Thursday, April 14, 2011

Catherine Zeta-Jones and Bipolar II—What’s That?

You may have read recently that Catherine Zeta-Jones was briefly hospitalized for the treatment of bipolar II disorder. While you may have heard of bipolar disorder, unless you took an abnormal psychology class in the last decade or so, or had direct experience with bipolar disorder, the numerical designations bipolar I and bipolar II are probably unfamiliar.

Here’s a brief primer: Bipolar I is what most people think of as bipolar disorder: episodes of mania that typically alternate with episodes of depression. During a manic episode, people aren’t simply in an “up” mood. They are euphoric—feeling that they can do most anything, that they’re creative, brilliant, supercompetent. Except that they’re not. Among the symptoms of mania are: less need for sleep, a sense of racing thoughts, beginning new projects (for which they may not have appropriate experience), being sexually promiscuous, going on spending sprees. Some people are extremely irritable during their manic episodes rather than euphoric (click here for the full criteria list).

People may become psychotic when manic; for example they may develop delusions. For a diagnosis of bipolar I, the manic episode must last for at least a week and significantly impair daily life. That’s a long time both for the individual and those living or working with the individual.

People who have had a manic episode typically previously have had and/or will go on to have episodes of depression. The term depression can sometimes be overused, so when mental health clinicians use the term, they mean a subjective sense of feeling “depressed” most of the day for most days and/or significantly less interest or pleasure in activities. Other symptoms of depression include feeling worthless or inappropriately guilty, difficulty making decisions or thinking clearly, and recurrent thoughts of death or of suicide (click here for the full criteria list). These symptoms must last for at least two weeks to be considered a major depressive episode. (People with bipolar I may have mixed episodes, which are symptoms of both mania and depression at the same time, rather than manic or major depressive episodes.)

Bipolar I is the form of bipolar disorder that used to be called manic-depressive disorder. Patty Duke Astin describes their experiences with bipolar disorder in a way that that sounds like bipolar I.

In contrast, bipolar II doesn’t involve manic episodes; instead, its hallmark is hypomanic episodes, which typically alternate with episodes of depression. Hypomania is a less intense form of mania that doesn’t impair functioning significantly. A hypomanic person may be overly talkative, but you can interrupt him or her (which is hard to do when someone is manic); the person may be overly self-confident, but not grandiose, and may even be more creative than in his or her normal state (click here for the full criteria list). For a diagnosis of bipolar II, the hypomanic episode must last for at least four days, and the person must also have had at least one episode of depression. Carrie Fisher reports that she’s been diagnosed with bipolar II.

Bipolar II is more common among women than men, whereas bipolar I is equally common among men and women. Moreover, women with bipolar (I or II) tend to have more depressive episodes than manic or hypomanic ones, whereas men with bipolar (I or II) tend to have more manic or hypomanic episodes, respectively, than depressive ones. When women are premenstrual, their mood symptoms (mania, hypomania, depressive) are likely to be worse than at other times of the month. The good news: Various treatments (e.g., medications, cognitive behavioral therapy) can help.

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