Diagnostic Reliability of Bipolar II Disorder

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Abstract
ALTHOUGH THE reliability of mania and major depression and their derivative diagnoses, bipolar I (BPI) and recurrent unipolar (RUP) disorder, is well established,1,2 there is controversy about the reliability of the diagnosis of hypomania and bipolar II (BPII) disorder.1 In clinical settings, individuals with BPII usually present for treatment of depression. If the history of hypomanic symptoms goes undetected, there is concern about the risks of treatment with antidepressants alone. When asked about hypomanic symptoms, many patients do not report them, either because the symptoms are not commented on by others or because there is little impairment, and sometimes improved function, associated with them.3 The symptoms of grandiosity and poor judgment are often absent. There is a further source of doubt about the diagnosis of BP disorder in these patients since they tend to have more comorbidity, especially in the form of Axis II psychopathology.4,5