Bipolar Disorder, Type Ii: How is it Like Rodney Dangerfield?

Rodney Dangerfield was an American comedian and actor best known for his catchphrase, "I don't get no respect". It can seem the same with Type II bipolar disorder. In show biz, things that are flashy are popular, but when it comes to the cast of bipolar disorder, Type II is a stick in the mud—the shy, quiet member of the cast. Some even think it a less serious form of bipolar disorder! Don’t be fooled. The real problem is that Type II don’t get no respect.

Talk about bipolar disorder and the average person is thinking about mania. Mania gets all the media play—it’s what the average person on the street thinks of when bipolar disorder is mentioned. Celebrities with Type I get all the attention and become spokespeople for bipolar disorder. The drama of Type I overwhelms its seductive, depressive fellow actor, Type II.

But those of us who experience Type II, know how its tendrils can snake into the very cockles of our hearts. So what is the power of bipolar disorder, Type II? How is it different from Type I? Why is it a challenging diagnosis?

Lifelong, Type II is characterized by depression interspersed with episodes of hypomania or normal mood. Its episodes of hypomania distinguish it as a disorder in the family of bipolar disorders, but depression, rather than mania, is the major characteristic of Type II. Depression is its true power.

And Type II is a supporting actor—not in the limelight. Hypomania rather than mania constitutes its high point. Hypomania seeks the limelight but ends up at the back of the stage while the mania of Type I dances its way to celebrity.

Truth be told, hypomania just isn’t as flashy and impressive as mania. Mania causes dysfunction, hospitalization and perhaps psychotic features. Those with mania may spend to unbelievable excess, or push the limits of the criminal justice system or write memoirs that soar to dizzying heights.

Hypomania goes unnoticed, and cannot keep up with mania. It’s a “can do” mood with plenty of energy. It’s a mood of elevation, expansiveness or irritability that can result in highly productive activity. Frequently the person with Type II sees hypomania as a welcome relief from the depressive episodes rather than as part of a complex actor on the bipolar stage. Sometimes hypomania isn’t even noticed by the person who has it. Hypomania also flies in under the radar screen of many clinicians. It definitely takes back stage to mania.

Those with Type II usually seek help during depressive episodes. The depression is usually easy to diagnose. The person’s symptoms of bipolar depression can be severe and certainly are recurrent. Too frequently a diagnosis of unipolar or major depression is made without consideration that the true diagnosis is a member of the bipolar family.

Well-informed and astute clinicians ask whether there have ever been periods of time with little sleep and high energy. A “yes” to these questions are red flags that will lead to further investigation with questions about “persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood” (DSM-IV-TR).

Trouble is, who remembers episodes of hypomania when seeking help for depression? Since hypomania by definition doesn’t cause marked impairment in functioning, the person with Type II may not even recognize it as part of an illness monopolized by depression.
So the power of Type II is depression. It differs from Type I in being characterized by hypomania that isn’t as flashy as the mania of Type I. It can be a missed diagnosis because hypomania doesn’t cause the dysfunction of mania. Here are some important consequences of these three facts.

• Since Type II is fueled by depression, it is a serious illness and can cause an extreme amount of partial and total disability. Don’t be fooled into thinking it is a less severe form of bipolar disorder! Hope for regaining wellness is always present, but recognizing potential pitfalls of this serious illness is a vital part of gaining wellness skills.

• Type II can cause frequent and persistent suicidal thinking, even at an early age. People with Type II have more suicide attempts but it’s the high energy of Type I that results in more completions of suicide. With Type II there can be persistent suicidal thoughts causing intense and distracting psychological pain. These thoughts can seem rational and sometimes persist in the absence of suicidal attempts. The person experiencing suicidal thoughts may not realize that they are not a normal part of life.

• In Type II, once a person is diagnosed, it is difficult to gain insight as to why bipolar disorder was diagnosed since the flashy mania of Type I is not a part of the illness.

• Most research on the family of bipolar disorders, until recent years, focused on bipolar disorder, Type I. Since Type I holds the limelight, there is less information about Type II.

• The depression of Type II stews and simmers beneath the surface. It frequently becomes so much a way of life that the person who experiences it long term fails to get treatment until it’s boiling over.

• Type II is frequently misdiagnosed and treated with anti-depressants alone (without a mood stabilizer). This can worsen symptoms.

• Hypomania is frequently not recognized as part of the illness. When it occurs, it may be seen as a sign of improvement rather than as a part of the overall illness.
Like Rodney Dangerfield, Type II doesn’t get no respect. But if you have Type II, take hope. Type II is a rising star. More and more attention is being paid to it these days. While it may never take over the limelight of Type I, it is being recognized for its role in the family of bipolar disorder. Appropriate treatment and use of wellness skills can usher in a life without the constant drama of overwhelming depression.

The good news is that wellness skills can work effectively for bipolar disorder, Type II. Clinicians are recognizing that Type II requires a different approach from that used for Type I. The medical community is getting better at looking for the red flags that distinguish it from unipolar or major depression. Researchers are recognizing the distinctive role Type II plays among mood disorders. In reality, Type II is beginning to get more respect.

Ten Tips For Dealing With Bipolar Disorder, Type II

1. Realize that Type II is no less serious than Type I.

2. Ask questions to get clear about why you were given the diagnosis of Type II.

3. Learn what normal mood is so you don’t confused between hypomania and normal mood.

4. Begin or continue to understand your moods by keeping a mood chart or graph.

5. Recognize hypomania as being part of the illness and pay attention to its treatment as well as that of depression.

6. Explore evidenced based psychotherapies such as Interpersonal Social Rhythm Therapy that are highly effective with Type II.

7. Learn wellness skills to deal with both hypomania and depression.

8. Stave off suicidal thoughts by carrying a note or card on which you have written, “I need help. I am feeling suicidal. Please stay with me and help me call…(your doctor, family member, friend). Include the phone number.

9. Stay in treatment even when you feel well.

10. Develop a network of family and friends who can help you maintain a healthy lifestyle.