How to Help Someone Grieve
Depression, Anxiety, Substance Abuse and Stress in America

Diagnosing Bipolar Disorder

Diagnosing Bipolar Disorder

A diagnosis of Bipolar Disorder is a very serious matter and much more serious than mere "mood swings".  What are the diagnostic criteria for diagnosing Bipolar Disorder and what do Bipolar mood swings look like?

A diagnosis of Bipolar Disorder requires the occurrence of at least one full blown Manic Episode or one Mixed Episode in the lifetime of the client.  Clients have often experienced one or more Major Depressive episodes as well.  It is important to note the time requirements for each episode.  These are not moods that swing many times a day or even once per day.  These episodes must persist for at least one to two weeks to constitute a Manic, Mixed or Major Depressive Episode and therefore Bipolar Disorder. 

For more information see; 
Diagnostic Criteria for Major Mental Illnesses
Mood Swings are Normal
Other Articles about Bipolar Disorder
Articles about Psychiatric Medications

Criteria for Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  1. inflated self-esteem or grandiosity

  2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

  3. more talkative than usual or pressure to keep talking

  4. flight of ideas or subjective experience that thoughts are racing

  5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

  6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

  7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.


Criteria for Mixed Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Criteria for Hypomanic Episode

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  1. inflated self-esteem or grandiosity

  2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

  3. more talkative than usual or pressure to keep talking

  4. flight of ideas or subjective experience that thoughts are racing

  5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

  6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

  7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.


Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

  1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.

  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

  3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

  4. insomnia or hypersomnia nearly every day

  5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

  6. fatigue or loss of energy nearly every day

  7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

  8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Comments

Feed You can follow this conversation by subscribing to the comment feed for this post.

laney

This is a good list of indicators. One thing I was looking for in particular was a manic symptom - denial of anything being wrong. Although this might be a subset of inflated self-esteem or grandiosity? I found a reference to this (ref: http://www.brookhavenhospital.com/bipolar-treatment/). I ask because I'm a parent of a teenager who has got to be the poster-child for most of the manic episode symptoms shown here, and very likely going to seek some form of bipolar treatment for her... so thanks for the information here.

Kellen

Hi Laney,

I think denial of anything being wrong is fairly common with many serious mental health disorders. Who wants to be mentally ill?

I hope you find the help you need for your teen. I wish you all the best.

The comments to this entry are closed.