Bipolar II Disorder DSM-5 296.89 (F31.81)
DSM-5 Category: Bipolar and Related Disorders
Bipolar II disorder is characterized by high episodes of euphoria and low episodes of depression, together known as hypomania . Hypomania differs from mania in two important respects. While hypomania can affect functioning and quality of life in all facets of life for an individual with bipolar II disorder, it is not as severe as manic episodes, which may require hospitalization. Second, hypomania does not involve psychosis.
Mood episodes are intense emotional states of excitation or depression occurring for distinct periods . An important change to DSM-5 is the inclusion of activity and energy level, as well as mood level in the diagnosis. Under the DSM-5, the mood criterion now includes hopelessness. Specifically, DSM-5 classifies a hypomania episode as the presence of one or more major depressive episode and at least one hypomania episode. The hypomania episode must last for most of the day each day for at least four days. In addition, three or more of the following symptoms will be present (American Psychiatric Association, 2013):
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative
- Subject experience of thoughts/ideas racing
- Increase in goal-directed activity or psychomotor agitation, or
- Excessive involvement in pleasurable activities with a high potential of painful consequences
- The individual will not have experienced a manic episode or mixed episode.
BP is sometimes misdiagnosed as borderline personality disorder and major depression due to the similarities in symptoms.
Under DSM-5, major depressive disorder (MDD) is part of the new “Depressive disorders” section, which is separate from “Bipolar disorders.”
Impact of Bipolar Disorder II on Daily Life
Bipolar disorder can have a major impact on quality of life. Hypomania, mood and depressive episodes can influence daily functioning. Adaptation strategies and behavioral changes can help an individual to manage moods and remain balanced. Many of those with BPD II require daily medication. Establishing the right medication and dose, and dealing with side effects can have a significant impact on QOL.
Occupational functioning is a major problem for those experiencing hypomania and depression. As a result, they may have problems with concentration and socializing. Employment rates are reported to be low among this population. As a result of hypo/mania episodes, an individual may not enjoy job stability, take more time off due to illness and face stigmatism (Michalak, Yatham, Maxwell, Hale, & Lam, 2007). Consequently, a higher percent of bipolar disorder sufferers are in lower socioeconomic classes.
With the help of professionals, individuals can learn to identify their triggers for a mood episode. A lack of sleep or exercise, for example, may trigger a mood disorder. Adaptive strategies can include regulating daily routines, sleep patterns, energy levels and emotions.
Bipolar II Disorder Therapies
The overuse of psychotics and antidepressants and their serious side effects has hastened the search for alternative therapies. Mood stabilizers are also commonly recommended.
A focus of research is early intervention. Therapy approaches showing improvements in symptoms such as mood and hypomania include family-focused therapy (Miklowitz et al., 2013), group interpersonal and social rhythm therapy (IPSRT) (Hoberg et al, 2013), and cognitive behavioral therapy (CB). An important target of behavioral therapy is preventing and controlling mood episodes. When an episode occurs, CB can help how one manages his/her response to a manic or mood episode.
Interpersonal and social rhythm therapy has shown to improve occupational functioning. Biological rhythm disturbance is related to the severity of bipolar disorder. One IPSRT approach focused on interpersonal skill development and role functioning. Although long-term success has not always been achieved, the results are promising enough to produce a number of follow-on studies seeking to improve implementation in recent years.
Group therapies are increasingly being pursued and showing good results. Group therapy could help address the high correlation between drug dependency and bipolar disorder. A study applying integrated group therapy found that participants have less severe addiction and abstained from drugs longer. A group IPRST study produced improvements in depression and social rhythm, producing reductions in manic and depressive episode (Bouwkamp et all, 2013). Cognitive group therapy has reduced relapses of episodes. (Pearson and Burlingame, 2013).
A review of 125 studies revealed that psychotherapy is more effective than medication in treating mood disorders such as bipolar disorder. CBT and family-focused therapy (FFT) proved to be the most efficacious in treating bipolar disorder while interpersonal social rhythm therapy proved promising. In the prevention of bipolar episodes, CBT, FFT and IPSRT were effective (Hollon and Ponniah 2010). Several studies have shown that psychoeducation can reduce hypomania.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Michalak, E. E., Yatham, L. N., Maxwell, V., Hale, S., & Lam, R. W. (2007). The impact of bipolar disorder upon work functioning: a qualitative analysis. Bipolar Disorders, 9(1‐2), 126-143.
Miklowitz, D. J., Schneck, C. D., Singh, M. K., Taylor, D. O., George, E. L., Cosgrove, V. E., ... & Chang, K. D. (2013). Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 121-131.
Hoberg, A. A., Ponto, J., Nelson, P. J., & Frye, M. A. (2013). Group Interpersonal and Social Rhythm Therapy for Bipolar Depression. Perspectives in Psychiatric Care.
Bouwkamp, C. G., de Kruiff, M. E., van Troost, T. M., Snippe, D., Blom, M. J., de Winter, R. F., & Judith Haffmans, P. M. (2013). Interpersonal and Social Rhythm Group Therapy for Patients with Bipolar Disorder. International journal of group psychotherapy, 63(1), 97-115.
Pearson, M. J., & Burlingame, G. M. (2013). Cognitive Approaches to Group Therapy: Prevention of Relapse in Major Depressive and Bipolar Disorders. International journal of group psychotherapy, 63(2), 303-309.
Hollon, S. D., & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression and anxiety, 27(10), 891-932.
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