Clinical differentiation of bipolar II disorder from personality-based “emotional dysregulation” conditions

BackgroundThe non-psychotic mood swings experienced by those with a bipolar II disorder can lead to diagnostic dilemmas, especially in differentiating this condition from personality styles marked by emotional dysregulation. This paper provides a clinical vignette and then offers some indicative parameters that might assist differentiation.MethodsA clinical vignette is provided of a patient who had longitudinal features consistent with either a bipolar II disorder or of distinct personality-based dysregulation and the reader is invited to consider the likely diagnosis. A relevant literature is overviewed and, in conjunction with clinical observations, diagnostic parameters for differentiating the two diagnostic groupings are derived.ResultsIt is suggested that the derived parameters assist diagnostic clarification in most instances but reference back to the clinical vignette tempers that level of confidence.LimitationsMany of the indentified differentiating features are clinically derived and are subject to limitations of clinical observation and biases.ConclusionsThe importance of differentiating a primary bipolar II disorder from a personality-based condition is of high clinical importance. This overview seeks to advance the objective.