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.

Greg Marlow
I was able to cure my bipolar disorder with calcium and omega-3 supplements. Omega-3 allows higher blood calcium levels and calcium dampens neuronal excitability.
9/16/2017 9:56:52 AM

I would like to see more written on cyclothymia also, since that is on the spectrum. Good article though. :) I never realized cyclothymia was on the Bi-Polar spectrum, but it clarifies a lot of suspicions for me now.
4/7/2017 10:46:41 PM

Eddra Jones
Reading all this makes me thing misdiagnosis and the wrong Ned's create years of poor life for many. My son struggles like all. Is there bipolar 4. What causes Schizoeffevtive disorder how is it treated. How long does it last. Thanks
3/7/2017 7:40:05 PM

As a Bipolar 1 I have been successfully on meds consistently for 26 years. My biodad (guilty of sexual abuse) took his life at age 88. We have never been certain of the diagnosis of his mental illness, but we suspect Bipolar. I have experienced two psychotic episodes that took me to the hospital. It is agreed upon by my doctors and therapists (and me) that I am high-functioning and after 35 years taking classes at 6 colleges I graduated with my B.A. at age 53! I recently found a bipolar group provided by my health coverage and I am benefting from every moment that I am in group.
3/5/2017 2:27:43 PM

I was surprised there was no mention of cyclothymia in this article: mood cycling that does not reach the intensity of Bipolar I or II.

I believe the "mood spectrum" has been proposed by researchers, but has not been recognized in the DSM (DSM-5). I have Bipolar II and don't see it as a "light" version of Bipolar I. It also doesn't seem quite right to put Bipolar II "between" depression and Bipolar I. The spectrum model is interesting and maybe useful, but does not seem to have a medical/scientific basis at this time.
2/28/2017 5:21:21 PM

judie russell
I have been battling depression since I lost my son to suicide. I was diagnosed with major depression and later ptsd and aniexty disorder when 9 years later my son killed his father. I really wonder if all these years I have been misdiagnosed and have a form of bipolar. despite many different medications, I have never found a good resolution to my illness.where can I find good answers?
2/27/2017 7:33:19 AM

Jo Mullen-Regner
My husband was bipolar. When his meds quit working, he took his own life in 1998. When he went into a rage, it was directed at me. He once held a loaded, *****ed gun to my head & said "give me ONE reason why I shouldn't shoot you right now!" Then walked away. About 2 years later he descended on me lying in bed & began choking me, then suddenly stopped & walked away. When his meds stopped working in 1998 & the docs told us there was nothing more available, he gave up hope & was afraid of what he might do. I did write about it hoping our story might help someone. Although meds have been improved & lots has changed, I alway hope someone might be helped in some way by reading our story.
2/25/2017 5:50:55 PM

Very good article. I have a dx of Bipolar II but only recently understood the difference between the 1& 2. I always thought I had a Major Depressive disorder but was prescribed a mood stabilizer and never understood why. Years ago I went to a support group for bipolar and never went back because I never experienced mania. I was fortunate to be employed by a great company with an Employee Assistance Program. My position was always there following hospitalizations. Proper diagnosis and education to the patient and public is so important!
2/24/2017 9:24:15 PM

Very Informative Writing! Thank you for this article.
I am sharing it with several friends, co workers, & family members who have not experienced bipolar or any mental illness in their family/home life. I am 31 yrs old.an only child raised by my mother who was Bipolar Manic Depressive with Rapid Cycling. Like many, she went undiagnosed until her mid thirties, as an only child she & I were close. She talked openly to me about mental illnesses, we watched documentaries together, interviews of celebrities who suffered with the illness, etc. She found ways to help me relate to the information on a level that was interesting and in a way that sounded very simple for such an unsimple subject. I am thankful that my mother educated me (as much as one aged 12/ 13 y/o can understand) because I then wanted to share what I learned with my friends. By the time I was away in college I learned my mother had attempted suicide twice. I eventually moved home from school to live with her and care for her by just being there to support her. My mother was 2 weeks shy of her 52nd birthday when she completed suicide. The lack of resources available and the ignorance this world has of mental illness, of the most vital organ in our body is not taken serious enough to ensure anyone no matter where you live, has access to adequate mental health professionals+ long term care/support to . I was 25 years old. Week of her passing I learned #1 a medication she was recently put back on was recalled due to suicide in patients with a history of suicide attempts #2 I learned this was the 3rd time her doctor put her on this medication (at its highest strength). The times before were when she attempted suicide and was taken off the drug. I have now worked in the medical field for 6 years, I wish I could have saved her but I can be her voice, a voice to comfort others, to teach those who are not aware of bipolar & mental illness except for its stigma. Also, it'd be nice not overhearing people just casually throwing around the word & labeling others as "bipolar". That is one of the many reasons I appreciate this information and all the stories and comments shared. Thank you for sharing your experience and knowledge. Thank you all for listening to my rant/story/venting. God Bless
2/24/2017 6:12:29 PM

George Shields
It has been my experience that psychiatrists are very open to discussing the uniqueness of ones bipolar. I do think it would be a tremendous benefit if we did discuss bipolar within the perimeters of a spectrum. Sadly I don't see that happening real quickly though.

Hospitals and doctors do their coding for insurance companies and one must into a category. The government is the same should SSD be involved.

On a personal level I don't even know what my diagnosis is after all of these years. You see have a mixed state problem. I am manic all of the time. Finding medications for anxiety and depression is a chemistry project in its truest form. Lithium for the manic is a constant. Sadly even your right hand, left hand test will not hold water. Obviously the topic of spectrum is a great one.
2/24/2017 1:04:49 PM

A couple factors to consider: hormone fluctuation during my 40s changed the spectrum.

Vitamin B an D deficiency ---MUST be considered with depression. Also, low magnesium. Then adjust antidepressants.

Life is good today
2/24/2017 1:31:01 AM

Trudy Bostick
Your article was very insightful. I have just recently within the past few years been diagnosed with bipolar disorder after many years of major depression and sporadic episodes of mania, especially in my teens that went undiagnosed for many many years. I am now 65 years young and on a good combination of meds that really works for me.
Thanks for the information, it helped me to determine where I fall in the spectrum of bipolar disorder.
2/23/2017 10:20:00 PM

ned davidson cherry
my first-bi polar (manic episode) occurred while a 21 year old student at columbia university in new york city. since then i've experienced five more manic episodes with the last one at age 64. since then the v.a. has taken care of me and i've been on lamotrigine successfully ever since. in between these episodes i managed to graduate from columbia's graduate school of architecture & planning and have had a reasonably successful career as an architect ever since. it took 25 years from the first manic epi-
side until a proper diagnosis was achieved. many ups and downs in between, mostly ups that caused
loss of jobs, friends, and in one case a spouse. with the v.a. as my6 advocate it's been smooth sailing.
this is not a blanket endorsement of the v.a. but they do good work.//n.c.
2/23/2017 5:40:37 PM

Michele Regal
So glad to see this article. I am Bipolar II. I'm in the sad, crying, depressed mode the majority of the time, and just as the article explains, my mania presents as fast talking and quick to anger. The general public thinks bipolar folks are all on the mania spectrum. That's the only way I've seen the media portray us.
2/23/2017 5:33:13 PM

Claudia Pinto
Muy interesante el articulo ! Tengo una hija bipolar II necesito comunicarme con ustedes estoy en Miami florida
2/23/2017 4:06:15 PM

Great post... I am very surprised however to hear of a test that you can take to differentiate between bipolar and depression. I was not aware that such a test existed, and a Google search led nowhere. Would you be able to point me in the right direction with the name of this test or at least the name of the company that sells it? Thank you!!!
2/23/2017 1:16:12 PM

Kathleen Kusel (Kathy)
I am 73 y/o and have had Bipolar II, misdiagnosed in my 20s and finally dx in my early 30s. I successfully completed a 40+ year. career as a mental health nurse and nurse educator. There were many mood swings and after the birth of my first son when I was 33y/o I experienced severe post partum depression and an unsuccessful suicide attempt. It was only after I was hospitalized and changed psychiatrist that I was correctly diagnosed and medicated. My story has many discoveries- like choose your psychiatrist when you are stable and do not be afraid to question his dx or to choose another more qualified psychiatrist. There is more to my story but this is sufficient to introduce me to the group. If you have questions contact me.
"Never give up and never accept inadequate mental health care."
Kathy Kusel
2/23/2017 11:26:47 AM

Great article. I was unaware of a bipolar spectrum but have witnessed it in two of my daughters who are at opposite ends of that spectrum. Therefore, I always suspected there was more to it than bipolar I or II. One of my daughters is dx with schizoaffective disorder bipolar type. Where does that fit on the spectrum? Thank you!
2/23/2017 10:23:48 AM

Really great piece. Thank you. I deal with BP II and only finally "got that" diagnosis after almost 20yrs of varying diagnoses ranging from major depression to BP I - and many failed med attempts along the way. I am finally at a manageable place and that includes accepting what I have to deal with. Thanks.
2/23/2017 9:26:07 AM

Thank you for this article. Also on the spectrum are cyclothymic disorder and "unspecified" bipolar disorders. My son has Bipolar 1 and I have cyclothymia. I have a sister who swings from a stable non-depressed state to a very agitated type of mania. Her mood swings are pronounced and chronic but she lacks the depressive episodes (during her stable periods becomes needy but does not appear depressed). I suspect she is on the bipolar spectrum (unspecified?) but since her symptoms are atypical she has never been diagnosed.
So yes indeed Bipolar is a spectrum and I welcome the day it becomes treated as such by the professionals. I believe there are many people out there who are not getting help because they don't fit the typical test results for bi-polar.
2/23/2017 9:10:27 AM

Thank you for this article. Also on the spectrum are cyclothymic disorder and "unspecified" bipolar disorders. My son has Bipolar 1 and I have cyclothymia. I have a sister who swings from a stable non-depressed state to a very agitated type of mania. Her mood swings are pronounced and chronic but she lacks the depressive episodes (during her stable periods becomes needy but does not appear depressed). I suspect she is on the bipolar spectrum (unspecified?) but since her symptoms are atypical she has never been diagnosed.
So yes indeed Bipolar is a spectrum and I welcome the day it becomes treated as such by the professionals. I believe there are many people out there who are not getting help because they don't fit the typical test results for bi-polar.
2/23/2017 9:08:14 AM

Soft Bipolar is what I live with, and I was just recently diagnosed. Since the Bipolar II stuff doesn't apply to me I was confused about where I truly placed on the spectrum until this article. Everyone in my family lives with some form of depression or anxiety related disease. Thank you.
2/23/2017 7:59:31 AM

Judy Watkins
Thank you for helping people by allowing them to express their feelings and share their experiences!
2/23/2017 7:21:32 AM

Judy Watkins
I have struggled with depression often on mine tire life. I started having periods of severe depression when I was about 28. (I thought this was due to being in a very difficult marriage with 2 small children). As the years progress my periods of depression became more frequent and lasted longer. It was like a black cloud would just move over my mind, and everything was sad! This would last anywhere from one week to over a month. Then one morning I would wake up and the saddens would be gone. I wasn't actually diagnosed as being bipolar until I was in my early 40s. I have been on medication ever since that has helped immensely.
Both of my children have also been diagnosed as being bipolar, but their issues are very different than mine. My daughter was definitely bipolar 1, she would go into very manic episodes that were intensified by alcohol. She has been on Seroquel for 10 years now and doing very well. I think that my son has a more complicated form of bipolar. I am suspicious that he has a form of schizophrenia also. He was diagnosed as having attention deficit when he was seven years old and was on Ritilin during his school years. He has always been resistive to taking medication and insist that he can manage better without it. He has had a very difficult time in his adult life, holding a job and managing relationships. Three years ago he left his wife and four children and set out to find himself! He had very grandiose ideas and actually felt that he was a genius. But he also seemed somewhat paranoid and felt that people were out to get him and were always watching him. Anyway he is now in prison on the other side of the country, and I rarely hear from him. I guess I was wondering how genetics work in bipolar illness? My exhusband, father of my children, was never diagnosed, but I'm certain he has some sort of mental illness. Have there been studies showing the likelihood of bipolar being inherited? And how could we all be diagnosed as "being bipolar" but be so different?
2/23/2017 7:17:54 AM

The article was very interesting. Mental illness/addiction is very prevalent in my mothers family. Unfortunately, my adult daughter is has a dual diagnoses (bipolar/addiction). Although she's now been clean for just over a year, it's heartbreaking to watch the struggle with her mental illness. The stigma attached is horrible too. She does see a therapist twice a week, which definitely helps but hasn't taken the steps yet to reach out to NAMI for a support group. If my prayers are answered, that will be next.
2/23/2017 7:09:26 AM

So...i have had almost all the diagnosis's of a mental illness. I believe it actually started when I was in my teens. I started drinking and then using illicit drugs. It was handed down to my generation. I finally quit the drug use. My family was not very supportive. I had a baby, with the doctor strongly advising me to never get pregnant. I told my doctor a few months ago that I hate my mental illness. People still shun me. I have been dealing with this for 40 years. Thanks for your story and for letting me share mine.
2/23/2017 12:55:21 AM

After many, many years of care taking my 45 year old daughter with Schizoaffective Disorder I believe I've come to the correct notion that the idea of the spectrum is infers that "no two people are alike", and we should not compare one persons to another. We just have learn how to listen better to our loved ones and to people who are afflicted with mental diseases, because people are all the same – just different.
2/22/2017 8:23:55 PM

I was finally properly diagnosed as bipolar 2 after many years of suffering from depression. Finally put on a mood stabilizer, I felt so much better. I worked in the mental health field as a therapist for 30 years. We were basically told bipolar meant manic and depressive episodes. I never saw my periods of feeling "good" as hypomanic. I struggled for far too long until my wonderful psychiatrist correctly identified the problem. I have been free of deep depression for 10 years! We need to educate the public and professionals so others don't have to suffer needlessly.
2/22/2017 7:59:03 PM

Ron Koff
Excellent information. Very complete and concise. I will send it to all the people in my support group.
2/22/2017 7:38:36 PM

Robert Acton
Thank you NAMI for the very interesting article.
I will check with my psychiatrist on this since I have been diagnosed with generalized anxiety disorder and major depressive disorder and have been on different medications for many years with little change. I am 54 years old now and have been suffering from this since my late teens. It is worse than ever now and I hardly leave the house. I suffer from agoraphobia and I really isolate and withdraw. I feel so alone in this but I am glad to hear from others that suffer as well.
2/22/2017 7:21:47 PM

Much has advanced in the last few years. My husband would likely have been properly diagnosed years earlier if anyone had explained to us that 'mania' included episodes of rage. The question 'does he have episodes of mania?' would have been answered differently.
2/22/2017 6:51:54 PM

Thank you
2/16/2017 6:12:06 PM

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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