BP I or BP2?

My diagnosis is Bipolar 2, but another site member pointed out that my descriptions of hypomania sound more like mania so maybe I'm BP 1. I have only had 3 episodes like that, but they were pretty full on - I don't sleep, can't stay still, and I do really dangerous things ie. sex, drugs, etc. Anyways, the last time I had a severe episode was 2 years ago, and I had a mixed episode which landed me involuntarily hospitalized for 3 weeks. I did some very stupid things during that episode, and I'm still dealing with the consequences of my actions. I have had depression way more frequently than hypomania or mania, or whatever that was. I have also had more subtle fluctuations, which were definitely just hypomanic. I don't know that it really matters whether I'm 1 or 2, because it all sucks, and the meds are basically the same, but it would be nice to be more clear about what I'm dealing with. My pdoc told me that I am pretty classically BP II, but that was before my hospitalization. Maybe I should ask her what she thinks now, but I feel like she would have told me if she changed the diagnosis. I don't want to be a hypochondriac, I just want to understand what has happened and why my life is the way it is.

It's so hard to know where the line between mania and hypomania is, and even harder to have insight into myself when I get that way.

So, how do you tell the difference between hypomania and mania in yourselves?

involuntarily hospitalize makes me think bp1

The doctors really determine what is mania because usually by the time I'm manic I've lost insight into how bad it really is.

I have always considered my highs as Hypomania. But I have been admitted for it, and have done life threatening things while in this state. For me the line is psychosis and delusions. I get really high and out of control but I do not suffer from psychosis, nor do I have delusions of grandeur. To me, this is what makes my highs hypomania rather than mania.

My hypomanias involve dangerous activities, sex, drugs, alcohol, money spending, lack of sleep, roadtrips, over the top confidence, rapid speech and thoughts, obsessions, new ideas and fleeting interests just to name a few symptoms.

My diagnosis is BPII but I have experienced mixed episodes too. My doctor recently wrote on my admission forms that I was BPII with mixed episodes, so my doctors at least, do acknowledge that some BPII can involve mixed states.

I havent had a hypomanic episode for almost 4 years now, mine are few and far between. I hope that I will never have one again, but that wont change my BP diagnosis.

I think some of the distinctions are subject to interpretation by individual doctors. One person's BP 2 may be another's BP 1.....some doctors determine the 'flavor' by whether the pt has ever been hospitalized, while others draw the line at frank psychosis.

Technically, if you've ever had a full-blown manic episode or experienced psychosis, your dx is BP 1. I don't know if that helps, but in the end the number doesn't really matter---what does is whether your doc is treating you or an ICD-9 code.

ETA: I have two very distinct stages of mania---one I'd call hypomania (but my pdoc calls it mania) which is a lot of fun, and another which I consider to be full-on mania and is NOT fun.

The hypo is when I feel WONDERFUL and everything is possible and I want to clean/organize everything in sight and I love everybody and the world is full of bright colors and beautiful things. But then it turns on me and my thoughts start to race, I get mean and nasty and I pick fights, my outlook is terrible and I'm full of rage. Everything irritates me, I get itchy/scratchy and can't find a place for myself, and it's like all 250 TV channels are on in my head at the same time. I can't channel the energy so I pace around and fidget incessantly, and the last two times I've been manic I had auditory hallucinations.

I know the difference between 1 and 2 is if there has ever been a full manic episode. I'm just not sure if what i've experienced qualifies as that, or if it was just severe hypomania. I guess it really doesn't matter, because there is no clean line between hypo and full mania, it's a continuum. I'm just trying to understand myself better.

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Before getting changed to mood disorder nos, I was diagnosed bipolar 1 because the doctor thought I was having a mixed episode, and that to him meant I could only be bipolar 1.

Wow, how did you go from BP 1 to Mood Disorder NOS? Different doctors?

It used to be that mixed episodes were a feature only of BP 1, but now it's thought that they can be found in BP 2 as well. What distinguishes BP 1 from 2 is the presence of full-blown mania as opposed to hypomania, so if you've never had a manic episode, you can't be BP 1. I wonder about that Mood Disorder NOS, though.....that's a pretty vague diagnosis.

Ok, i was reading dsm-v, and BP nurse is right, BP 2 can now have specified mixed features, so that's new since dsm-iv. But it also says that hypomanoa is not severe enough to caused marked functional impairment or to require hospitalization, which was what i thought, but i checked and confirmed it.

So i'm not sure because the episode that got me hospitalized was mixed. You can get hospitalized for depression and still be BP 2, it's only mania that distinguishes. I'm not sure what severe mixed does to the diagnosis. I had 2 previous episodes that i think were full blown mania, but i didn't see a doctor the first time, and when i saw a pdoc the second time i don't know if he diagnosed 1 or 2. I think i'm kind of 1 1/2, lol. Probably should be 1, but officially diagnosed 2. I guess time will tell if i ever get manic again, but i doubt that will happen if i stay on meds.

So i wonder what mixed requiring hospitalization is classified as. Dsm really doesn't say.

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To clarify I went from mood disorder nos, to bipolar nos, to bipolar 1, and then right back to mood disorder nos. You're right; it is vague.

The bp1 diagnosis was back in 2012 before DSM V, so that may be part of it. They changed it back because despite having been hospitalized for what they thought was a manic episode a full year after the "mixed" episode that landed me the diagnosis, I've never had the iron clad classic manic symptoms. Even more importantly, when they thought I was manic, I had no sleep issues.

My thoughts/reasoning and to a lesser extent, my behaviors, were out of character and odd, and I was grandiose, but I wasn't spending money or talking fast or doing anything destructive considering that they hospitalized me for "mania."

It was a different doctor during a recent hospitalization that listened to me over several days and finally said I was nothing at all like she had expected for having that diagnosis on my records. This, combined with never having responded to medications, she dropped it for the more vague mood disorder nos diagnosis, and recommended a lengthy psych eval.

I had the eval a few weeks ago and it found nothing, although the psychologist said she admitted she thought I could have tricked or influenced the personality test because it found that I wasn't disturbed or disordered (despite multiple hospitalizations and history of self harm), and it came back with exactly what I suggested it would say (schizoid and borderline tendencies, or social isolation and labile affect with suicidal ideation, to be specific).

Wow, Curiosity, do I ever relate to your question! (I've jokingly thought the "1 1/2" too, lol.) I'm glad the new DSM recognizes mixed in II, because sure as hell I had a whopper awhile back. My psych said she absolutely would have had me hospitalized. But I was 2,000 miles away at the time (and certainly in no state to set up new provider). That's a really good question regarding how the DSM would categorize a mixed requiring hospitalization in a II. Do you happen to have a link handy to this stuff in the new DSM?

I've always thought BP 1 1/2 would be more accurate for me too. I have mania, no question about it, and I've experienced psychosis. However, my version of mania has never caused me to strip off all my clothes and stroll down Main Street naked, or try flying out of a second-story window, or become violent, or have any really extreme behaviors. I've never even been in the hospital (came close a couple times, but wasn't admitted). It seems that there's still a lot of room for interpretation within the bipolar categories. Wonder if the next DSM revision will have BP III, IV, and so on?

I have a DSM-V app on my phone, which lists all the info for the major disorders. It doesn't have the rare stuff, but it has all the criteria related to bipolar, as well as a lot of other stuff. It was $45, but I use it for work, so it was worth it for me. You can probably find all the info for free online though.

I don't know about you but I get into the short line at the DSM-V. I know I'm BP1. (That was my failed attempt at humor)

Sent from the dark side of the moon

I don't have too much wisdom to offer other than I know your dilemma. I'm not "confirmed" either, and it drives me nuts. (Hehe.) I really want to fully know what is going on with me and what I can identify with. It is indeed a continuum like you mentioned, but having an accurate diagnosis really helps when it comes to treatment. It's all so tricky!

I was Dx'ed as BP II (3 years ago, by a pdoc who I no longer see), but my current pdoc writes down the codes for BP I, but I think she does that because it's easier for insurance and billing purposes because she has said before that I was more II, so I really don't know...but with my insurance it really doesn't matter, so I don't really care. The label doesn't make a difference as long as I'm getting the right treatment.

If you have full mania, you are type 1. if the doctor isn't aware that you have experienced mania, they will diagnose wrong.

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How do you find out? I have been in treatment for 7 months. Since I am unemployed without insurance, I am receiving treatment at a clinic. I have only seen a dr. twice. Each visit was a total of 10 minutes each, however I see where they bill for 30 and 45 minutes each time. I've been wondering whom are they screwing out for the additional time that I am not getting. Plus I never get but 30 -40 minutes with therapist but I have seen they always put down 1 hour.

I'm not going to complain since they are giving me free treatment. However, if and when I have to pay myself, my bipolar rage will show it's ugly side.

I think you find out your type by discussing your symptoms with your pdoc or other mental health professional. That sucks that you don't get much time with yours.

I could probably figure out the answer to my question if i discussed it with my pdoc, but we don't have a lot of time either, and she likes to keep the conversation focused. I think i might be bp 1, misdiagnosed as bp 2, but i have really good functioning between episodes. I pull it together well. I also question the whole bp diagnosis itself, 1 or 2. Maybe it's just my personality, that i'm too reactive so my moods get extreme - because if that's the case, then i don't need all these meds. But i've had about 6 pdocs all tell me bipolar, so i should probably just accept it, and not worry about type 1 or 2.

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Curiousity, I appreciate your willingness to respond back to me.