Bipolar II disorder is a less severe version of bipolar I disorder.
That’s likely an assumption you’ve already come across. Maybe you read it in an article. Maybe you heard it from someone else, maybe even a mental health professional. Author Julie Kraft has heard bipolar II called “bipolar light” and “diet bipolar.”
This is a common belief, because mania is a defining feature of bipolar I disorder. And mania has devastating consequences. Empty bank accounts. Soaring debt. Lost jobs. Broken relationships. Divorce. Car accidents and injuries.
But bipolar II isn’t less severe than bipolar I. It’s different.
It’s best to think of bipolar II as having “unique characteristics and complications,” said Michael Pipich, MS, LMFT, a psychotherapist who specializes in mood disorders in Denver, Colo., and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder.
In order to be diagnosed with bipolar II, you need to have a history of one hypomanic episode and one episode of major depression, he said. You also need at least one person to confirm a noticeable change in your behavior, which provides a clearer picture of consequences, he said. For instance, a wife recounts that her normally penny-pinching husband goes on several shopping sprees—and ends up regretting it.
(For a diagnosis of bipolar I, the only requirement is one manic episode, and the person’s subjective report is enough.)
The consequences in bipolar II can be painful, too. Kraft, who was diagnosed with bipolar II at 36 years old, recalled times when her kids were late to school or absent altogether; times when they didn’t play sports or have playdates; times when her husband didn’t have his best friend and co-pilot; times when he had to tiptoe around her moods, and do his best to shelter their children from what was going on.
“There is most definitely shame over the ways my disorder has affected my family,” Kraft said.
Depressive episodes in bipolar II disorder can be very severe, even suicidal, Pipich said. “[I]t’s not unusual for bipolar II depression to be quite devastating and also defy some of the more traditional forms of treatment for non-bipolar major depression.”
It also can take years for people with bipolar II to receive the correct diagnosis. “As a result, they may suffer consequences over a longer period of time—again, making the side-by-side comparisons of bipolar I and II misleading,” Pipich said.
“And because it may appear more subtly, hypomania can easily be misidentified as other conditions, including anxiety, ADHD, OCD or personality disorders, further delaying effective treatment interventions.”
What bipolar II looks and feels like varies from person to person and within the same person. As Shaley Hoogendoorn said, what her illness feels like “depends on the day, month or season.”
Also, there’s a wide array in severity and symptoms. “It was very hard to get anyone to believe me that there was something going on because I am considered high functioning,” Hoogendoorn said.
Below, she, Kraft and others share what the depressive and hypomanic phases feel like.
Depression in Bipolar II
Lisa Rumpel, a writer, speaker and mental health advocate, was diagnosed with bipolar II at 18 years old. When she experiences a depressive episode, she feels fatigue and has little interest in doing most things. She also has a hard time getting out of bed to go to work.
“When I am depressed, I feel so low I begin to wonder if life is worth living. I call a friend or family member and have the company of someone so I don’t feel alone. The suicidal thoughts leave once someone is present with me.”
Karla Dougherty, a writer and author of the book Less Than Crazy: Living Fully With Bipolar II, described her depression as “being tied up with heavy, scratchy rope. You are simply too helpless to do anything.”
“I am so, so sad or I become numb and apathetic,” said Hoogendoorn, a speaker, vlogger and mental health advocate who aims to dismantle the stigma around mental health and create a safe community for neuroatypicals. She was diagnosed with bipolar II in 2010 after an increase in her anxiety medication (Zoloft) triggered rapid cycling and sent her to the ER.
“I just want to sleep until I feel better. Everything seems bleak and lonely. I do not enjoy anything that I usually do,” she said.
Kraft is an artist and author of The Other Side of Me: Memoir of a Bipolar Mind. She’s also a mental health advocate devoted to spreading awareness and shattering stigma. Before Kraft’s diagnosis, her depressive phase would sneak in without warning, and look like an “off” day. But one off day would quickly turn into an entire dark week.
She’d feel isolated and alone. She’d bash herself for feeling depressed, and become convinced that she’s weak and worthless: “Why can’t I handle everyday life? Why can’t I do normal things that everyone else seems to being doing without a second thought?”
She’d miss everything from important events to friends’ birthdays to bill payments. “I now realize that I was so deep into my own darkness that I was utterly incapable of seeing outside myself.”
Today, thanks to treatment, Kraft’s depression is less severe.
Hypomania in Bipolar II
For Kraft, hypomania used to feel exhilarating, energizing and electrifying. It was “a sudden surge of confidence and incredible optimism. The world is my oyster and nothing can bring me down. Nothing. It’s living up on cloud number nine and wanting to pull the entire world up there to share it with me.”
This is when she’d reach out to friends she ignored for months and say yes to coffee dates. This is when she’d accomplish a month’s work in a single day. But this is also when she’d be tempted to disregard basic needs, from showering to getting her kids from school. This is when she’d start a slew of projects but finish very few because her “tank of rocket fuel and endless energy [would run] out.”
Inevitably, when the hypomania would disappear, she’d be “left to live up to the technicolor alter-ego of [herself].” The pressure to recreate the confidence and energy from days earlier was crushing. Afraid to disappoint others, she’d put on a mask or withdraw.
Today, Kraft still experiences hypomanic phases “when I am soaring higher than a kite.” However, the difference is that she’s gained an understanding of her symptoms (and herself), and how to navigate them.
During hypomania, Rumpel feels so creative and energetic that she becomes overwhelmed. She has a hundred ideas for what she wants to do and create. Yet she also cries easily and becomes extremely fatigued. “When I am in this state I have to remember to take things slow, unplug and rest.”
For Dougherty, hypomania is more of a belief system: “I can do anything I want. Anything. Write a bestseller. Paint a masterpiece. Become a CEO and become fantastically rich. Anything. And I will…Tomorrow.” In the meantime, she ruminates about different fantasies and dreams.
Hypomania also can spark anxiety. As Dougherty said, “instead of being the life of the party, you’re anxious about going.”
Hoogendoorn, too, experiences intense anxiety and loses trust in herself. (She candidly shares her specific hypomanic symptoms in this first video.)
Like other illnesses, bipolar II looks different in different people. But one thing is consistent: Bipolar II disorder is highly treatable.*
Rumpel wants readers to know that “Life is worth living even with the constant succession of ups and downs…I can have wonderful experiences of pure joy and sometimes it’s sweeter after coming out of a depressive low.”
Kraft has a favorite quote from Terri St. Cloud that gives her peace about her past and hope for the future: “She could never go back and make some of the details pretty, all she could do was move forward and make the whole beautiful.”
As Kraft added, “I face the future with the confidence that I’ll be able to handle whatever bipolar, or life itself, throws my way. The best is yet to come.”