Understanding the Different Types of Bipolar Disorder

Bipolar and Substance Use

The relationship between bipolar disorders and alcohol and other drugs is completed. It should be mentioned that none of the bipolar symptoms can be a result of substance use, so someone who has incredible energy from an intoxication of cocaine will not meet criteria for a manic episode, and someone tired and unmotivated from using a lot of opioids will not qualify for a depressive disorder.

Sometimes though, it is impossible to tell if the mood changes trigger the desire to use substances or the substances trigger the mood changes because substance use commonly co-occurs with bipolar disorder. To make the best possible diagnosis for someone, the mental health professional must know that no alcohol or other drugs are influencing the behaviors of the individual.

Bipolar Specifiers

The diagnoses described are only the beginning of the information related to bipolar disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nine additional classifications of bipolar disorders. These are known as specifiers that provide more detailed information regarding someone’s particular symptoms. The specifiers are:

  • With anxious distress.
  • With mixed features.
  • With rapid cycling.
  • With melancholic features.
  • With atypical features.
  • With psychotic features.
  • With catatonia.
  • With peripartum onset.
  • With seasonal pattern.

This means someone’s complete diagnosis could be bipolar I disorder with rapid cycling, or bipolar II disorder with seasonal pattern. The extra information included in the specifiers provides the patient and treatment team with valuable information related to the symptoms so treatment can be tailored to the needs of the patient.

Some of the more common specifiers include with rapid cycling, with psychotic features, with seasonal pattern, and with peripartum onset.


With Rapid Cycling

Rapid cycling means someone will experience more symptom changes than the average person with bipolar disorder. This specifier leads to some of the misconceptions about bipolar meaning that someone can be happy one minute and sad the next.

True rapid cycling means someone will have at least four episodes during a year. That means they might have three depressive episodes with a manic episode during a 12-month period. The key is there is a period of symptom remission between the episodes.

Too often, people mistakenly think that they have rapid cycling bipolar disorder because of their mood changes frequently. In reality, a person who experiences periods of irritability, sadness, and happiness all in the same day could be depressed or only experiencing a normal range of feelings. Bipolar will never cycle through multiple mood episodes in one day.

With Psychotic Features

With psychotic features can be a confusing and misleading specifier. In this case, the person with bipolar may begin to exhibit psychotic symptoms like:

  • Hearing, seeing, feeling, tasting or smelling things that are not present.
  • Delusional thinking marked by having odd beliefs without grounding in reality.
  • Paranoid thinking that people or organizations are listening to their thoughts and conversations or conspiring against them.

A person with psychotic features link to bipolar disorder will experience a significant disconnection from reality. It will be impossible to think rationally and carry on meaningful activities during the psychosis because the symptoms will affect all aspects of life.

To the outside observer, a person with bipolar disorder with psychotic features will seem unhinged and very confused. They will make comments about bizarre experiences or appear suspicious and accusatory.

These symptoms do not indicate another disorder like schizophrenia because the symptoms will only be present during a period of intense depression or mania. Once the episode ends, the symptoms will diminish.

With Seasonal Pattern

With seasonal pattern is known commonly as seasonal affective disorder. This means the symptoms will match the changes in the seasons. Usually, winter brings periods of depression and summer sparks times of less depression and possible mania.

This specifier is based on the belief that longer periods of daylight and changing activity levels can impact mood in significant ways. With this information, the person with bipolar and their treatment team can take preventative measures to maintain or improve their functioning based in the seasons.

With Peripartum Onset

Peripartum onset refers to bipolar symptoms that are triggered by pregnancy or the birth of a child. People often recognize postpartum depression as a serious mental health condition affecting new moms and their family.

Peripartum is used instead of postpartum because in many cases, the symptoms of bipolar emerge before the child is born. Just like peripartum depression, peripartum bipolar imposes a very serious impact on the mental health and well-being of a woman and her new baby.

In the worst cases, a woman will become violently aggressive or detached from her child during times when symptoms are high. People with bipolar disorder with peripartum onset and their loved ones should always practice extreme caution when this condition is a possibility.

The Importance of the Proper Diagnosis

It may seem like all of the attention paid to bipolar disorders and their specifiers is a waste of time, money, and energy, but nothing could be further from the truth. By knowing the correct diagnosis, a person can get the type of treatment that is the best possible fit for their life.

A mechanic needs to know the precise problem with a car just as a surgeon needs to know the true problem with the organ before they can resolve the issue. When armed with a thorough and well-thought-out diagnosis, the mental health professional can offer treatment aimed at the individual and their symptoms.

For example, a person with bipolar disorder with psychotic features will require a completely different treatment plan than someone with a cyclothymic disorder. This plan includes a separate set of prescribed medications and therapy options. Someone with psychotic features may not be a good candidate for group therapy while someone with cyclothymic disorder could be a great fit.


Bipolar is a multi-dimensional mental health disorder — it is not as straightforward as some may believe. Learning about the different types of bipolar disorder gives someone the increased ability to understand themselves or others in their lives with bipolar.

With increased information comes higher levels of acceptance and better treatment. Knowing more about bipolar disorder can minimize its impact.

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