[lbrown1]

http://psychcentral.com/blog/archive...polar-episode/

Why do the labels exist on 1 and 2.. and who is to judge whats more serious.. it all depends on the person! Im bipolar 2 and my best friend is 1 and i tell ya honestly neither one of us believe the others condition is less serious.. This article blew my mind when I read those words!

[cocoabeans]

Hmm, in general. Doesn't apply to individuals.

[Clinte89]

They are not more serious than the other just different symptoms is all.

[Eliza Jane]

I'm pretty shocked by that statement. He's an educated professional and he is repeating a common misconception. Actually Dr. Phelp's book about bipolar II "Why am I still depressed?" clearly makes the point that this is not the case. BP II is not "BP lite." There is even some research evidence that the depressions associated with BP II are often more severe and more dangerous than the depressions associated with BP I. (Of course, on the other hand hypomania is not going to be severe as mania, so perhaps that is where the doctor gets confused.)

Also, as others have stated, there is huge individual variation. I don't doubt that there are people with BP II that experience severe disturbance in their life and people with BP I who have their disease totally under control.

From a personal standpoint, it feels very minimizing to have a disorder that has nearly derailed (and ended) my life at times dismissed as "less serious."

Isn't the guy that wrote this the guy who runs this forum? Perhaps he will clarify his comment.

Best,
EJ

P.S. I know I am a bit of a constant commercial for Phelps, but i felt like I learned so much from his book and website! Great read on BP II!

[Rapunzel]

Bipolar I is often referred to as more severe just because the criteria for Bipolar I include full manic episodes, while by definition Bipolar II has no full mania but only hypomania. The first time someone with Bipolar II experienced a full manic episode, their diagnosis would change to Bipolar I. The criteria have nothing to do with how serious the depression can get or how profound the impact of the disorder is on each person's life. Both include depressive episodes as well. Mania is considered more severe than hypomania because people's judgment and behavior are more impaired with mania than hypomania.

I can understand how those statements can feel invalidating. I've been diagnosed with dysthymic disorder several times, and I felt like that category completely overlooked the fact that I had continuous depression that lasted most of my life with no remission and that I also do experience major depressive episodes. A dysthymic episode would be considered less severe than a depressive episode because not all of the criteria are met (at that time) for a depressive episode, just like a hypomanic episode doesn't meet all of the criteria for a manic episode.

What none of those diagnoses are even meant to do is to define the degree to which any individual is affected by their symptoms. Each person is different, and I do agree with you that often people with the "less severe" diagnosis have more persistent symptoms - just being that way more of the time, and it does seem like that ought to count for something too. Maybe it would be better, rather than the labels we have, to have a visual representation that shows like a thermometer where each person's mood sits and their individual range of moods, as compared to whatever normal is.

[Eliza Jane]

I don't know if others agree, but for me, using the word "severe" would have been less offensive than using the word "serious". It is certainly a true statement that mania is more severe than hypomania. (Although I still don't think you can jump from that to saying BP I is more severe than BP II). "Serious" feels more like a value judgement than "severe".

I think I'm a little stuck on this because I am just so surprised that someone in his position would perpetuate this misunderstanding...

Best,
EJ

[hamster-bamster]

The European classification does not distinguish between I and II.

For a reverse standpoint from a Type I, possible Schizoaffective... I hate when they call something more "serious" then something else. It almost implies that one person has less of a chance than another to experience recovery. : /
But at the same time, this article seems like it's from an objective standpoint. If in trying to keep things factual he accidentally slips up a little & unintentionally offends? I can't really be too upset. I'd rather have things put realistically than lightly IMO.

[Travelinglady]

From somewhere I got the idea that folks with Bipolar I also have psychotic episodes, whereas folks with Bipolar II don't. However, I think Bipolar II's might be in the long haul more prone to suicide. What have you folks read on these issues?

[Anneinside]

Originally Posted by PAYNE1

From somewhere I got the idea that folks with Bipolar I also have psychotic episodes, whereas folks with Bipolar II don't. However, I think Bipolar II's might be in the long haul more prone to suicide. What have you folks read on these issues?

I just read an article about research done on suicide and BPI and II. It said people with BP II have more suicidal ideation than those with I but there is no difference in suicidal actions.

[krisakira]

Bipolar 1 has at least 1 full mania episode while bipolar 2 has hypomania. However, I have 2, and the depression gets so severe i have attempted and nearly succeeded with suicide. They are not comparable like that. Just different symptoms.

[insideout]

Bipolar 1 is more severe.

but they are both "serious".

it like the difference between having a badly infected foot and having a badly infected toe. better get some antibiotics or you could die.

I had to look this up because I knew I had read something about this in one of my many bp books. This is what I found in Why Am I Still Depressed? by Jim Phelps, MD. The study he is referring to is linked below. He has a very extensive website, www.psycheducation.org, that contains a great portion of the book, but I wasn't able to find the diagram that I will try to describe from the book to you on the website itself. The diagram is on page 29 of the book if you get a look at it.

He says:

"Depression is by far the predominate symptom in bipolar disorder of all kinds [both bp I and bp II], but especially in the middle of the [bipolar] spectrum [which he basically says corrolates to bp II]. In this study [see link below for study], patients were found to have symptoms about half the time. In Bipolar I, depression accounted for about two-thirds of that symptomatic time. But in Bipolar II, over 90% of the time spent ill was due to depression. Bipolar disorder in the middle of the Mood Spectrum [again, basically bipolar II] is experienced almost entirely as depression! Manic-side symptoms account for only a very small fraction of the experience."

Pg. 12: "The suicide rate Bipolar II is as high as, and in some studies, higher than, in Bipolar I." (I couldn't find what studies he is referencing here though.)

http://archpsyc.jamanetwork.com/arti...ticleid=207252

[Travelinglady]

No info about the psychotic episodes with Bipolar I? I have a friend IRL who is Bipolar I and she has had them....

[krisakira]

Originally Posted by insideout

Bipolar 1 is more severe.

but they are both "serious".

it like the difference between having a badly infected foot and having a badly infected toe. better get some antibiotics or you could die.

I think you mean to say the mania in bipolar 1 is more severe than in bipolar 2. Yes? Because the depression can be just as bad or worse, depending on each case.

[Travelinglady]

farmergirl, I was interested in reading that Bipolar II's have depression 90% of the time when they are having any kind of episode. That fits my story. But I understand that only one episode of mania puts a depressive into the bipolar category, unless it can be demonstrated that the mania was solely caused by anti-depressants.

Not to sound like a broken record, but I still think having psychotic episodes is one distinguishing factor between I's and II's. I'm going to look this idea up to see if it does have validity.

Note: My husband has been labeled as a "Mild Bipolar I." I think that's interesting. Anybody else get this kind of label?

[Eliza Jane]

Originally Posted by PAYNE1

No info about the psychotic episodes with Bipolar I? I have a friend IRL who is Bipolar I and she has had them....

My understanding is that psychosis CAN occur during mania, but you don't necessarily have to have psychosis during mania. Further confusing the issue is that some people can have (unipolar) depression with psychosis. Does that answer the question?

EJ

[Travelinglady]

Yes, I just read that it IS possible for Bipolar II's to have psychotic episodes (hallucinations, for example), but the mania of Bipolar I makes them more likely. But Bipolar I folks don't necessarily have psychosis during mania.

Sigh. Well, I conclude that neither Bipolar I or II is all that great! I happen to be a II, so my "mania" is "hypomania." Yet, that can make me miserable, too. The depression is just as bad in either one. It seems like it just depends on how "serious" is defined.

Originally Posted by PAYNE1

No info about the psychotic episodes with Bipolar I? I have a friend IRL who is Bipolar I and she has had them....

Let me look . . . .

Okay. This book, by the way, focuses mainly on bpII and approaching bipolar as a spectrum of symptoms as opposed to two distinct types. This is what he says:

"The rules of the DSM also say that hypomania is not associated with psychosis. Therefore, if a person has lost contact with reality, that person by definition has mania." (pg. 17)

Now, let me see if he says anything at all about depressive psychosis. Hang on . . . .

(pg. 43 - a definition): "Psychotic [depression]: depression is accompanied with a loss of contact with reality, including delusional beliefs and hearing voices (and rarely, other forms of hallucinations)

Notice that psychosis is possible in both mania and in depression, so this is where his discussion of bipolarity being on a spectrum comes in. A person, according to him, can fall anywhere along that spectrum/range of symptoms which is why pdocs have so much trouble distinguishing bp I from bp II. There is no hard dividing line between the two, according to him, except that which the DSM has imposed/specified: mainly duration of symptoms and mania vs. hypomania. Everything else is defined exactly the same by DSM but actual presentation of symptoms is much fuzzier/varied than the DSM really allows for.

It's an interesting book. I haven't picked it up in a couple of years, but I may just have to give it a re-read.

[Eliza Jane]

I was hoping that DocJohn would weigh in on this thread because he was the author of the blog that started this discussion. Does anyone know if he reads the posts here? I have seen him comment on things here and there.

EJ

[Seaswept]

I think Bipolar 1 is looked at as more severe than 2 because of the manic episodes. Meaning they can be so bad and disruptive in so many ways, especially when someone gets pyschotic.
Being that depression seems to last longer and maybe more severe in type 2 than 1 is just as serious and dangerous- but can be quiet, not always outwardly seen (intovert) as apposed to mania- which is "in your face" and loud. extrovert

I think of it like the mania is more objective and depression subjective. Both are equally serious and severe I guess.

[lbrown1]

I think which ever bipolar a person may be, should never be judged as less or more severe. I'm not a dr but I know every individual has their own separate issues aside from the disease and damn anyone who thinks they can judge what's worse or more severe. I was in disbelief when I seen this doctors post.

[Jim62]

I think bipolar I is more serious for several reasons. For example, when I am manic I am psychotic, have delusions of grandeur, think I am invincible and think I can fly. One of these days I just may try. Additionally, bipolar I people can have mixed states where they are both manic and depressed at the same time. This means that someone may feel like killing themselves and will have the energy to do it.

By definition, bipolar II people only experience hypo-mania which can be feelings of euphoria, iincreased energy, racing thoughts, and little need for sleep By definition, bipolar II people do not experience delusions and hallucinations.

Biplar I people, as compared to bipolar II people, have a wider range of symptoms which may lead them to do something that is dangerous to themselves or intentionally kill themselves.

[cocoabeans]

You forget that with bipolar 2 you can experience psychotic and agitated depressions though, which are just as dangerous.

[lbrown1]

This is a never ending, opinion based post. I did enjoy everyones outlook and thoughts. I say a mixed episode is worse than any bipolar 1or 2