with bipolar II disorder have a higher rate  of co-occurring anxiety disorders compared
with those with bipolar I diso rder, and the anxiety disorder most often predates the bi-
polar disorder. Anxiety and substance use diso rders occur in individuals with bipolar II
disorder at a higher rate than in the genera l population. Approximately 14% of individuals
with bipolar II disorder have at least one lif etime eating disorder, with binge-eating dis-
order being more common than bulim ia nervosa and anorexia nervosa.
These commonly co-occurring disorders do no t 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 ea ting disorders tend to associate most with
depressive symptoms, and substance use disord ers are moderately associated with manic
symptoms. 
Cyclothymic Disorder
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 sym ptoms 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-