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The Diagnosis of Bipolar II Disorder

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The Diagnosis of Bipolar II Disorder

By Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego

Bipolar II Disorder  is a mood disorder, characterized by shifting states between hypomania and depression. Diagnosing Bipolar II Disorder is particularly difficult, because those with this disorder often do not recognize their hypomanic episodes as being abnormal and so do not report their presence. They may also loathe to give-up these hypomanic states. Patients usually present for help during the depressive stage (Perugi, Ghaemi, & Akiskal, 2006), and when in a depressive state, patients may have difficulty remembering their hypomanic states, feeling that they have always felt low; insight is state-dependent. “Diagnosis may only be possible retrospectively utilizing histories from patients who have distorted recollections” (Stahl, 2005, p. 14.)  Because of these distorted recollections, it is important to have collaborating information from family members or close friends.  The hypomania, which the client so often enjoys, is often more problematic to those close to the patient than to the patient themselves and may lead to dysfunctional family interactions and stress.

It may be the patient’s unwillingness to disclose these hypomanic states and the stressful events that trigger them that often leads to misdiagnosis. As a case example, Mr. Smith symptoms of depression had become so severe that he was no longer able to function. From the age of 30, he was treated intermittently for depression, acquiring a long medication history from many different psychiatrists, even one of the leading authority in psychopharmacology in the world, but he continued to cycle in and out of depression. It was not until he was persuaded, at the age of 57, to bring a close friend in with him to treatment that he was finally given a diagnosis of Bipolar Disorder II and received adequate treatment. It was Mr. Smiths’ unwillingness to share his hypomanic states, which were generally triggered by stressful events, which kept him from receiving a diagnosis of Bipolar II Disorder.

When assessing anyone with repeated periods of depression, it is extremely important to carefully consider the possibility of Bipolar II Disorder.  By creating an open and safe environment for the client to recount his/her history, periods of mood instability and hypomania are more likely to be revealed to the therapist. Mood-charts, which detail lifetime events and mood events, are particularly beneficial for use with those who either do not recognize their own hypomanic states or who may be unwilling to address them. Once properly diagnosed, someone with Bipolar II Disorder can be helped to manage their hypomanic and depressive states with various therapeutic methods.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbac  


Perugi, G., Ghaemi, N., & Akiskal, H. (2006). Diagnosis and clinical management approaches to bipolar depression, bipolar II and their comorbidities. In S. Hagop, & A. Tohen, Bipolar Psychopharmacotherapy: Caring for the Patient. John Wiley & Sons, Ltd.

Stahl, S. (2005). Diagnosis and treatment of bipolar spectrum disorders. NEI Psychopharmacology Academy 2-Day Series (pp. 37-54). United States: Neuroscience Education Institute.