This month we are continuing our series comparing recall vs. reasoning questions. Every two months, we are taking a topic that could show up on the ASWB exam and are first doing a recall (or application) question on the topic. Then the next month we come back with a reasoning question on that same topic. In February and March we covered Narcissistic Personality Disorder. In April and May we covered Antisocial Personality Disorder. Now for June and July we are delving into the differences between Bipolar 1 and Bipolar 2. This month instead of doing a straight recall question, we are going to do an application question, where you apply the knowledge of these diagnoses to a client scenario.
Bipolar 1 Disorder
For Bipolar 1 you need to have one thing: a manic episode. Bipolar 1 does not require a major depressive episode. With Bipolar 1 you will see someone with a significantly elevated mood. They could also have depressive symptoms, but these are not required for a diagnosis of Bipolar 1. Once there is a manic episode, it is Bipolar 1.
Bipolar 2 Disorder
polar 2 Disorder, you need to have a hypomanic episode and at least one major depressive episode. There has to be a major depressive episode (along with a hypomanic episode) for a Bipolar 2 diagnosis.
When you are distinguishing between these two, remember that as soon as they have a manic phase, it’s Bipolar 1 (even if they also have a major depressive episode). The one thing you need for Bipolar 1 is a manic episode-a major depressive episode can also occur, but you must have the manic episode. For Bipolar 2, you need a hypomanic episode and a major depressive episode.
What is the difference between mania and hypomania?
First and foremost, it is important to note that a manic episode is more severe and typically longer in duration than a hypomanic episode. A manic episode must last a week or longer and symptoms include: feelings of heightened energy, creativity, and euphoria; talking a ‘mile a minute’, needing very little sleep; being hyperactive; feeling all-powerful, invincible, or destined for greatness. During mania people may go days without sleeping, spend well beyond their means (even going into debt), and may neglect duties and responsibilities in their life. Mania is severe enough that it interferes with daily functioning and can require hospitalization for stabilization.
Hypomania is a milder form of mania lasting at least four days; it can still be marked by elation and hyperactivity or can even come across as intense irritability, but is not at the same level as a full manic episode where people feel invincible, can’t complete tasks of daily functioning, or require hospitalization for stabilization. A simple way to think about it is that if someone were hypomanic, you may notice their behaviors seem different or off, but if someone was manic you would defin
itely know something was wrong.
ASWB Practice Question
A social worker meets with a 30 year old client who came to therapy after receiving an ultimatum from her spouse. The client reports experiencing periods of feeling ‘on top of the world’ followed by periods of severe depression. When the social worker inquires about what led to her spouse’s ultimatum that she attend therapy, the client shares that last week she quit her job and maxed out her credit cards to start a new business venture that came to her in the middle of the night. The client shares that she hasn’t slept in days, but feels like she can take on the world. What is the MOST likely diagnosis?
A. Cyclothymic Disorder
B. Bipolar 1
C. Bipolar 2
(scroll for answer and rationale)
The correct answer is B: Bipolar 1. The symptoms being described indicate the client is experiencing a manic episode. The symptom severity is beyond that of a hypomanic episode, which allows us to rule out Cyclothymic Disorder (A) and Bipolar 2 (C). Even though the client shares that she experiences periods of severe depression, remember that as soon as a manic episode is present, the diagnosis is Bipolar 1 (even when there are also depressive symptoms). The symptoms being described go beyond that of ADHD (D).
ASWB Masters and Clinical Exam Preparation
This topic can be a tricky one for many test takers. Do you feel confident in the differences between Bipolar 1 and Bipolar 2, or do you need additional support? One of the great things about TDC is that every customer has access to a coach they can email anytime questions come up as they go through the program. If you still have questions around this topic, be sure to reach out to your coach. And if you haven’t signed up for one of our programs yet, we encourage you to read one of the thousands of real customer testimonials. TDC has helped THOUSANDS of social workers successfully pass their social work licensing exams. Will you be next?