with bipolar disorder is associated with more episodes of depression, older age, increased
rates of current panic disorder, and lif etime history of alcohol use disorder.
Differential Diagnosis 
Major depressive disorder. Perhaps the most challenging differential diagnosis to con-
sider is major depressive di sorder, which may be accompanied by hypomanic or manic
symptoms that do not meet full criteria (i.e., either fewer symptoms or a shorter duration
than required for a hypomanic episode). This is  especially true in evaluating individuals
with symptoms of irritability, which may be associated with either  major depressive dis-
order or bipolar II disorder. 
Cyclothymic disorder. In cyclothymic disorder, there are numerous periods of hypo-
manic symptoms and numerous periods of depr essive symptoms that do not meet symp-
tom or duration criteria for a major depressive  episode. Bipolar II disorder is distinguished
from cyclothymic disorder by the presence of  one or more major depressive episodes. If a
major depressive episode occurs after the firs t 2 years of cyclothymic disorder, the addi-
tional diagnosis of bipolar II disorder is given.
Schizophrenia spectrum and other related psychotic disorders. Bipolar II disorder must
be distinguished from psychotic disorders (e .g., schizoaffective disorder, schizophrenia,
and delusional disorder). Sc hizophrenia, schizoaffective di sorder, and delusional disor-
der are all characterized by periods of psychotic symptoms that occur in the absence of
prominent mood symptoms. Other helpful considerations incl ude the accompanying
symptoms, previous cour se, and family history.
Panic disorder or other anxiety disorders. Anxiety disorders need to be considered in
the differential diagnosis and may frequent ly be present as co-occurring disorders.