Bipolar II disorder and suicidal behavior

Z. Rihmer, P. Pestality

Research output: Contribution to journalArticle

182 Citations (Scopus)


The diagnosis and treatment of depression are only one - although important - aspect in the recognition and management of suicidal patients. Therefore, better identification of bipolar II disorder - this quite common and dangerous but frequently unrecognized condition - may play a decisive role in this process. This has been the experience in Hungary, a country with a high rate of suicide. Bipolar II patients are often misdiagnosed as unipolar - and worse, as substance abuse or sociopathic, histrionic, or borderline personality disorders. These diagnoses make it unlikely that the patient will receive appropriate mood stabilization. Should suicide attempts occur, they would be trivialized as gestures or manipulative interpersonal maneuvers. The physician who cares for unstable bipolar II patients must see beyond the impulsive behavior to appreciate the lifelong affective disorder. Only then can the physician provide the requisite compassionate care that provides the context of a therapeutic alliance in which the physician can learn about the patients' assets - such as their social and creative bent - and, while treating them medically, minimize the destructive potential of the unstable mood states. Despite the fact that the nosologic position of bipolar II disorder was debated until the late 1980s, findings clearly indicate that bipolar II disorder is a distinct nosologic category that should be separated either from bipolar I disorder or from unipolar major depression. This article demonstrates that the lifetime risk of suicide attempts is the highest in bipolar II patients, lowest in unipolar patients, intermediate in bipolar I patients. Two published results show that bipolar II patients are extremely overrepresented among suicide victims. The possible causes of the high suicidality of bipolar II patients are also briefly discussed.

Original languageEnglish
Pages (from-to)667-673
Number of pages7
JournalPsychiatric Clinics of North America
Issue number3
Publication statusPublished - Jan 1 1999

ASJC Scopus subject areas

  • Psychiatry and Mental health

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