I and II disorders by identifying, based on best clinical evidence, a causally related medical condition.
Generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or other anxiety disorders. These disorders need to be considered in the differential diagnosis as either the primary disorder or, in some cases, a comorbid disorder. A careful history of symptoms is needed to differentiate generalized anxiety disorder from bipolar disorder, as anxious ruminations may be mistaken for racing thoughts, and efforts to minimize anx- ious feelings may be taken as impulsive behavior. Similarly, symptoms of posttraumatic stress disorder need to be differentiated from bipolar disorder. It is helpful to assess the ep- isodic nature of the symptoms described, as well as to consider symptom triggers, in mak- ing this differential diagnosis.
Substance/medication-induced bipolar disorder. Substance use disorders may mani- fest with substance.medication-induced manic symptoms that must be distinguished from bipolar I disorder; response to mood stabilizers during a substance/medication- induced mania may not necessarily be diagnostic for bipolar disorder. There may be sub- stantial overlap in view of the tendency for individuals with bipolar I disorder to overuse substances during an episode. A primary diagnosis of bipolar disorder must be estab- lished based on symptoms that remain once substances are no longer being used.
Attention-deficitlhyperactivity disorder. This disorder may be misdiagnosed as bipolar disorder, especially in adolescents and children. Many symptoms overlap with the symp- toms of mania, such as rapid speech, racing thoughts, distractibility, and less need for sleep. The "double counting" of symptoms toward both ADHD and bipolar disorder can be avoided if the clinician clarifies whether the symptom(s) represents a distinct episode.
Personality disorders. Personality disorders such as borderline personality disorder may have substantial symptomatic overlap with bipolar disorders, since mood lability and impulsivity are common in both conditions. Symptoms must represent a distinct ep- isode, and the noticeable increase over baseline required for the diagnosis of bipolar dis- order must be present. A diagnosis of a personality disorder should not be made during an untreated mood episode.
Disorders with prominent irritability. In individuals with severe irritability, particularly children and adolescents, care must be taken to apply the diagnosis of bipolar disorder only to those who have had a clear episode of mania or hypomania—that is, a distinct time period, of the required duration, during which the irritability was clearly different from the individual’s baseline and was accompanied by the onset of Criterion B symptoms.
When a child’s irritability is persistent and particularly severe, the diagnosis of disruptive mood dysregulation disorder would be more appropriate. Indeed, when any child is being assessed for mania, it is essential that the symptoms represent a clear change from the child’s typical behavior.
Co-occurring mental disorders are common, with the most frequent disorders being any anxiety disorder (e.g., panic attacks, social anxiety disorder [social phobia], specific plio- bia), occurring in approximately three-fourths of individuals; ADHD, any disruptive, im- pulse-control, or conduct disorder (e.g., intermittent explosive disorder, oppositional defiant disorder, conduct disorder), and any substance use disorder (e.g., alcohol use dis- order) occur in over half of individuals with bipolar I disorder. Adults with bipolar I dis- order have high rates of serious and / or untreated co-occurring medical conditions.
Metabolic syndrome and migraine are more common among individuals with bipolar dis- order than in the general population. More than half of individuals whose symptoms meet criteria for bipolar disorder have an alcohol use disorder, and those with both disorders are at greater risk for suicide attempt.
Diagnostic Criteria 296.89 (F31.81)