ABSTRACT
It has often been said that comorbidity represents the rule more than the exception in bipolar disorder. Observational studies indicate that about two-thirds of individuals with bipolar disorder have at least one additional Axis I diagnosis, while nearly half have two or more (McElroy et al., 2001). From a diagnostic standpoint, the frequent comorbidity of other psychiatric problems in tandem with bipolar illness may partly contribute to the oft-noted lengthy delays from initial symptom onset to actual diagnosis, or the frequent “misdiagnosis” of other conditions (Lish et al., 1994; Hirschfeld et al., 2003). Clear diagnostic impressions may be difficult to formulate even by the most experienced clinicians when presentations of bipolar disorder are complicated by prominent comorbid conditions. Furthermore, unclear chronologies among multiple disorders can easily confuse distinctions between “primary” and “secondary” diagnoses when affective, anxiety, substance-related, or personality disorder features become confluent.
