Rodney Dangerfield was an American comedian and actor best known for his catchphrase, “I don’t get no respect”. It can seem the same with Bipolar Disorder, Type II,. In show biz, flashy is popular, but when it comes to the cast of Bipolar Disorder, Type II, is a stick in the mud — the shy, quiet member of the cast. Some even think it a less serious form of bipolar disorder. Don’t be fooled! The real problem is that Type II “don’t get no respect”.

Talk about bipolar disorder, and the average person is thinking about mania. Mania gets all the media. Celebrities with Type I get the attention and become spokespeople for bipolar disorder. The drama of Type I overwhelms its seductive, depressive fellow actor, Type II.

But Type II’s tendrils can snake into the very cockles of our hearts. So, what is the power of Bipolar Disorder, Type II? How is it different from Bipolar Disorder, Type I? Why is it a challenging diagnosis?

Lifelong, Type II is characterized by bipolar depression interspersed with episodes of hypomania or normal mood. Its episodes of hypomania distinguish it as a disorder in the family of bipolar disorders, but depression, rather than mania, is the major characteristic of Type II.

And Type II is a supporting actor—not in the limelight. Its high point is hypomania, rather than mania. Hypomania seeks the limelight but ends up at the back of the stage while the mania of Type I dances its way to celebrity.

Hypomania goes unnoticed, and cannot keep up with mania. It’s a “can do” mood with plenty of energy. It’s a mood of elevation, expansiveness or irritability that can result in highly productive activity. Hypomania is a welcome relief from the depressive episodes of Type II. It flies in under the radar screen of many clinicians. It definitely takes backstage to the mania of Bipolar Disorder, Type I.

Those with Type II frequently seek help during depressive episodes. Symptoms of bipolar depression are severe and recurrent. Too frequently, a diagnosis of Major Depression is made without considering the bipolar family.

When someone seeks help for depression, astute clinicians ask whether there have been periods of time with little sleep and high energy. A “yes” to these questions are red flags that will lead to further investigation. The criteria for hypomania are “persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, [a mood] that is clearly different from the usual nondepressed mood” (DSM-IV-TR). Hypomania doesn’t cause marked impairment in function, so the person with Type II may not even recognize it as part of an illness where depression takes top billing.

So, the power of Type II is depression. It differs from Type I in being characterized by hypomania that isn’t as flashy as Type I’s mania. It can be a missed diagnosis because hypomania doesn’t cause the dysfunction of mania. Here are some important consequences of these three facts.

* Since Type II is fueled by depression, it is a serious illness and can cause an extreme amount of partial and total disability. Don’t be fooled into thinking it is a less severe form of bipolar disorder! Hope for regaining wellness is always present, but recognizing potential pitfalls of this serious illness is a vital part of gaining wellness skills.

*The depression of Bipolar Disorder, Type II, stews and simmers beneath the surface. It frequently becomes so much a way of life that the person who experiences it long term fails to get treatment until it’s boiling over.

*When a diagnosis is made, it is difficult to understand since hypomania hides. Hypomania may be seen as improvement rather than a part of the overall illness. It gets mistaken for healthy mood.

*Bipolar Disorder, Type II, is frequently misdiagnosed as Major Depression and treated with anti-depressants alone instead of with a mood stabilizer. This can worsen symptoms.

Like Rodney Dangerfield, Type II “don’t get no respect”. But if you have Type II, take hope. Type II is a rising star. Researchers and clinicians are paying more attention to it. While it may never take over the limelight of Type I, it is better recognized for its role in the cast of bipolar disorder. Appropriate treatment and use of wellness skills can usher in a life without the constant drama of overwhelming depression punctuated by hiding hypomania.

Bipolar Disorder, Type II, is finally getting respect!