bad go to the hospital. ya that is very last resort. So now sitting here going through countless web sites on all my disorders to write down all the symptoms to try and help the doc. to be able to help me better, I have been retacking all my meds just to get through my days at work. Mind you I have not scean a doc sense 2008. SO this should be fun. Have a Blessed day all.

  • Brittany

    This was very helpful for me. I was once diagnosed as Bipolar 1, but recently bipoalr NOS. I was confused, but this makes so much sense. Thank you very much again for posting this!

  • Azreuk

    Something big just happened that caused a rift in everything that I've ever known. I feel totally Alone with nothing and no one to talk to because I can't for more reasons than one though I'm a victim. so, I've been totally stressed and confused. I have cyclothymia, and I wonder if I should ask my councillor about my meds because I'm not sure if it's just stress and sleeplessness or overthinking but I'm pretty isolated and my emotions have been spinning like a top and every little thing is just too big? I've just been thinking if I should ride it and wait, even though the past isn't gonna get any better, or talk to my councillor or what. I can't talk about anything.