Bipolar Disorder Core Subtypes

Bipolar disorder core subtypes refers to formally diagnosable conditions (as in DSM-5) defined by discrete mood episodes meeting specific criteria. In contrast, bipolar spectrum is a broader framework that includes subthreshold conditions with related traits and subclinical patterns. Course specifiers, including mixed features and rapid cycling, can be added to the diagnosis, where relevant.

• Bipolar Disorder I (BD I): The most severe bipolar type is characterized by dramatic mood swings from mania, psychosis, or mixed features to depressive episodes. In DSM-5, BD I is a syndrome in which a complete set of manic symptoms occurs and lasts for at least one week or required hospitalization. Manic symptoms is an elevated mood with three or more of: increased goal-directed activity, grandiosity, a diminished need for sleep, distractibility, racing thoughts, increased/pressured speech, and reckless behaviors. If mood is irritable instead of elevated, at least four manic symptoms are needed to meet the criteria for a diagnosis. 
• Bipolar Disorder II (BD II): BD II’s pattern of hypomania and depression is less extreme than BD I, rarely results in hospitalization, and does not end in psychosis. Yet, it’s hard to bear, its mood swings going from energy surges to depressive feelings of dark despair or no feelings at all — just numbness. In DSM-5, BD II consists of current or past major depressive episodes interspersed with current or past hypomanic periods of at least four days duration.
• Cyclothymia: Cyclothymia is diagnosed if recurring hypomanic and depressive symptoms are not intense or severe enough, or don’t last long enough, to qualify as BD I or II — nor are the depressive episodes severe enough to be diagnosed as major depressive disorder (MDD). For a diagnosis, episodes must alternate for at least two years, with symptoms lasting from hours to months. Its mood swings cause difficulties with concentration, thought, energy, and behavior, as well as changes in sleep and eating patterns.