Bipolar II in Adults

ICD-10 code: F31.81

Bipolar II Disorder (BPII) is part of a cluster of diagnoses called the bipolar and related disorders.  Bipolar and related disorders are a group of psychiatric conditions that include:

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder

These disorders are characterized by the occurrence of discrete mood episodes, including the presence of mania (in bipolar I disorder), hypomania (in bipolar II disorder), or hypomanic symptoms that do not meet full diagnostic criteria for hypomania or mania (in cyclothymic disorder). 

An individual experiencing mania or hypomania may experience a significantly decreased need for sleep (e.g., feeling rested after only a few hours of sleep), inflated self-esteem or grandiosity, an increase in goal-directed activity (e.g., starting new projects at work or home), pressured speech, and other symptoms.  Most individuals with bipolar and related disorders also experience discrete periods of depression, which are generally characterized by sadness or loss of interest, fatigue, difficulty concentrating, and/or sleep or appetite disturbance.  To be diagnosed with a bipolar-related disorder, these mood symptoms must represent a clear change from normal (baseline) functioning.

The bipolar and related disorders differ from each other in the duration, severity, and types of symptoms that the individual experiences.  Individuals with bipolar I disorder experience discrete manic episodes, in which manic symptoms last a week or longer, require hospitalization, or are accompanied by psychotic symptoms.  A history of a major depressive episode is not required for a bipolar I diagnosis, but such an episode will occur in the majority of individuals with bipolar I disorder. Individuals with bipolar II disorder experience hypomanic episodes, in which manic symptoms last at least four days, are not severe enough to cause marked impairment or necessitate hospitalization, and are not accompanied by psychotic features.  A bipolar II diagnosis requires a history of at least one major depressive episode.  Finally, individuals with cyclothymic disorder experience numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for hypomanic and depressive episodes, respectively. 

What is bipolar II disorder?

BPII is a psychiatric disorder that affects approximately 1% of adults.  BPIIis characterized primarily by the presence of hypomanic and major depressive episodes.  Hypomanic episodes are distinct periods of at least four days in which mood is abnormally and persistently elevated or irritable, along with other symptoms such as an increase in goal-directed activity or energy.  

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Understanding Bipolar II Disorder

BPII severity can range from mild to debilitating.  In severe cases, BPII can lead to inability to work or attend school, particularly during depressive episodes, and can cause serious problems in interpersonal relationships.  Many people with BPII also have other psychiatric conditions, most commonly personality disorders, substance abuse or dependence, and anxiety disorders.

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How is bipolar II disorder treated?

BPII is generally thought to be a chronic disorder, but it can be managed effectively.  BPII generally should not be managed in primary care; primary care management should occur only in consultation with a specialist.

Published treatment guidelines for bipolar disorder include those from the American Psychiatric Association (ApA), the Society of Clinical Psychology, and the National Institute for Clinical Excellence (NICE). NICE and ApA state that these guidelines should be applied to the treatment of both BPI andBPII.  However, the guidelines also note that few studies have explicitly distinguished between BPI and BPII; the studies that do distinguish between the disorders more often include BPI samples.  Therefore, caution is warranted when applying these guidelines, particularly with respect to managing hypomanic symptoms.

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