View Full Version : Bpi vs. Bpii


sarahsweets
02-15-13, 05:50 AM
Hello all...I know there are clinical definitions and differences between BPII and BPII but I was wondering what BP people think are the personal differences between the two that relates to themselves? I am not necessarily looking for scientific points (although that is welcome too) just some people who have an opinion on the differences between the two in their personal experiences, the experiences with loved ones etc. I think its good to get some bi-polar talk going every now and then because this section can drag a bit sometimes.:p

So what is your opinions between the two? Do you have family members that have been misdiagnosed with BPI only to find out it was really BPII ? (or vice versa)

Oh, and by the way, all are welcome to post, not just us crazies.:D

Fuzzy12
02-15-13, 06:25 AM
Well, I've been diagnosed with BP II. I think, the main difference is that mania (or hypomania in our case) isn't as extreme as in BP I and it's never accompanied by psychosis. When I'm hypomanic, I feel extremely euphoric, social, confident, active and driven (though not in a focussed, productive way) but it feels more like a very good mood, you know? I never even suspected that my "good moods" were anything else, anything medically disordered.

I think, with BP II the main reason for dysfunctionality lies in the depressive episodes rather than the hypomanic ones. Hypomania is when I'm doing well, depression is when I'm reduced to a vegetable.

I'm not sure if there are many cases where BP II is mistaken for BP I. From what I've read it's more common that BP II is initially diagnosed as unipolar depression. If I remember right, I read in a paper that on average it takes about 10 years for people with BP II to actually get diagnosed with BP II from the time they've been diagnosed with depression. It's easy to miss, especially because hypomanic episodes aren't really disabling so many patients don't report them (or recognise them as anything but a good mood). For me, my hypomanic episodes were just times of welcome relief from the seemingly endless depression. I did think they were a bit odd but the main reason why my GP suspected BP II is because I kept complaining of extreme mood swings.

Also, according to my GP in the UK apparently, many psychiatrist either don't recognise BP II or don't believe in it.

My husband's cousin has BP I and his episodes of mania really are extreme. He becomes completely deluded, there is a significant break with reality. He actually is a danger to himself when he's manic and it's pretty obvious when he is manic.

peripatetic
02-15-13, 08:02 AM
well...as you know, s...i'm not bipolar myself...but...i do have... i'm not a stranger to the rodeo and...i'm me...so...will say this...the technical definition...that's not the distinction i see as most....well...that's not how i'd frame it (mania vs hypomania...nah...that wouldn't be my...distinguishing factor in actual illness lived)

in my experience and also...knowing others...

bpII...is a hell, for sure. one i'm not really as familiar with despite someone i lvoe very much, and you(oh! and rebel :-))...and of course dear blue...though she's ...yeah...bipolar maybe unspecified :-)...but abi has it..and i konw him best of the bpIIs...it's different somehow...that i can't explain...

but here's something i can explain...

bpI...schizoaffective (bipolar subtype) and schizophrenia...there's a lotta cross over...not with all bpI people...i'm not bpI and i know my bpI person like the back of my hand...and his symptom presentation is of the euphoric-grandiose-hypersexual mania with the psychotic features in both and during mixed, but strongest in depressive going into catatonic depression type with psychotic features.

others are not that same presentation, so noting...

that...plus or minus a little formal thought disorder...

or presenting first with a psychotic break of a certain flavour...

those three...it's like..a grab bag diagnosis. initially x...then adjusted to this...then...well maybe it's bpI...no, wait..there are psychotic features when mood is what we think is baseline...

that's the difference i can tell you. i've never known anyone with bpII or heard of their experience...where there's that...cross over potential that...

you konw how some pepole...you feel like...maybe you're chocolate chocolate swirl and they're chocolate chocolate chunk? and then there's a flavour that's...like..there's chocolate...but a lot of other stuff you can hear about...but...there's more difference than similarity it feels? that's...i see bpI as a lot closer to ...not II...but...as i said...my bpIperson...is of a certain presentation that...was never, and would never have been, diagnosed II...but was not initially or always bipolar...

i wil say...that i can't imagine bpI without psychotic features...so..maybe those who don'thave them...are a lot morelike the IIs...? no experience personal or secondary with..............well...not that i'm aware of...maybe there's someone on here with bpI without psychotic features...but not someone i'm close to at all. or they're ******* medication compliant and responsive as all hell...or...as i said...it looks different and i don't recognize it.

peripatetic
02-15-13, 08:12 AM
actually, fuzzy...bpII can manifest psychotic features...dysphoric hypomania...i know someonen who does..


it's different than...

it's more on the "delusional" and less on the..."hallucination"...i've never seen anything remotely looking like formal thought disorder...

but...a tendency toward what would be clinically termed (i ******* kinda think it's presumptuous to basically say reality equal...well whatever...) "delusional thinking"/thought patterns...that is absolutely possible with bpII...and enough to qualify as "psychotic features"....


oh...and with the II morphing into I...i believe....but i have only directly researched I extensively and seen II more...referenced in contrast...but...the hypomania part... i believe far less frequently includes euphoria...and far more frequently, is dysphoric (irritable/angry/combative)...though...i've also seen research suggesting women, with I or II...tend toward the dysphoric and men more frequently the euphoric presentation in bpI

medication non compliance...kicking out on antipsychotics on after another because stopping/starting reduces efficacy potential...taking "below therapeutic levels" of lithium...chasing the mania...by doing certian things that can throw you, in combination with neglecting lithium...into very strong manias...

cycling..repeatedly...harder and harder...it ****s you. it can speed up rapidity of cycling...increase presence of mixed episodes...and....once you crack...you can shellac the **** outta things..but you can UNcrack...and the harder you do it...off and on...the more treatment resistant you can become and the worse mixed episodes get...

i dont' konw if getting stabilized and being as 100%on meds as possible would have the saame...like...that ****s you in the others i mentioned...could that lead to someone who's bpII converting to bpI...? i don't konw. but...yeah...that's the only hope really...so...so hard though.

daveddd
02-15-13, 08:16 AM
its tuff to say

it seams like the description of a hypomanic state in BP2, that i read about the most, is pretty much my baseline

my manic episodes involved floods of ideas(a strange phenomena ) and grandiose delusions

but im still BP nos

and my depressions are of the extremely agitated type

peripatetic
02-15-13, 08:39 AM
and my depressions are of the extremely agitated type

that's interesting to me.

becauase...that's something i'd associate with mixed episode for my bpI...and apart from bp...with...certain phases of breaks...orbeing jarredout of..sorta...

daveddd
02-15-13, 08:45 AM
all of the mood episodes ive had

anger, agitated, manic, hypomanic, over productivity

all seem to fit what would be my currently, repressed, and UNREGULATED state of emotion

namazu
02-15-13, 09:02 AM
that's interesting to me.
becauase...that's something i'd associate with mixed episode for my bpI...and apart from bp...with...certain phases of breaks...orbeing jarredout of..sorta...
Agitated depression basically is a (flavor of?) mixed episode. It's pretty miserable,* and may [?] engender higher risk for self-harm because there's often more pent-up energy, irritability, and sometimes impulsivity (as opposed to more "vegetative" types of depression where one doesn't have the energy; obviously oversimplifying here).

I think technically if you have mixed episodes, that's an automatic qualifier for BPI.

That said, at one point I was dx'd with "BPII with rapid cycling and mixed episodes", so I don't think docs necessarily all agree that you can't have a mixed episode if you've never had a frank manic episode.

That said, at this point, no one dx's me with BP-anything anymore (just recurrent MDD); it sure made for a few hellish years, though.

I think that, in the absence of frank mania (<--who's he?!), distinguishing between [(depression +/- anxiety) + undx'd or inadequately treated ADHD] and mixed episodes (not that they're mutually exlusive; they aren't) can be a real problem, because the ADHD and depression exacerbate each other and both can include marked restlessness/irritability/etc. Throw in substance use on top and it's a real mess.

*Though, I should clarify, not necessarily more or less miserable than other types of crappy mood states.

saturday
02-15-13, 12:03 PM
My doc recently told me that because I work and go to school that I dont have BPi or schizzoaffective. I dont buy his logic, but that what he thinks.

crystal8080
02-15-13, 07:05 PM
Well my dr just told me the other day that Cyclothymia is really considered BPII, its just that people with BPII generally have more problems with depression, and people with Cyclothymia generally have more problems with hypomania. He also said that people with Cyclothymia have higher rates of anxiety, but I don't have a diagnosis of an anxiety disorder. This is just the umbrella I guess. And all these things fall under it.

I think he is getting annoyed with me because I keep asking him if my diagnosis has changed. What's worse is I thought I only asked him once, but he says I've asked him 3 times. I do worry that my depressions have gotten deep enough for BPII, or my manias high enough for BPI, or I have an anxiety disorder, but he is saying that its all Cyclothymia and ADHD.

Rebelyell
02-15-13, 07:41 PM
:umm1::scratch::eek::faint::eyebrow:I guess this really describes and explains alot why I have alot of private parties and Ill smile and laugh like im on acid or drugs and people wonder why im on or whats up w me:p:giggle::doh:I take maniacal to a whole nother level sometimes if any one remmebers dennis leary in his heyday where hed be all nutty,chain smoking cussing talking all fast and crazy and ya thought he wa on crack or something I swear thats me when I get hyper or manic or whatevah ya wanna call it.

keliza
02-16-13, 12:24 AM
It's pretty uncommon for someone to be diagnosed as BPI and then find out it was BPII. Manic episodes are really hard to miss, and they don't indicate any other illness but bipolar I disorder or BP-NOS (or substance abuse, but that's not a manic episode, that's being high off your rocker on a stimulant drug like cocaine).

It's a lot more common for a person to be misdiagnosed as having major depressive disorder, when they really have BPII, because the hypomanic episodes are not reported to doctors very often. Who reports something that feels good, helps them be productive, creative, and happy, and doesn't have any apparent negative impact on their lives? So those go under the radar for quite a while in many people. The average time between onset of symptoms and accurate diagnosis for bipolar disorder in general is about 7 years; for those with BPII disorder, it's usually longer, sometimes a decade or more.

I had my first major depressive episode when I was about 12. I was misdiagnosed as having major depressive disorder, generalized anxiety, social anxiety, and accused of drug abuse at various times during my teenage years before I was finally diagnosed with bipolar I disorder in college. The hypomanic episodes throughout my early teenage years went unnoticed - it wasn't until I had my first full-blown manic episode that I got the proper diagnosis and treatment.

My doc recently told me that because I work and go to school that I dont have BPi or schizzoaffective. I dont buy his logic, but that what he thinks.

Your doctor's an idiot, get a new one. I was diagnosed with BPI while I was in university, and still managed to graduate with my bachelor's degree. I also work two jobs. There are many, many productive people in the world with BPI and/or schizoaffective disorder. If your doctor doesn't believe this is possible, he's stigmatizing you and the entire patient population, and he's not a good doctor.

Well my dr just told me the other day that Cyclothymia is really considered BPII, its just that people with BPII generally have more problems with depression, and people with Cyclothymia generally have more problems with hypomania. He also said that people with Cyclothymia have higher rates of anxiety, but I don't have a diagnosis of an anxiety disorder. This is just the umbrella I guess. And all these things fall under it.

What is with doctors and all this false information? Geez... it's amazing these people make it through medical school at all. BPII and cyclothymia are separate illnesses. BPII is characterized by major depressive episodes and hypomanic episodes. Cyclothymia is characterized by dysthymic episodes (mild depressions) and hypomania. The difference is not that people with cyclothymia have more issues with hypomania, the difference is that people with cyclothymia do NOT have depressive episodes that meet the diagnostic criteria for a major depressive disorder. They are either not severe enough, or not long enough, or both.

actually, fuzzy...bpII can manifest psychotic features...dysphoric hypomania...i know someonen who does..

Actually, part of the diagnostic criteria for BPII is that there is no presence of psychotic features during hypomanic episodes. There may be presence of psychosis during severe major depressive episodes, but that is also extremely uncommon. One of the major hallmark differences between hypomania and mania is the absence of psychosis in the former. If your friend is having what look like hypomanic episodes with psychosis, they may not be having hypomanic episodes at all, they may just be having psychotic episodes.


oh...and with the II morphing into I...i believe....but i have only directly researched I extensively and seen II more...referenced in contrast...but...the hypomania part... i believe far less frequently includes euphoria...and far more frequently, is dysphoric (irritable/angry/combative)...though...i've also seen research suggesting women, with I or II...tend toward the dysphoric and men more frequently the euphoric presentation in bpI

In general, women tend more towards dysphoric mania, and men tend more towards euphoric manias with delusions of grandeur. But hypomania is overwhelmingly euphoric, not dysphoric. That is what makes BPII so hard to diagnose, is that the hypomanic episodes are so often masked as a "really good mood" that the patient never bothers bringing up to their psychiatrist. Why report something that just feels good? It doesn't appear clinical to them because it's NOT dysphoric, overwhelmingly. It's euphoric. It's positive and lovely and very productive, generally speaking. YMMV, but as a generalization, hypomania is usually euphoric in quality.

cycling..repeatedly...harder and harder...it ****s you. it can speed up rapidity of cycling...increase presence of mixed episodes...and....once you crack...you can shellac the **** outta things..but you can UNcrack...and the harder you do it...off and on...the more treatment resistant you can become and the worse mixed episodes get...

Yes, this is called the kindling effect. The more untreated mood episodes a person has, the more severe and frequent their future mood episodes become, as a general rule. This can lead someone who was initially diagnosed as BPII to have their diagnosis changed to BPI later on in the progression of the illness, if they eventually progress into full-blown manic or mixed episodes.

saturday
02-16-13, 01:16 AM
But hypomania is overwhelmingly euphoric, not dysphoric.]

Interesting, cuz I know plenty (acually five people from this and other forums) of people with mainly dysphoric hypomanic episodes.

peripatetic
02-16-13, 02:44 AM
regarding bpII and psychotic features being possible...as i said...i do not have bpII...but i do listen to people who tell me their experiences and reported them to the best of my knowledge....and i konw the level of ...similitude in their descriptions...and i accept their reporting.

i guess my mileage...and that of at least...a...r...b..c...s......a.........i know there's another.........

well...at any rate...they would be surprised to learn their experiences are extremely rare and/or they're all misdiagnosed and impressively clinicians around the world have failed in the exact same way...for years...or...yeah...i don't know...as i said...that's not my flavour or one i know as well as i know myself...but unless they're all misreporting...
yeah...out of the ten bipolars i know...four I...six II...those six would all be anomalous/misdiagnosed and they're just having psychotic breaks.

and schizoaffective...with bipolar as the mood element...can look exactly like bpI with psychotic features. including presenting with mania until the mood is stabilized and the psychotic features remain...they can look exactly alike. and...really...at least one type of schizophrenia...which...*can* change over the course of a person's lifetime....*can* look a hell of a lot like mania with psychotic features...a type presenting more and certain variations on specific positive symptoms, to be precise...and psychotic features of bipolar I...there's can be a common language there that permits an understanding between people...that simply isn't the same strength of similitude as bpI and bpII...for SOME..not to mention more in common regarding functionality and decompensation, and medication/treatment/inpatient stays between the two i noted.

and with the whole...manic episodes don't indicate anything but bipolar I...(except schizoaffective, as i noted above)...and...they're "really hard to miss"....

are you claiming, barring physician incompetence, that the diagnosis would be a no brainer if one presents with what is ultimately found to be a manic episode (with psychotic features)...?

there IS enough similarity in experience...that BPI with psychotic features bears enough in common with a particular psychotic disorder that diagnosis the former IS frequently the latter initially...and then later that diagnosis is corrected...FROM the latter...TO BPI with psychotic features...


there is substantial research that the presentation looks a hell of a lot alike to trained clinicians...oftentimes..if certain criteria are met.

and i would like to think that when others report their experiences...it wouldn't be so easily dismissed...

i'm not an authority on differential diagnosis and so forth...but, as i said...i'm not new at the rodeo or new to researching the things i have...

here are some abstracts of peer reviewed articles of published studies conducted by people who ARE experts in the subject...and who are noting the difficulty in diagnosis by people with hundreds...thousands among them...years of clinical experience, not to mention formal education on doing differential diagnosis...leading to what constitutes a level of expertise nobody on this forum has...but which corroborates the experiences actual people are telling you they have...or rather...telling sarah...since she asked for experiences...

there's was one other super good one...but...here are three:

http://journals.cambridge.org/action/displayAbstract;jsessionid=03AA241F7E663EF8F426686 FA36D1F9C.journals?fromPage=online&aid=4978788


The age of onset in bipolar affective disorder was determined in 200 hospitalized patients. The mean age of their first affective syndrome was 28·3 years, and the mean age of first hospitalization was 30·8 years. However, the median age for first affective syndrome was 23 years (26 years for first hospitalization), and the most common age of onset was 15–19 years. Those patients with an early onset, especially if they were first hospitalized for mania, were most likely to have received a diagnosis of schizophrenia.

Fity-nine child and adolescent psychotic patients (mean onset age 13.9, range 7–17, 83% 13 + years) had history and outcome studied using diagnses confimed at follow-up after 1 to 16 years (mean, 5 years), There were no differences in sex ratio, socioeconomic status, age of onset, and symptoms, but bipolar patients (N = 23) were often misdiagnosed as schizophrenic, had a better outcome, and a 50% homotypic family history. Schizophrenic subjects (N = 30) were more abnormal premorbidly, and only 17% were well at follow-up. Schizoaffective disorder was unreliable, infrequent, and more severe. Premorbid adjustment and IQ were the best predictors of outcome. Differences from the adult disorders were only quantitative. Careful follow-up of psychotic patients is needed to detect diagnostic errors.

http://www.sciencedirect.com/science/article/pii/S0890856709645664


http://journals.lww.com/co-psychiatry/Abstract/2007/07000/Schizoaffective_disorder_merges_schizophrenia_and. 11.aspx
Purpose of review: Schizoaffective disorder was named as a compromise diagnosis in 1933, and remains popular as judged by its place in the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, its frequent use in clinical practice, and its extensive discussion in the literature. Some, however, have questioned the validity of schizoaffective disorder as separate from psychotic mood disorder. We examined the literature to assess the rationale for the continuation of schizoaffective disorder as a legitimate diagnostic category.

Recent findings: The diagnosis of schizoaffective disorder depends on the disease specificity of the diagnostic criteria for schizophrenia; however, the psychotic symptoms for schizophrenia, traditionally held as specific, can be accounted for by psychotic bipolar. Further, the interrater reliability for diagnosing schizoaffective disorder is very low. A recent and expanding body of comparative evidence from a wide range of clinical and basic science studies, especially genetic, reveals multiple similarities between schizoaffective disorder, schizophrenia and psychotic bipolar.

Summary: Schizoaffective disorder unifies schizophrenia and bipolar, blurring the zones of rarity between them and suggesting that schizoaffective disorder is not a separate, 'bona-fide' disease. Patients diagnosed with schizoaffective disorder likely suffer from a psychotic mood disorder. The diagnosis of schizoaffective disorder, which can result in substandard treatment, should be eliminated from the diagnostic nomenclature.

peripatetic
02-16-13, 03:05 AM
Agitated depression basically is a (flavor of?) mixed episode. It's pretty miserable,* and may [?] engender higher risk for self-harm because there's often more pent-up energy, irritability, and sometimes impulsivity (as opposed to more "vegetative" types of depression where one doesn't have the energy; obviously oversimplifying here).

i recall keith posting a thread citing some study indicating mixed is statistically the most associated with at least attempts...and maybe completions...but i'd have to re skim.


i can say...i lost my bpI when mixed. that was a ******* hell to watch...to live...yeah...that makes sense.

peripatetic
02-16-13, 03:33 AM
kindling...

i did not know that term was the technical one in affective disorder discussion to denote development of refractory symptoms...which is what my BPI went through and what i described above...because ...and i'm not familiar with transition from bpII to bpI...but took a stab that it might be similar to *decompensation*, which is a term perhaps not applicable to bipolar and i misappropriated because it's one i am kore than a little familiar with.

but what i was saying above...is that development of I from II...maybe is made less likely by remaining treatment compliant...and i said using the bpI experience as the comparable example to what is linked to development of refractory symptoms and really i posted because...hindsight is twenty twenty ...but lacking insight can **** you in a big way. and whether it fits your bp experience or not...the level of functionality you have...

if that's the result of staying consistently medication compliant...

i hope everyone reading this follows your example...

and i can't even begin to say

yeah...

i have more experience with the other path and wouodn[t recommend it.

...and i know something comparable happens in BPI...because i watched it...and treatment resistance... that whole decompensation thing...if avoidable regardless of diagnosis... if you possess the insight requisite to 100% treatment compliance...i highly recommend not ******* yourself, because it does **** you...and that you kinda did it to yourself...brutal.

Rebelyell
02-16-13, 11:36 AM
When I took the bp test at the psyche office I kind of lied on a few answers like are you hypersexual,I was embarrassed to answer that one.I remember when i was younger mom showed me how to make my bed and she'd go out of the room do other stuff,I would try like she showed me3-4 times and I couldnt get it right,Id be so angry So I would go over to the bedroom mirror,look at it punch it,kick the dresser like 3 times all mad and then sit on the bed and start crying and think what the hell is wrong w me why cant I make this damn bed and why am I getting to the point of crazy *** mad here everytime I have to make this bed.It was like you didnt know what to call it at 11 but knew something was wrong w me.She would eventually come back in the room and ask why I wasnt done yet,smile and say Your a real mess today arent you now let me help you and then it would get done.

keliza
02-16-13, 02:36 PM
Interesting, cuz I know plenty (acually five people from this and other forums) of people with mainly dysphoric hypomanic episodes.

I'm sure you do, and I don't doubt their experiences at all. But euphoric hypomanic episodes are still the "classic" and more common form of hypomania. Be careful not to fall into "person-who" reasoning - that is, when a person says, "I know a person who..." and uses that as their reasoning by which to judge the reality of a situation. Common example: "Cigarettes don't really cause cancer, because I know a person who smoked for 50 years and never got cancer." Just because you know a person or people who had a certain experience doesn't make it the norm.

regarding bpII and psychotic features being possible...as i said...i do not have bpII...but i do listen to people who tell me their experiences and reported them to the best of my knowledge....and i konw the level of ...similitude in their descriptions...and i accept their reporting.

i guess my mileage...and that of at least...a...r...b..c...s......a.........i know there's another.........

well...at any rate...they would be surprised to learn their experiences are extremely rare and/or they're all misdiagnosed and impressively clinicians around the world have failed in the exact same way...for years...or...yeah...i don't know...as i said...that's not my flavour or one i know as well as i know myself...but unless they're all misreporting...
yeah...out of the ten bipolars i know...four I...six II...those six would all be anomalous/misdiagnosed and they're just having psychotic breaks.

I'm not arguing the point, it's in the DSM-IV-TR. Psychosis during mania is the HALLMARK that separates mania from hypomania. In the DSM-V that may change, I am not entirely sure. But psychosis is not an aspect of hypomanic episodes. It's simply not. A person may be having an agitated depression with some psychotic-like features, which also isn't a hypomania, it's a mixed episode. I do know that the DSM-V is allowing for mixed episodes to be included in diagnosis of BPII, which is a change from the DSM-IV-TR since as of now mixed episodes are only considered an apsect of BPI. So maybe they are having mixed episodes. I certainly don't know their lives - I'm just telling you what the DSM says.

and schizoaffective...with bipolar as the mood element...can look exactly like bpI with psychotic features. including presenting with mania until the mood is stabilized and the psychotic features remain...they can look exactly alike. and...really...at least one type of schizophrenia...which...*can* change over the course of a person's lifetime....*can* look a hell of a lot like mania with psychotic features...a type presenting more and certain variations on specific positive symptoms, to be precise...and psychotic features of bipolar I...there's can be a common language there that permits an understanding between people...that simply isn't the same strength of similitude as bpI and bpII...for SOME..not to mention more in common regarding functionality and decompensation, and medication/treatment/inpatient stays between the two i noted.

Yes, of course a person with schizoaffective disorder can present with symptoms that look like mania. If you conceptualize bipolar disorder and schizophrenia to be on two ends of a spectrum of mood/psychotic disorders, schizoaffective would be the lovechild of those two disorders, right in the middle of the spectrum. But it's not a pure bipolar mania, it's a schizoaffective episode. There is, in my understanding, a difference between true bipolar mania and the manic/psychotic experiences of those with schizoaffective disorder.

and with the whole...manic episodes don't indicate anything but bipolar I...(except schizoaffective, as i noted above)...and...they're "really hard to miss"....

are you claiming, barring physician incompetence, that the diagnosis would be a no brainer if one presents with what is ultimately found to be a manic episode (with psychotic features)...?

there IS enough similarity in experience...that BPI with psychotic features bears enough in common with a particular psychotic disorder that diagnosis the former IS frequently the latter initially...and then later that diagnosis is corrected...FROM the latter...TO BPI with psychotic features...

If a person has a manic episode with psychotic features, and no psychotic symptoms outside of severe mood episodes, and a person has a history of major depressive episodes, then YES - the diagnosis of bipolar disorder is fairly clear.

Schizophrenia does not have manic episodes, period.

Schizoaffective disorder has more psychotic symptoms outside of major mood episodes that indicate more of a psychotic component to their illness. As per the DSM, those with schizoaffective disorder must have had a period of 2+ weeks of psychosis WITHOUT mood features. They could certainly have mania with psychotic features, but they are also having psychotic episodes that are in no way correlated to mood episodes.

Therefore, if a person is ONLY having psychotic episodes during a full-blown, profound mood episode (manic or depressive) with a history of depression, there is no reason to think it would be anything but bipolar I disorder. Why would schizoaffective even be a consideration if there is zero history of psychosis outside of major mood episodes? As long as you have eliminated the possibility of schizoaffective based on their history of psychotic episodes, what else exactly do you think they would fit the criteria for?

Is it possible that a person could later develop psychotic episodes OUTSIDE of major mood episodes, and then fit the criteria for schizoaffective rather than bipolar disorder? Yes, of course. But the absence of mania with no psychosis outside of mania or major depression is indicative of bipolar I disorder.

SquarePeg
02-16-13, 03:05 PM
wow I was hoping for some clarification here but the topic seems so complicated. my 17 year old thinks she may be bipolar. her friends have commented on this a number of times. I thought her extreme moods, especially the downs where she doesnīt want to live, life is futile, nobody understands etc was because she was doing so badly at school (undiagnosed ADHD).

now that she has been diagnosed add and on concerta and doing really well at school, I thought these ups and down were a thing of the past.

Sadly they are not, today she is crying (rarely cries), so angry, frustrated but doesnīt know why. She canīt bear to be near me or her brother so is staying out with a friend tonight. She says nobody understands her, she has been keeping it all in, she doesnīt understand herself etc.

I didnīt press her as she can get very agitated and so unhappy so itīs best to leave her. I dropped her off at her friends and she called me an hour later to apologise. she said that she always gets like this, happy for months and then crash.

I told her we will discuss this at the next pdoc appointment along with the aspergers autism stuff I posted. This has been going on for about 4 years. I thought it was PMT but didnīt keep a track of it and my concept of time is non existent. I have no idea when her last outburst was or how long it lasted. She said the last one was in October.

Any ideas, I am confused. I read that bipolar often coexists with adhd.

daveddd
02-16-13, 03:30 PM
I'm sure you do, and I don't doubt their experiences at all. But euphoric hypomanic episodes are still the "classic" and more common form of hypomania. Be careful not to fall into "person-who" reasoning - that is, when a person says, "I know a person who..." and uses that as their reasoning by which to judge the reality of a situation. Common example: "Cigarettes don't really cause cancer, because I know a person who smoked for 50 years and never got cancer." Just because you know a person or people who had a certain experience doesn't make it the norm.



I'm not arguing the point, it's in the DSM-IV-TR. Psychosis during mania is the HALLMARK that separates mania from hypomania. In the DSM-V that may change, I am not entirely sure. But psychosis is not an aspect of hypomanic episodes. It's simply not. A person may be having an agitated depression with some psychotic-like features, which also isn't a hypomania, it's a mixed episode. I do know that the DSM-V is allowing for mixed episodes to be included in diagnosis of BPII, which is a change from the DSM-IV-TR since as of now mixed episodes are only considered an apsect of BPI. So maybe they are having mixed episodes. I certainly don't know their lives - I'm just telling you what the DSM says.



Yes, of course a person with schizoaffective disorder can present with symptoms that look like mania. If you conceptualize bipolar disorder and schizophrenia to be on two ends of a spectrum of mood/psychotic disorders, schizoaffective would be the lovechild of those two disorders, right in the middle of the spectrum. But it's not a pure bipolar mania, it's a schizoaffective episode. There is, in my understanding, a difference between true bipolar mania and the manic/psychotic experiences of those with schizoaffective disorder.



If a person has a manic episode with psychotic features, and no psychotic symptoms outside of severe mood episodes, and a person has a history of major depressive episodes, then YES - the diagnosis of bipolar disorder is fairly clear.

Schizophrenia does not have manic episodes, period.

Schizoaffective disorder has more psychotic symptoms outside of major mood episodes that indicate more of a psychotic component to their illness. As per the DSM, those with schizoaffective disorder must have had a period of 2+ weeks of psychosis WITHOUT mood features. They could certainly have mania with psychotic features, but they are also having psychotic episodes that are in no way correlated to mood episodes.

Therefore, if a person is ONLY having psychotic episodes during a full-blown, profound mood episode (manic or depressive) with a history of depression, there is no reason to think it would be anything but bipolar I disorder. Why would schizoaffective even be a consideration if there is zero history of psychosis outside of major mood episodes? As long as you have eliminated the possibility of schizoaffective based on their history of psychotic episodes, what else exactly do you think they would fit the criteria for?

Is it possible that a person could later develop psychotic episodes OUTSIDE of major mood episodes, and then fit the criteria for schizoaffective rather than bipolar disorder? Yes, of course. But the absence of mania with no psychosis outside of mania or major depression is indicative of bipolar I disorder.

the DSM is the only thing that is cut and dry when it comes to this stuff

not many people put this much stock in a book that constantly changes

im not trying to be insulting or argue at all, but this stuff is far more complicated then a book meant for writing prescriptions and getting insurance coverage

keliza
02-16-13, 03:38 PM
the DSM is the only thing that is cut and dry when it comes to this stuff

not many people put this much stock in a book that constantly changes

im not trying to be insulting or argue at all, but this stuff is far more complicated then a book meant for writing prescriptions and getting insurance coverage

Of course it is, I am well aware of how complicated the clinical presentation of bipolar disorder is. I've been living with it for over a decade - it's my daily reality. I spend time with bipolar support groups, and have a lot of friends who also have varying shades of bipolar disorder - everything from bipolar I that is even worse than mine, to BPII, to cyclothymia, to those dropped in the BP-NOS category because they don't fit cleanly into any of the other diagnostic categories.

The points I was making were relevant to clinical presentation and diagnosis. And to be clear, many people put stock in a book that "constantly" (if you can consider decades between updates constant) changes. Real life is messy, real people and real symptoms are messy. Diagnosis is difficult, but there are some parts of it that are very clear delineations between illnesses. Those are what I am talking about.

daveddd
02-16-13, 03:55 PM
a lot of us live with it

also, ive never had a doctor who went by any strict dsm criteria

daveddd
02-16-13, 04:04 PM
i know the dsm only changes every so often

but the second it hits the market, they start to propose changes, not to mention arguing of categories the whole time its out

you just seem to put a lot of stock in it, despite peoples personal experiences

thats all i was saying


ive seen ADHD with psychotic episodes

social anxiety can have psychotic episodes

MellyFishButt
02-16-13, 04:16 PM
Of course it is, I am well aware of how complicated the clinical presentation of bipolar disorder is. I've been living with it for over a decade - it's my daily reality. I spend time with bipolar support groups, and have a lot of friends who also have varying shades of bipolar disorder - everything from bipolar I that is even worse than mine, to BPII, to cyclothymia, to those dropped in the BP-NOS category because they don't fit cleanly into any of the other diagnostic categories.

The points I was making were relevant to clinical presentation and diagnosis. And to be clear, many people put stock in a book that "constantly" (if you can consider decades between updates constant) changes. Real life is messy, real people and real symptoms are messy. Diagnosis is difficult, but there are some parts of it that are very clear delineations between illnesses. Those are what I am talking about.

I have a question for you. Since you have friends with cyclo, can you tell me how cyclo and ADHD are both similar and different? I find that my difficulties are cyclical but since I never feel elated I have always assumed that it was depression brought on by difficulties related to ADHD/stress. I do have periods where I am more consistently productive and dare I say happy (last from a week to a month) but maybe this is totally normal since I don't make grand plans, I just suddenly realize that I feel great. It's like all the stars align for a short while (this is all before I was medicated). But then something happens, or I get bored with being happy and I go back to my normal pattern of frustration and over-indulgent self medicating and lack of focus and **** mood.

I also thought that an SSRI would disturb cyclo/BP and run me into manic mode and since that hasn't happened, I assumed I wasn't either. Has this been your experience?

(And thanks!!)

/thread jack

peripatetic
02-16-13, 04:34 PM
psychotic breaks...there are phases within, depending on the nature of and manifestation of positive symptoms specifically that can look EXACTLY like certain presentations of mania with psychotic features. so much so...that there can be an understanding....of experience between two people with different diagnoses....and can be bridge of understanding in what a life lived is like...that...is often lived felt never understood...never really really understood by another...and...being truly understoood...seen...is a process and not wholly that..

but...to feel similitude....to feel truly known and seen...given how difficult it is for SOME people with the presentations i'm talking about of a partiular flavor of psychotic disorder...and a partiular flavor of BPI... that can be very...isolating...and...even when others....are...when some amount of psycho social supports are maintained...no matter how much those people might want to understand...and you to explain.... bridging that gap FOR SOME...is impossible...but then...due to the fact that there is a COMMON presentation POSSIBLE such that there is often initial misdiagnosis...of first florid break and first prevention of psychotic mania...NOT ALL first breaks...NOT ALL first manic episodes...


BUT...asi showed with research links...SOME...and not just two...

BUT: this has happened. i don't give a crap if another believes it's possible or everyone's whatever. i'm saying...THAT CAN HAPPEN.and...given the fact that frequently first manic episodes with certain features...are thought first breaks and people are as frequently as stated in cited studies...initially diagnosed schizophrenic...and later identified as actually BPI with psychotic features or schizoaffective

i NEVER SAID schizophrenia includes mania. and let's just be clear...i am well aware of a hell of a lot more than the DSM criteria for schizophrenia, and if you're posting for my benefit...thanks...but i'm good on that--don't need to have schizophrenia explained to me and soooo not interested in debating criteria... seriously. but make no mistake, i'm not in need of your assistance in understanding that particular diagnosis. what i SAID...that the intial presentation of one illness in the psych ward...can overlap in features with the initial presentation of a second illness. not ALL schizophrenics ...not ALL bipolarI...but...SOME can manifest similar enough features....such that...MY response to sarah on what *I* perceive as the difference between BPI and BPII is that one is relatable...and the other is not. clearly...not ALL bpI is equally so...and there are tons of permutations of presentations of schizophrenia.


i'm not interested in debating DSM criteria with anyone on this thread about any illness.

i'm answering sarah's question...and i don't really give a **** what online diagnoses you want to try to slap on people you don't even know...who...have whole histories...that...i respect you've lived with bipolar for however long...and it presents in you as it does...i'm not doing that though....i'm simply not going to support that length of this or that...hell...next it'll be like..list all medications...how many inpatients....how many...you know..and **** THAT. quite frankly...i don't know and i'm not about to try and calculate. i'm here now. listen or not. that's cool either way.

but let's not forget illness is not a one size fits all. and...yeah..your experience is your experience and legit as such...and glad to learn of another way things can manifest. but don't for a second think you're the only person here with an extensive history and an equally legitimate experience that has manifested differently.

i'm not interested in some ******* contest over who's the expert on mental illness or stacking up years this ...i'm not going to be offering anything to promote comparing (not years diagnosed, medications, inpatients ...none of it...because...nobody should have to "prove themselves" to share their experiences and hear others) none of that...and frankly...i think that's...yeah...i don't want part of that and i'm not participating in it. i understood sarah as being interested in learning about others' experiences.

and that's why i posted...and why i post now...to say...i'm interested in hearing others experiences and understanding and being understood. to do so...requires me to hear the other, who is THE only expert on that experience that matters...as i ...if someone wants to understand....i'm capable reporting my experience...and...i am THE expert on it IF what's sought is to understand...i thought tha'ts what sarah was interested in..and i think i'm prolly right because...well, i can read and i do know sarah. and i just checked again...so...yeah...that i have been in any way wrapped up in what resulted in "who knows criteria best"...i'm gonna...not engage in that discussion any further.

i've said what *I* have personally experienced as the difference between bpI and bpII...based on my experience with mental illness and my connections with people diagnosed bpI/II. and that's it. and make no mistake, my decision not to engage in discussion of criteria for different diagnoses...i'm not stomping off or anything...i'm just bowing out of that part of this discussion becauase...i posted because sarah asked an interesting question and i'm interested in hearing others EXPERIENCES and understanding them

my BPI person...meant EVERYTHING to me in a way...we were, and are, beyond words and that's just a fact. those who know, know....and..understand why i would be sharing my experience...and perhaps those who are interested in just learning about others......and ...i have more than one BPII persons whom i love with all my heart. so...their experiences ...hearing them and understanding them...because i care about these people not...anything but...the individuals i know...i'm interested to hear. i don't care about the DSM or anything else...and i apologize for engaging in that because...i just wanted to hear what sarah and rebel and abi...and several others...have to say...about their experiences...and others, i'm sure, who want to share.

crystal8080
02-16-13, 05:09 PM
Yeah I thought the point of the thread was the step outside the clinical DSM definitions and look at real life experience. My doctor has been practising for 30 years, and comes from Europe as well so his ideas may be different from someone trained in North America. I really don't know enough about it except what I have experienced and am experiencing. Liking the discussion though.

Rebelyell
02-16-13, 05:29 PM
I remember having told my therapist when I was 12 that I thought I was BP and she asked me why i thought that and I told her why and she dismissed it and said nooo your not.I dont know too many people who couldnt do something get so frustrated that they threw /slammed something or shook there dresser so hard it almost fell over.

mirandatoritess
02-16-13, 06:54 PM
A person with bipolar I has manic episodes, while someone with bipolar II has hypomanic episodes



Other differences between bipolar I mania and bipolar II hypomania

One or more of the following conditions has to exist in mania but can't be present in hypomania:
Mania may include psychotic symptoms - delusions or hallucinations. Hypomania does not have psychotic symptoms.A person may firmly believe he is the mayor of his town and introduces himself to people as such, telling them about grandiose and sometimes bizarre plans he has for making improvements to services and infrastructure. If he had a similar delusion, his diagnosis would be bipolar I rather than bipolar II. The presence of psychosis automatically rules out hypomania.

While hypomania may interfere to a degree with daily functioning, in mania day-to-day life is significantly impaired.
Robert missed an important business meeting because of a spur-of-the-moment decision to take flying lessons. Hank may be longing to take flying lessons while hypomanic, but if he does, he takes them at a reasonable time when he has no other obligations.

The manic person has to be put in the hospital because of the severity of symptoms.
During an irritable manic episode, they began throwing crockery, silverware, pots and pans at his wife because he wasn't satisfied with that night's dinner.they are subsequently hospitalized because they had become a danger to others.Their hypomania does not escalate to such an extreme extent.

peripatetic
02-16-13, 08:07 PM
Hello all...I know there are clinical definitions and differences between BPII and BPII but I was wondering what BP people think are the personal differences between the two that relates to themselves? I am not necessarily looking for scientific points (although that is welcome too) just some people who have an opinion on the differences between the two in their personal experiences, the experiences with loved ones etc.

sarah...the bolded parts...are why i really wanted to participate in your thread and see what others would offer...because...knowing eshy...knowing abi and you and blue and rebel...and how your flavor of illness is experienced BY YOU...has been ...i know that if someone said to me...peri....i understand your suffering...i have a list of bullet points... i'd know that not only was i not understood...but i wasn't to be understood...because instead of seeing me...wanting to know me...because...there's not that and then me...maybe i'm different.

but eshy...he was like that...and...his experience....his bpI with psychotic features/schizoaffective (he was recategorized)...it affected his whole life.it was always there...it was always part of his experience...so there was no...sure...there's facts and values and circumstances....but...it was never....not a factor...and it...

a lot of people...especially if you got through lots of hospitalizations and such...or...if ...those around you...aren't able to reach in...or you out...and your world starts shrinking.... and i know exactly what that's like....and it makes it harder and harder to connect and be known and understood...and...i'm so grateful for knowing you guys...for being able to see and share in your lives...it kinda makes me sad that...anyone's experience of struggle is suffered in solitude...isolation...and the point i want to make about that is this:

the only way i could understand your experiences of your illness...was to listen to you...sure...i abso****inglutely spent...hours and hours a day for a while there...reading everything on bipolarI with psychotic features....and refractory depression with psychotic features...every opinion and study and suggested treatments and had people researching for me and with me...yeah...consulted the **** outta some science...

but...if my primary orientation to his illness...had been that...if i'd started anywhere else but listening to him...hanging out with HIM...none of the sciencey would've mattered...because how could i'd've applied any of that information to...how could i have known what study subjects were more/less like his particular presentation...and which ones...considering their results...the results were on people who....

since bipolar has sooo many possible permutations...starting with knowing the PERSON'S experience...seems so critical...

i know what eshy would say...and he's a flavor of bpI...so...i'm curious...those of you bpIIs...he felt VERY strongly about that...i feel strongly about that..

do you guys? do you think in order for loved ones to truly understand your bpII that it is *imperative* they start with you...with you reporting your experience..sharing it...how this manifests...etc...

or...would you say that in fact, for people to understand your illness...they need to come with the categories known...and then listen to you and fit what you say into those categories?

or does it not matter?

Rebelyell
02-16-13, 08:38 PM
When you say your world closes in on you this is exactly how I feel especially when I say i cant seem to relate or feel like I can relate to any one and it seems to become less and less that I feel like I can connect w people ,this is what I feel and mean.Sorry to get off the subject matter.I really dont know if people should get to know me or the otherway around.Id like people to get to know me on any level before totally writing me off for not being on there so called level of high society in there little warped world of pompoused *** ignoramussedness.

peripatetic
02-16-13, 09:19 PM
I really dont know if people should get to know me or the otherway around.

i feel you...i really do. i will say...the fact that i got kept on...that means more to me than i can express...that...he let me stay...through...and that i ...was able to be his bestie...and to have been all someone needed...if i contribute else of value in the world...that at least time in my life i didn't disappoint someone i care for infinitely...

but then...at times i struggle to allow people to invest in me...but then...i want company. but then..i think of how much potential there is that they will suffer for having known me. that the more they know me, the more they care...the more painful it will be if i just can't... there've been a lot of people i've just...let them slip away...or just faded out of their lives. and it kills me...that maybe they think they never really mattered...or don't still.

like...sometimes, i just can't ...i can't respond to texts...i can't look at email..i can't come here...especially people who tend to be more the...nurturer/find a way types... and then they just want to be around...but...it's like...you're so...hoping that you're going to be able to do something...and i feel like more **** because i can't ...

as much as i want to be dependable...to be able to be counted on...and...yeah..i'm loyal as ****...i'd do anything i could...but...it's hard to let people depend on me... because if i just can't...then not only does that suck in itself...but i let someone down. so then i'm like...don't depend on me...don't need me...and the worst, in a way...recognize that as much as i love you...i need you to recognize that at times...probably the times you'll be most wanting be able to reach me or "be there" or...you'll want me to blah blah blah...and you'll want that you want to be enough... there is nothing you can possibly do or say or want is going to matter. and if i just kinda go isolate and i'm just hanging out with my head... you will not be able to reach me. calling me...seeking me out... you might think that you'll be able to find a way...but i guarantee... i'm better at being unreachable...than you will ever be at getting through.

and even.....like...i say ****** up things sometimes...and then there ARE people...i do trust...they get it...but then sometimes...it's not about them...not just about protecting them from me. letting someone be present...means ME having to cope with them suffering me...even if they want to...*I* can't handle the weight of them. and then...when i can...if they're not still there...i'm never going to go reach out and find them...because...i jsut can't.

so..yeah...if that's what you mean...but then...all i want in the world lately is to just...have m sit next to me...listen to retro tell me about his day..and this once-censored book he's reading... look at the photo of F's latest video game character...or S send fun texts... map out to abi the next synthesis in the dialectic of phenomenology...find out what pickled goods ap got at the farmer's market...

saturday
02-16-13, 09:33 PM
The DSM is kinda like painting by number and only using the 10 most basic colors.

Talking to someone, getting to know them, getting to know how their diagnosis presents in and affects them, will paints a much more vivid, true to life, picture.

For me, I like saying I'm on the BP spectrum. And I like using the word episode rather than specifically saying mania or depression, because although there were times of extreme highs they were usually followed or coincided with depression and looking back its hard for me to be discrete about it.

The one and only time I had a low with absolutely NO signs of (hypo)mania was after my second child was born. It lasted 12 months straight and all I did was lay on the couch, face into the cushions and my back to everyone. People had to come to my house to watch my kids for me. They would hand me the baby when it was time to feed and sadly, that was pretty much the only interaction I had with my baby in the first year. Those who were around me may say this is an exageration but, thats how I remembered it.

When I was a teenager I had all the classic signs of mania. But I do remember being very depressivish. Im surprised I wasn't diagnosed earlier, except for the fact that the adults in my life were all fvcked up in their own way, so no one thought any different. For a while the main activity during my day was getting high. I would wake up, get high, the day would pass with no remaining recollection of the actual events, then on occation I would go to sleep, and then repeat. I overdosed twice and ended up in the hospital. Dont ask me how I never went to juvi, Im baffled by that actually. I had more sexual partners from the ages of 14-18 than I had passing grades in school, possibly even total days attended.

Jumping back to when I started my family. That is when I went hyper-religious (after the depression). I can see clear delusions of grandiosity during this period. God loved me and I had a clear connection with his powers, or the universe if you will. I dont want to go into too much detail here because this area I still suffer from, but in the reverse. Like because of that clear connection I had once upon a time, and since I've now kinda turned from that, I have these "delusions" that Im condemned.

And please, no one try telling me that if Im aware Im deluded, then I must really not be. Thats annoying.

I dont know why Im sharing this stuff. I guess just to show some of my colors. I have a hard time with getting to know people too Rebelyell. I know I have people who care about me, but sometimes its easier if I distance myself from them. Its less scary sometimes. It can take so much effort to maintain friends and its sometimes so stressful.

Rebelyell
02-16-13, 09:56 PM
I guess I mistunderstood you a little bit,as I thought you were talking about people rejecting you and not getting to know you because of your disability now i got you.

peripatetic
02-16-13, 09:59 PM
thank you for sharing so much saturday...i really appreciate a lot of things you note... and..i ...i admire you had the balls to ... i wish.....i could reply...but... your contribution... what you shared...is meaningful. x

peripatetic
02-16-13, 10:03 PM
ah...i see, rebel...

i do see...no...i'm not so much ...avoiding rejection.

but...i understand you are...every time you post or share that someone is unkind to you...or makes you feel like that...it breaks my heart to think anyone would reject you...and then i think about it and get angry as hell because what kind of ******* goes the extra step to hurt someone who's a a really solid person hurt? you're such a good guy...through and through. love you. x

Rebelyell
02-17-13, 12:19 AM
Half the time it seems when Im talking apples someone is talking oranges or it seems the conversation turns into the exact opposite and almost argumentive and Im like dammit to hell why do I bother trying to relate and fit in w society?

crystal8080
02-17-13, 12:57 AM
do you guys? do you think in order for loved ones to truly understand your bpII that it is *imperative* they start with you...with you reporting your experience..sharing it...how this manifests...etc...

or...would you say that in fact, for people to understand your illness...they need to come with the categories known...and then listen to you and fit what you say into those categories?

or does it not matter?

I never really thought of it that way before. I guess I 've been trying to see how I fit into it all - when I should be seeing how it fits me.

I love this place. A revelation every hour. :cool:

My flavor right?:p

peripatetic
02-17-13, 03:24 PM
Half the time it seems when Im talking apples someone is talking oranges or it seems the conversation turns into the exact opposite and almost argumentive and Im like dammit to hell why do I bother trying to relate and fit in w society?

here's what i think...sharing who you are with someone...sharing your life, experience, perspective and time ...that's a gift you give and anyone who doesn't appreciate it is unworthy of it. as long as you keep talking...i'll keep trying to understand :-)

Rebelyell
02-17-13, 03:40 PM
I dont think Im that hard to understand or even figure out.Thats both good an bad. I get mad as all hell for that too when people go the xtra mile to be a douchebag towards me.I chose to be nice and kind not that I even have to,thats what people seem to forget I could be the biggest ******* of I wanted too.Why do you go into your head and tune people out?

Bird's Mom
03-13-13, 06:16 PM
Well, I've been diagnosed with BP II. I think, the main difference is that mania (or hypomania in our case) isn't as extreme as in BP I and it's never accompanied by psychosis. When I'm hypomanic, I feel extremely euphoric, social, confident, active and driven (though not in a focussed, productive way) but it feels more like a very good mood, you know? I never even suspected that my "good moods" were anything else, anything medically disordered.

I think, with BP II the main reason for dysfunctionality lies in the depressive episodes rather than the hypomanic ones. Hypomania is when I'm doing well, depression is when I'm reduced to a vegetable.

I'm not sure if there are many cases where BP II is mistaken for BP I. From what I've read it's more common that BP II is initially diagnosed as unipolar depression. If I remember right, I read in a paper that on average it takes about 10 years for people with BP II to actually get diagnosed with BP II from the time they've been diagnosed with depression. It's easy to miss, especially because hypomanic episodes aren't really disabling so many patients don't report them (or recognise them as anything but a good mood). For me, my hypomanic episodes were just times of welcome relief from the seemingly endless depression. I did think they were a bit odd but the main reason why my GP suspected BP II is because I kept complaining of extreme mood swings.

Also, according to my GP in the UK apparently, many psychiatrist either don't recognise BP II or don't believe in it.

My husband's cousin has BP I and his episodes of mania really are extreme. He becomes completely deluded, there is a significant break with reality. He actually is a danger to himself when he's manic and it's pretty obvious when he is manic.

You and my daughter must be twins. She's bipolar II as well and her "mania" was like yours most of the time. Other times, she was just nasty as all get out, belligerent, and destructive (punching walls, throwing glasses, etc). Her depressive episodes were like yours too, a complete vegetable. Lamictal saved her life. She's on 150 mg and is "normal" in her words. She also had crippling anxiety, especially with school, but in almost any social situation. The Lamictal actually got rid of that too.