Understanding the Spectrum of Bipolar Disorder

By Cheryl Cranick | Feb. 01, 2017


We do a great disservice to people diagnosed with bipolar disorder by ignoring the condition’s types. Too often I see "bipolar disorder" used alone, yet the illness actually exists on a spectrum.

For most of my teenage years, I struggled with sadness, lack of energy, rapid mood cycles and suicidal thoughts without knowing the cause of the symptoms. By age 16, I had been diagnosed with OCD and depression, but treatment wasn’t helping.

At age 20, my mother found a home screening test to determine if my depression might actually be bipolar disorder. When the results placed me on the spectrum, I was deeply confused. Based on my understanding of the disorder, its symptoms did not match what I experienced. My dominant symptom was depression, and I never reached mania.

After receiving a formal diagnosis from a mental health professional, I began to better understand how I could have bipolar disorder without the "typical" symptoms I had heard so often. My condition is bipolar II disorder—I just didn’t know there was more than one type.

This was back in the early 2000s, when talking about mental health was still rather hushed. While, we know more now, and we talk more about mental illness, it still seems the bipolar disorder types are often left out.

Why the Details Matter

Beyond the occasional reference to Types I and II, bipolar disorder is usually grouped as one condition. Ignoring the spectrum prevents the public from better understanding the complexity of this illness, and what’s worse is the prevalence of misdiagnosis. Studies have found 40% of patients with bipolar disorder were initially diagnosed with unipolar (major depression). This does not surprise me. With bipolar II disorder specifically, depression is usually the most common or stronger symptom of the high/low mood scale, whereas manic symptoms may go unreported to a doctor because the elevated (or increased) mood is not severe enough to affect the person's life.

Understanding the Spectrum

For those who don't know the difference—or want to easily explain the difference to others—I often hold up my two hands. One hand is unipolar (depression). The other hand is bipolar I (manic depression). What exists in the middle is the bipolar II spectrum. Unfortunately, the spectrum is wide and unique to each person.

You can also think of the bipolar spectrum as a hill, with unipolar (depression) at the bottom and bipolar (manic depression) at the top. The space between the upward curve is the spectrum and each person with bipolar II disorder exists somewhere along it. The closer a person’s symptoms are to one end, the more likely that person is to receive a diagnosis of major depression or manic depression.

With bipolar I, the mania is usually quite clear. In bipolar II, the mania is "milder." Depression is usually present in both, and may be more severe and prevalent in bipolar II. However, these conditions rarely feature across-the-board symptoms for everyone. It's the cluster of symptoms that need to match up for a diagnosis.

I am somewhere in the middle. My lows are low and have reached suicide ideation. My mania, however, is classified as "hypo," and expresses itself in behaviors such as talking faster than normal, staying up late with lots of energy or being quick to anger.

Educating Others

The spectrum is not new to people who live with the disorder, but it is news to many. As a NAMI In Our Own Voice presenter, two responses I received during presentations last year have stuck with me.

After sharing my story at a CIT training, one officer asked me: "How am I able to help people in my community if I don't even know this exists?"

Months later, while speaking at a NAMI Family-to-Family class, a woman told me about her husband, noting his depression treatment was not working. Visibly relieved, she said: "I've never heard of this. I think you just diagnosed my husband, daughter and sister-in law."

While only a health care professional can diagnose, we must be active self-advocates and educators. We must be clear when referencing this illness in hopes that fewer people will endure the pain and frustration that comes with misdiagnosis.

For more information on the bipolar spectrum, check out the book: "Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder" by Jim Phelps.


Cheryl Cranick fictionalized her bipolar II misdiagnosis and severe weight gain into a novel titled "Becoming" (http://www.cherylcranick.com). The book hopes to educate about bipolar II and encourage empathy, as her character struggles through college. Cheryl lives with her two rescue dogs in Jupiter, FL.

Kayla M
Thank you for sharing your story! I completely agree with you that this disorder is new to many. Just by reading your blog, I have more clarity on the subject. Health care providers really need to focus and pay close attention to their patients so there will not be so many misdiagnoses. We must raise more awareness in our communities and break the stigma of mental illness in general. A very important part I believe in spreading awareness is self-advocating. It is okay to speak up and share stories and symptoms. Sharing your own story now is impacting others right now in a such a positive way!
2/8/2017 10:34:59 AM

Ann Getchman
Excellent article.
2/2/2017 1:21:33 PM

Thank you
2/1/2017 11:27:49 PM

I was treated, albeit unsuccessfully, for about 10 years with Unipolar Depression. The treatment did not work well for me. I was having manic episodes during the 10 years, but chalked them up to being just being in a more energetic mood for once and hey I felt great so why complain to the psychiatrist? Well a severe manic episode where I was awake for 6 days got me hospitalized. After this occurrence I was properly evaluated for bipolar and discovered I'm type 1 with rapid cycling. GET a second opinion. ASK for a bipolar evaluation even though you may not have it. Getting the right medications for bipolar vs. unipolar is key to feeling better and having a life again.
2/1/2017 10:49:59 PM

I have been living with bipolar for 22 years and have never heard of spectrum as reference. Interesting article and informative. I am so interested in helping others but don't know how exactly to get started. I have worked in mental health in hospital setting for 13 years. I would like to do more.
2/1/2017 10:26:32 PM

This story is very close to that of my dAughters, after being misdiagnosed with OCD, MDD and everything that seemed to end in a "D" finally came Bipolar II and it makes sense. The problem she is having is handling the anxiety, it's like colicky hours at night ugh. We are trying to figure if but is in part possible vitamin deficiencies which may contribute but every night has its paralyzing hours😔 would love to hear how others handle their disorder and symptoms as well.
2/1/2017 7:34:58 PM

I had a similar experience when a Doctor explained to me that there was a line and above the line (by a little and below the line ( a little) were the majority of where people's moods go. When you have hypo mania the line is higher. When the line is way low like wanting to commit suicide its obviously as low as it can go. I kinda wish I didn't have bipolar but I was a troubled teenager and using drugs,too. They diagnosed me with bipolar and put me on medicine. I was able to go back to highschool and graduate with a 4.0 my senior year. I quit using drugs and took my medicine even though for a majority of the time I did not want to take it but my family was my caregivier and forced it to me. I learned in college, I have an associates in human service technology that its not even legal to give someone a mental illness diagnosis without 6 months of sober time. So I was really hoping it was just the drugs. but MANY Doctors later still agreed I had a mood disorder and took a slu of mediciations. The side effects of the medication were terrible. I had tarnive dysconitia and myoclonus. Then in my 20's I was diagnosed with schizoaffective disorder. Before I was afraid to talk about my psychosis. I didn't want bad things to happen to me like stereotyping or talk or worse. Schizoeffective disorder is a mood disorder with long-term psychosis. I had psychosis for 6 years straight. Psychosis is a symptom of bipolar that usually happens during a paranoid state. Then I was diagnosed with behavior problems. The Doctors said the medication is in fact helping but most of your behaviors still remain. They told me that they can be worked through with therapy. They also diagnosed me with borderline personality disorder. It helps me to know that there are other people who suffer from similar things. Thank you NAMI. Sometimes I wish I could just not be in Doctor's care because I think I wouldn't have a mental illness.
2/1/2017 7:11:38 PM

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