November 2018 By

Bipolar II Disorder

Bipolar II Disorder is a mental disorder characterized by a clinical course of recurring mood episodes consisting of at least one major depressive episodes and at least one hypomanic episode. The depressive episode must last at least 2 weeks, and the hypomanic episode must last at least 4 days.

Criterion A

Criteria have been met for at least 1 hypomanic episode and at least 1 major depressive episode.

Criterion B

There has never been a manic episode.

Criterion C

The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Criterion D

The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Hypomanic Episode Criteria

Criterion A
  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood AND
  • Abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
Criterion B

During the period of mood disturbance and increased energy and activity, at least 3 of the following symptoms have persisted (4 symptoms if the mood is only irritable), represent a noticeable change from usual behaviour, and have been present to a significant degree:

  1. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  2. Indiscretion and excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual behaviours, or foolish business investments).
  3. Grandiosity or inflated self-esteem.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Activity (goal-directed) increasing (either socially, at work or school, or sexually) or psychomotor agitation.
  6. Sleep decreased (e.g., feels rested after only 3 hours of sleep).
  7. Talkative (more than usual or pressure to keep talking)


The mnemonic DIG FAST can be used to remember the criteria for bipolar I and II disorder.[1]

  • D Distractability
  • I Indiscretion
  • G Grandiosity
  • F Flight of Ideas
  • A Activity increased
  • S Sleep decreased
  • T Talkativeness
Criterion C

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

Criterion D

The disturbance in mood and the change in functioning are observable by others.

Criterion E
  • No marked social or occupational impairment
  • There is never hospitalization.
  • No psychotic features (If there are psychotic features, the episode is, by definition, manic)
Criterion F

The episode is not attributable to the physiological effects of a substance (e.g.,a drug of abuse, a medication or other treatment).

What is there is an antidepressant-induced hypomania?

A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis.

However, caution is indicated so that 1 or 2 symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a true bipolar disorder.


Episode specifiers


  • Current or most recent episode hypomanic
  • Current or most recent episode depressed

Severity specifiers


  • In partial remission
  • In full remission
  • Mild
  • Moderate
  • Severe

Additional specifiers

Specify if:

  • With anxious distress
  • With mixed features
  • With rapid cycling
  • With melancholic features
  • With atypical features
  • With mood-congruent psychotic features
  • With mood-incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern

Bipolar I versus Bipolar II

There are key differences in the diagnostic criteria between Bipolar I and Bipolar II disorder, the table below outlines these differences.


Bipolar I Bipolar II
Diagnostic Criteria manic episode only hypomanic episode + depressive episode
Length > 7 days > 4 days
Impairment Severe Minor to none
Hospitalization Possible No
Psychosis Possible No

Borderline Personality Disorder

Bipolar II and borderline personality can often present in very similar ways. Affective instability, is repeated, rapid, and abrupt shifts in mood, and considered the core pathology in borderline personality disorder. Affective instability can be misdiagnosed as hypomania, or vice versa. A good history can often help differentiate between the two (See:Paris J. Why Psychiatrists are Reluctant to Diagnose: Borderline Personality Disorder. Psychiatry (Edgmont). 2007;4(1):35-39.)


The “Ls” for bipolar depression - lithium, lurasidone, lamotrigine