Personality disorders. The same convention as applies for ADHD also applies when evaluating an individual for a personality disorder such as borderline personality disor- der, since mood lability and impulsivity are common in both personality disorders and bi- polar II disorder. Symptoms must represent a distinct episode, and the noticeable increase over baseline required for the diagnosis of bipolar II disorder must be present. A diagnosis the lifetime history supports the presence of a personality disorder.
Other bipolar disorders. Diagnosis of bipolar II disorder should be differentiated from ing the presence of fully syndromal hypomania and depression.
Bipolar II disorder is more often than not associated with one or more co—occurring mental disorders, with anxiety disorders being the most common. Approximately 60% of individ- uals with bipolar II disorder have three or more co-occurring mental disorders; 75% have an anxiety disorder; and 37% have a substance use disorder. Children and adolescents with bipolar II disorder have a higher rate of co-occurring anxiety disorders compared with those with bipolar I disorder, and the anxiety disorder most often predates the bi- polar disorder. Anxiety and substance use disorders occur in individuals with bipolar II disorder at a higher rate than in the general population. Approximately 14% of individuals with bipolar II disorder have at least one lifetime eating disorder, with binge-eating dis- order being more common than bulimia nervosa and anorexia nervosa.
These commonly co-occurring disorders do not seem to follow a course of illness that is truly independent from that of the bipolar disorder, but rather have strong associations with mood states. For example, anxiety and eating disorders tend to associate most with depressive symptoms, and substance use disorders are moderately associated with manic symptoms.
Diagnostic Criteria 301.13 (F34.0)
A. For at least 2 years (at least 1 year in children and adolescents) there have been nu- merous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
D. The symptoms in Criterion A are not better explained by schizoaffective disorder.
schizophrenia, schizophreniform disorder, delusional disorder. or other specified or un- specified schizophrenia spectrum and other psychotic disorder.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
Specify it:
With anxious distress (see p. 149)