Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood and energy levels. Bipolar disorder causes alternations between periods of mania (elevated moods, increased energy and activity) and periods of depression (low mood, loss of interest, low energy).
While the classic form of bipolar disorder involves clear episodes of mania and depression, some people experience milder symptoms that don’t fit neatly into either category. This has led to debate around whether a mild form of bipolar, sometimes called “bipolar spectrum disorder,” exists.
What is bipolar spectrum disorder?
The term “bipolar spectrum” refers to a range of mood issues that are similar to, but don’t fully meet the criteria for a diagnosis of bipolar I or II disorder. People with bipolar spectrum disorder have chronic mood instability and hypomanic episodes, but episodes don’t reach the intensity or duration required for a formal bipolar diagnosis.
Some key characteristics of bipolar spectrum disorder include:
- Mood swings that fluctuate between normal, depressed and elevated
- Hypomanic episodes that last 2-3 days
- Impairment of function, but ability to carry out daily activities
- Symptoms don’t meet the diagnostic criteria for bipolar I or II
While bipolar spectrum disorder is not an official diagnosis in the DSM-5 (the handbook used by mental health professionals for diagnoses), some clinicians believe it represents a milder or “softer” form of bipolar disorder.
Differences between bipolar spectrum and bipolar disorder
Bipolar spectrum disorder is differentiated from formal bipolar disorder by the intensity and duration of mood episodes:
Mania
In bipolar I disorder, manic episodes last at least 7 days and are severe enough to cause marked impairment in work/social functioning. Mania may include symptoms like heightened mood, risky behavior, decreased sleep, grandiose beliefs, rapid speech, and racing thoughts.
In bipolar spectrum disorder, hypomanic episodes typically last 2-3 days and don’t result in the same level of impairment as full mania. The mood elevation is noticeable but doesn’t completely disrupt the person’s ability to function.
Depression
The depressive episodes in bipolar I and II disorder last at least 2 weeks and cause significant distress or difficulty functioning. Depression in bipolar disorder also meets the criteria for major depressive disorder.
In bipolar spectrum, periods of depression are less severe than a major depressive episode and may only last a few days. The depression impairs functioning but not to the same disabling extent as bipolar depression.
What causes bipolar spectrum disorder?
Researchers aren’t entirely sure what causes bipolar spectrum disorder, but it likely arises from a combination of genetic, biological and environmental factors, similar to bipolar I/II. Contributing factors may include:
- Family history of bipolar disorder
- Brain structure and functioning differences
- Inflammation or hormonal imbalances
- Stress or traumatic life events
- Substance abuse
Abnormalities in brain regions that regulate mood, thinking, sleep, motivation and behavior play a role in bipolar spectrum disorder. Imbalances in neurotransmitters like serotonin, dopamine and norepinephrine are also thought to be involved.
Is bipolar spectrum a disorder?
There is some controversy over whether bipolar spectrum represents a distinct clinical disorder versus just a milder set of symptoms seen in temperament.
Arguments against bipolar spectrum disorder being its own condition include:
- It overlaps too much with bipolar I/II and major depression
- It lacks clearly defined diagnostic criteria
- It has low reliability in research settings
- The validity and clinical utility are unproven
However, proponents argue that bipolar spectrum identifies a subset of people with impairment who don’t meet the rigid criteria for bipolar I/II. Making the diagnosis may help guide treatment and prevent worsening of symptoms.
Most clinicians agree that people with any type of mood instability should be evaluated to determine the appropriate diagnosis and treatment.
How is bipolar spectrum disorder treated?
There are no medications specifically approved for bipolar spectrum disorder, since it is not an official diagnosis. However, similar principles guide the treatment approach:
- Mood stabilizing medications like lithium, anticonvulsants and atypical antipsychotics.
- Antidepressant medications may be used sparingly and with caution.
- Psychotherapy such as CBT, DBT and psychoeducation.
- Self-management strategies involving exercise, stress reduction, regular sleep and routine.
- Avoiding drugs and alcohol.
The same mood stabilizing medications used in bipolar I/II can help manage the mood and energy fluctuations in bipolar spectrum. Lower doses may be sufficient. Antidepressants may have limited benefit but also pose risks like inducing mania, so they should be closely monitored.
Talk therapy helps people better understand their moods, catch episodes early and develop healthy coping strategies. Making positive lifestyle changes is also an important aspect of treatment.
Coping strategies
Whether you have bipolar spectrum or a formal bipolar diagnosis, some self-care strategies that can help manage mood include:
- Take medications as prescribed.
- Keep a consistent sleep routine.
- Exercise regularly.
- Reduce stress through yoga, meditation, etc.
- Maintain a healthy diet.
- Limit alcohol and recreational drug use.
- Use a mood journal to track symptoms.
- Seek support from loved ones and support groups.
- Learn to identify triggers and early warning signs of mood episodes.
- Have a plan for coping with suicidal thoughts if they arise.
Making lifestyle changes to support mood stability and getting professional treatment can help minimize the impact of bipolar spectrum disorder.
When to see a doctor
It’s advisable to see a mental health professional if you are experiencing:
- Frequent mood swings
- Periods of depression or elevated mood
- Difficulty sleeping
- Reduced concentration
- Changes in activity levels
- Substance abuse
- Impaired work or social functioning
- Thoughts of self-harm
A psychiatrist can provide an accurate diagnosis and create a treatment plan involving medication, therapy and lifestyle changes to help manage symptoms. Getting appropriate treatment can greatly improve quality of life for people with bipolar spectrum disorder.
Conclusion
While not everyone fits neatly into the diagnostic criteria for bipolar I or II, many people do experience chronic mood issues characteristic of a bipolar spectrum disorder. Milder but still fluctuating episodes of mania and depression can significantly impact functioning without fully incapacitating the individual.
Identifying these symptoms and finding an effective treatment regimen is crucial, as bipolar spectrum disorder appears to exist on a continuum with more severe bipolar disorders. Early intervention can help prevent worsening of symptoms over time. By learning to manage mood swings, many people with bipolar spectrum disorder can thrive while avoiding the most destructive consequences of full-blown mania or depression.