134 Bipolar and Related Disorders
Note:  Criteria A–C above constitute a major depressive episode.
Note:  Responses to a significant loss (e.g., bereavement, financial ruin, losses from a nat-
ural disaster, a serious medical illness or disability) may include the feelings of intense sad-
ness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion
A, which may resemble a depressive episode. Although such symptoms may be under-
standable or considered appropriate to the loss, the presence of a major depressive episode
in addition to the normal response to a significant loss should be carefully considered. This
decision inevitably requires the ex ercise of clinical judgment ba sed on the individual’s history
and the cultural norms for the expression of distress in the context of loss.1 
Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode (Criteria A–F under “Hypo-
manic Episode” above) and at least one major depressive episode (Criteria A–C under
“Major Depressive Episode” above).
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode( s) and major depressive episode(s) is not
better explained by schizoaffective disorder, schizophrenia, schizophreniform disor-
der, delusional disorder, or other specified or unspecified schizophrenia spectrum and
other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation be-
tween periods of depression and hypomania caus es clinically significant distress or im-
pairment in social, occupational, or other important areas of functioning.
Coding and Recording Procedures
Bipolar II disorder has one diagnostic code: 296.89 (F31.81). Its status with respect to cur-