Despite the inconsistent relationship of alcohol use and alcohol dependence characteristics with affective episodes over time, subjects with bipolar I disorder and alcohol dependence in the current sample do in general worse than bipolar II or non-comorbid bipolar I subjects. Another reason why this group of patients has a more severe course of the affective disorder might lie in their high rate of psychiatric comorbidity. Although a higher rate of anxiety disorders was not found in comorbid bipolar subjects, groups 2 and 4 individuals met significantly more criteria for conduct and antisocial personality disorders and experienced significantly more alcohol-related violence, in particular women. Women accounted for many of the significant differences across the 4 groups, including alcohol dependence severity, alcohol-related aggression and physical consequences and more severe alcohol use disorder-related characteristics, lower social functioning and a higher amount of affective symptoms during the follow-up period. These individuals must therefore have reached a remarkable severity of both disorders and might therefore represent a high-risk group within these comorbid individuals. A previous study reported that the risk of having an alcohol dependence
