When diagnosing bipolar disorder, your doctor or therapist might use additional specifiers — or features — to describe the specific type of bipolar disorder that you have.
Bipolar disorder affects each person in different ways. The three main types are bipolar I, bipolar II, and cyclothymic disorder.
If you have one of these conditions, you might also experience extra symptoms, such as anxiety, psychosis, or seasonal shifts in mood. This is where additional specifiers come in.
Additional specifiers are descriptive terms that describe different features of bipolar disorder. They are outlined in the Diagnostic and Statistical Manual of Mental Health (DSM-5).
Knowing the specific diagnosis of bipolar disorder can help you get a treatment plan that best fits your needs.
You can read on to learn about the additional specifiers that can accompany bipolar disorder.
If you experience mood episodes that are a mixture of mania or hypomania and depression, your doctor might give you a diagnosis of bipolar disorder with mixed features.
For many people, manic episodes and hypomanic episodes are separate from depressive episodes. Experiencing symptoms of both at the same time, or in rapid succession, can feel especially distressing.
Want to know more? You can read about bipolar disorder with mixed features here.
If you experiences noticeable symptoms of nervousness or anxiety during a mood episode, you may get a diagnosis bipolar disorder with anxious distress.
To receive this diagnosis, you must have at least two of the following symptoms most of the time during the current or most recent mood episode:
- feeling irritable or short-fused
- feeling unusually restless
- having difficulty concentrating because of worry
- feeling a sense of dread, or feeling like something awful is going to happen
- feeling that you might lose control of yourself
Bipolar disorder with melancholic features is when you have an extremely intense depressive episode. In this type of mood episode, you feel like you have almost no ability to feel pleasure.
If you’re experiencing a melancholic state, you may not emotionally react to an event in an expected way. When something good happens, for example, your mood may not brighten at all, or it may only brighten slightly.
In bipolar disorder with melancholic features, you may experience the following symptoms:
- depression worsening in the morning
- waking up significantly earlier than intended
- excessive guilt
- weight loss
They’re more common in people diagnosed with a severe mood or psychotic disorder.
Bipolar disorder with atypical features is when a mood episode doesn’t fit traditional symptoms.
For example, it’s typical for someone with depression to have a chronic low mood. But in atypical cases, a person can be “cheered up” and no longer feel depressed for a period of time. This is usually because of a positive event in their life (a new job, celebrating a holiday, etc.).
To be diagnosed with this subtype of bipolar depression, you must have two symptoms involving changes in sleeping, eating, motor movements, or communication, including:
- significant weight gain or increased appetite
- hypersomnia, or sleeping more or for longer periods than usual
- feeling heavy or leaden in your arms or legs, as if you’re “weighed down”
- having constant fear of rejection to the point where it interferes in your personal life or workplace, which can happen when you’re not in a depressive episode but is exacerbated during a period of depression
In bipolar disorder with psychotic features, you experiences delusions or hallucinations, which might be auditory or visual, at any point during a mood episode.
Commonly known as postpartum depression, this form means that you experience an extreme mood shift and become very depressed following childbirth.
If you’re experiencing postpartum depression, you may believe you’re feeling normal “baby blues,” or sadness, after childbirth. But postpartum depression is more intense than this.
Symptoms of postpartum depression include:
- symptoms of depression, such as changes in appetite, depressed mood, loss of energy, and other indicators
- fear that you’re not a good caretaker
- severe anxiety or panic attacks
- thoughts of harming yourself or your baby
Mood episodes with a seasonal pattern are also found under the umbrella of seasonal affective disorder.
A seasonal pattern specifier is when depression or extreme mood shifts are triggered by the change in seasons. It’s more common during fall and winter but can also arise in the summer.
This pattern can be applied to how depression manifests in bipolar I disorder, bipolar II disorder, or reoccurring major depressive disorder.
The essential main feature of this specifier is that depression tends to occur and temporarily go away during certain times of the year.
To be diagnosed with this specifier, you must experience a pattern of depressive episode onset and remission during at least a 2-year period, without any nonseasonal episodes occurring during this time.
In addition, the seasonal depressive periods should significantly outnumber any nonseasonal depressive episodes over your lifetime.
It’s important to note that this specifier doesn’t apply to situations where the depressive episode pattern is better explained by seasonally linked psychosocial stressors, such as seasonal unemployment or school schedules.
Given how bipolar disorder symptoms can look similar to other mental health conditions, bipolar disorder can be confused with the following conditions:
- Borderline personality disorder (BPD). Notable symptoms in BPD include impulsivity, emotional instability, and chronic feelings of emptiness. These characteristics can look like mood episodes, such as mania and depression, which are common features of bipolar disorder.
- Depression. Depressive episodes are featured in bipolar disorder. Relief from depression can mirror a mood shift towards mania or hypomania.
- Substance use disorder. Ongoing substance use can cause extreme mood shifts that appear similar to bipolar disorder.
- Schizoaffective disorder. Mood episodes, such as mania and depression, are present with schizoaffective disorder. A person experiencing delusions or hallucinations, other symptoms of schizoaffective disorder, may receive a diagnosis of bipolar disorder with psychotic features.
If you think that you have bipolar disorder or you’ve already been diagnosed but believe you’ve a specific subset, there are many ways to get help.
Many people start by talking with their doctor to see whether they meet the criteria for a bipolar disorder diagnosis.
While this is a crucial first step, it’s also important to contact a mental health professional — such as a psychologist or psychiatrist — who’s an expert in mental health diagnosis.
If visiting a medical or mental health professional feels too overwhelming, you can begin your recovery journey by reading about bipolar disorder and its various subsets.
Check out a list of the best bipolar disorder blogs of 2020, or read about the best apps for bipolar disorder.
You might also find it helpful to try some self-help strategies as one part of your bipolar treatment plan.
Some people also find bipolar disorder support groups useful for finding community, even if they only suspect a bipolar disorder diagnosis. A support group can be a great way to talk about your experiences with mental health and how it feels to seek treatment.