ified and unspecified bipolar and related disord ers should be differentiated from bipolar I
and II disorders by considering whether eith er the episodes invol ving manic or hypo-
manic symptoms or the episodes of depressive symptoms fail  to meet the full criteria for
those conditions.
Bipolar disorder due to another medical co ndition may be distinguished from bipolar
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 consider ed in the differential diagnosis as
either the primary disorder or, in some case s, 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 ra cing thoughts, and efforts to minimize anx-
ious feelings may be taken as impulsive beha vior. Similarly, sympto ms 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.medicati on-induced manic symptoms th at must be distinguished
from bipolar I disorder; response to mood stabilizers during a substance/medication-
induced mania may not necessarily be diagnost ic 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-deficit/hyperactivity disorder. This disorder may be misdiagnosed as bipolar