Partial Symptoms of Bipolar Disorder: Understanding the Spectrum

Bipolar disorder is a mental health condition characterized by extreme mood shifts.

Like some other mental health conditions, bipolar disorder exists on a spectrum. There are three common types:

• bipolar I disorder
• bipolar II disorder
• cyclothymic (cyclothymia)

Not every person with bipolar disorder fits neatly into these categories. This can make getting an accurate diagnosis and effective treatment challenging.

People with mild or few symptoms may refer to their condition as “partial bipolar disorder” or “soft bipolar disorder.” These descriptors may be useful to you. But they’re not actual diagnostic terms.

The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition” (DSM-5) lists additional terms to account for these types of bipolar disorder:

• other specified bipolar and related disorders
• unspecified bipolar and related disorders

In this article, we’ll go over the symptoms of each type of bipolar disorder and discover how some symptoms may or may not be present.

Bipolar disorder presents as a spectrum of conditions. This means that the intensity and frequency of symptoms like mania, hypomania, and depression can vary from person to person. Sometimes, the hallmark symptoms may even be absent.

Bipolar I is characterized by manic episodes that last for at least a week at a time.

Mania can affect your sleep patterns. It can also cause you to engage in risky behaviors or to make decisions you wouldn’t typically make. In some instances, severe mania may trigger a psychotic break (break from reality).

Some people with bipolar I require hospitalization for symptom relief during extreme manic episodes.

You can receive a diagnosis for bipolar I disorder with or without depression.

If your high moods don’t quite meet the criteria for mania, your mental health professional may consider a diagnosis of bipolar II disorder.

Bipolar II is characterized by episodes of hypomania and depression. You may experience extreme and intense depression before or after having a hypomanic episode. People with bipolar II disorder may feel deeply depressed and hopeless for extended periods.

Depression can appear with symptoms such as:

• fatigue
• insomnia
• aches and pains
• suicidal thoughts

If you have rapid changes in mood but you don’t experience extreme highs or lows, you may be diagnosed with cyclothymia.

People with cyclothymia have hypomania and milder depression than those with bipolar I or II disorders. Your shifts in mood may be punctuated by long periods of stability.

Mild depression and hypomania must be present for at least 2 years in adults (or 1 year in children) to get a diagnosis.

Even though it is milder than bipolar I or II disorders, cyclothymia requires ongoing treatment to manage symptoms. Medical professionals typically treat this condition using psychotherapy plus medications such as mood stabilizers, antidepressants, and antianxiety drugs.

To review what we know so far:

According to the National Alliance on Mental Illness (NAMI), other specified and unspecified bipolar and related disorders occur when someone doesn’t meet the criteria for any of the three conditions but still has periods of clinically significant and unusual mood elevation.

• short or mild hypomanic episodes with depression
• hypomania without depression
• cyclothymia that persists for less than 2 years

The treatment for these subtypes is the same as for other forms of bipolar disorder. Your mental health professional may also advise you to make lifestyle changes, such as introducing regular exercise to your routine or eliminating drugs and alcohol.

The DSM-5 isn’t the only manual that seeks to define mental health conditions. The International Classification of Diseases from the World Health Organization (WHO), now on its 11th edition (ICD-11), has its own terminology. As one 2020 study explains, the ICD-11 is important because medical providers and insurance companies often use it.

The ICD-11 often refers to bipolar disorder in partial remission. This means your symptoms no longer meet all of the criteria for a manic, hypomanic, or depressive episode, but you still have some symptoms involving your mood or behavior.

It’s not clear how long symptoms need to be reduced for you to be in partial remission. An older 2007 study defined remission as reduced symptoms for at least 1 week. It also defined sustained remission as 8 to 12 weeks with minimal symptoms.

A relapse, or recurrence, is a return to full symptoms following remission of any length.

You and your psychiatrist should discuss the risks or benefits of altering your medication regimen during periods of remission.

To make a diagnosis, your healthcare professional may perform a physical exam and a psychological evaluation. There is no laboratory test to confirm bipolar disorder.

Your psychiatrist or other mental health professional will want to rule out other health conditions. They will also look at the medications you are currently taking.

Some health conditions and medications can cause symptoms also seen in bipolar disorder, such as depression, anxiety, and irritability. Health conditions with symptoms that mimic bipolar disorder include hyperthyroidism.

During a psychological evaluation, a specialist will ask about:

• your symptom history
• family history of mental health conditions
• your lifestyle habits, such as drug and alcohol use
• whether you have thoughts about suicide

You’ll receive a questionnaire to fill out. This will provide your healthcare professional with information about your symptoms and how they affect your daily life.

If your mental health professional believes that you have a form of bipolar disorder, they’ll discuss their findings with you and provide you with a treatment plan.

Bipolar disorders of all types are lifelong conditions that can be managed, but not cured. The changes in mood caused by bipolar I and II disorders may occur occasionally or often.

A treatment plan is needed to manage both conditions. Treatment consists of counseling plus medications, such as antianxiety drugs, mood stabilizers, and antidepressants. Specialists may use antipsychotics to treat bipolar I disorder.

Lifestyle changes, such as eliminating recreational drug and alcohol use, are also beneficial for symptom management.

Yes. Mania is a hallmark symptom of bipolar disorder, but it doesn’t always need to be present. Bipolar I disorder will always feature mania.

A person with bipolar II disorder may not experience mania but must have experienced at least hypomania (mild manic symptoms).

Yes. Although most people with bipolar I disorder will likely have symptoms that meet the criteria for depression, it’s not necessary for a diagnosis. The DSM-5 defines bipolar I as having mania with or without depression.

A diagnosis of bipolar II disorder requires at least one episode of major depression.

Yes. Bipolar disorder is a chronic, lifelong condition that may include periods of symptom-free or nearly symptom-free remission. There is not currently a cure for bipolar disorder.

Living with any subtype of bipolar disorder can cause you to feel exhausted and depressed. It can also cause episodes of high energy or mania. It is very important to see a mental health specialist if you have any symptoms of this condition.

Your mental health specialist can determine if you have bipolar disorder or another mental health condition. They can also provide you with treatment that can significantly reduce symptoms.

Beyond your mental health specialist or care team, there are other sources of support. Friends and relatives can be strong support, and several support groups are available.