Rare Bipolar Disorder Types: IV, V and VI

When discussing Bipolar Disorder, there are six types that are distinctly different from each other. Gerald Klerman MD, identified the six types of Bipolar Disorder, but only types I, II and III (or cyclothymia) can be officially diagnosed. The manual for diagnosing bipolar disorder, DSM-IV-TR (Diagnostic Statistical Manual), only contains the first three types. Bipolar I is defined as having both depressed and manic phases with severe mood swings. Bipolar II is chosen when depression rules with phases of hypomania and the mood changes are not as severe. Bipolar III or Cyclothymia is the "mild" form of bipolar, phases of hypomania and dysthymia (a mild form of depression) accompany this diagnosis. Many people with bipolar experience "mixed episodes" of depression and mania, but there is no distinguished diagnosable label. And some bipolar patients go through "rapid cycling" experiencing mood changes constantly, swinging between mania and depression. Rapid Cycling is identified when a bipolar patient experiences four or more major mood changes in a year, and the term is overly used, often in inappropriate situations.

There is a huge difference between hypomania and mania, and a lot of patients label hypomanic episodes as a manic phase. True mania has symptoms that destroy the life of the victim and those close to him. Spending money that doesn't exist, being sexually promiscuous regardless of being in a relationship, having no desire or bodily need to sleep or eat, paranoia, delusions, excessively talking with a sense of pressure to keep talking, outrageous and unacceptable behavior, thoughts, and ideas, extreme agitation and irritability, claiming to receive divine messages from God or angels, wreck less driving, no remorse for anything, and not regarding anyone else in life and acting "God-like" are all symptoms of a true manic phase. Hypomania is identified by milder symptoms, mostly unexplainable happiness or agitation is the identifiable factor.

With both manic and depressive symptoms, the possibility of experiencing some form of psychosis is a real and sometimes unpredictable threat. Some bipolar patients never experience psychosis while others may develop psychosis only in mania or only in depression or both. Bipolar psychosis can be extremely hard to distinguish from schizophrenia in patients if there is no case history. Psychosis can be defined as being out of touch with reality. Mild forms of psychosis could include only paranoia, while more serious kinds of psychosis can produce auditory, visual, or other sensory hallucinations. A common form of mild psychosis in mania is patients hearing their name out loud constantly when no one is around.

Bipolar IV is identified when antidepressant medication causes a hypomanic or manic phase. The most common class of antidepressants that cause this reaction are SSRI's (selective serotonin reuptake inhibitors).Doctors who suspect bipolar disorder in depressed patients sometimes prescribe SSRI antidepressants to expose manic and hypomanic symptoms. The patient who develops this type of bipolar disorder normally only suffered from depression with no signs of mania before treatment. Antidepressants can be too much for patients sometimes by stimulating excessive amounts of the neurotransmitters it targets, and instead of lifting the depression to a normal mood they are sky rocketed into mania and all the accompanying symptoms. Often times these patients are not able to identify the mania as being abnormal because they have no experience or understanding of a manic phase. Usually by the time the mania is diagnosed and antidepressant treatment stops, the patient has left a path of destruction behind them.

Bipolar V involves patients who only experience depressive symptoms as a diagnosis of major depressive disorder, but have a family history of bipolar disorder. The knowledge of bipolar disorder existing in family history would suggest starting depression treatment with a mood-stabilizer or an antipsychotic that treats depression. Because of the family history, if a patient was started on an antidepressant it could easily act as the trigger for developing bipolar because it produced manic symptoms (type IV). In family studies, the link between genetics and mental disorder has been proven to be strong. Patients should remember that genetics doesn't doom them to developing a disorder, there must be a trigger.

Finally, the Bipolar VI type is defined as having no depressive symptoms, only manic or hypomanic moods. There is a great amount of controversy surrounding "unipolar mania." Some professionals do not believe in a unipolar mania, claiming there is a supported theory that mania is caused by depression. Others do not recognize unipolar mania because they do not label mania as being debilitating, so why call it abnormal and treat it? A connection between manic phases and artistic and creative abilities in famous bipolar people and everyday bipolar victims has been proven many times over, further fueling the belief mania isn't devastating. Those who do support the concept of unipolar mania understand the catastrophic effects it can have on patients lives. The greatest debate remains in publishing unipolar mania in the next version/addition of the DSM. It gives clear diagnostic criteria for major depression, bipolar disorder, depressive, dysthymic, manic, hypomanic, and mixed episodes, and supporters of the unipolar mania concept are demanding its inclusion in the DSM-V that has an estimated publishing year of 2011.

A lesser-known system defining the types of bipolar disorder was developed by Hagop Akiskal and was published in 1999. He identified bipolar ½ as schizobipolar disorder, bipolar I with full-blown manic-depressive illness, bipolar I ½ as depression with extended hypomania, bipolar II defined depression with hypomanic episodes, bipolar II ½ as depression superimposed on cyclothymic temperament, bipolar III is hypomania caused by antidepressant drugs, bipolar III ½ addresses hypomania and/or depression associated with substance abuse and its persistence after substance abuse ends, and bipolar IV as depression associated with hyperthymic temperament. Akiskal provided his own definitions for hypomanic episodes and cyclothymic and hyperthymic temperament, The biggest advantage in using this model is that it identifies and addresses the element of substance abuse as a cause for bipolar disorder. The popular and widely accepted reference to substance abuse in bipolar disorder is a dual-diagnosis of the two problems.

The future of bipolar disorder diagnosis types appears to not include any new concepts according to material that has been published about the development of the DSM-V. It seems that an official diagnosis of any type other than the ones already established will not happen in the near future.