DSM-5 Criteria for Bipolar Disorder

Manic, hypomanic, and major depressive episodes defined below. DSM-5 Criteria for Bipolar I Disorder (must have both A-B): Criteria A. ≥1 manic episode (may also have hypomanic and/or major depressive episodes). B. Episode(s) not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. DSM-5 Criteria for Bipolar II Disorder (must have all A-C): Criteria A. ≥1 hypomanic episode and ≥1 major depressive episode. B. No history of manic episode. C. Episode(s) not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. Manic episode (must have all A-D to qualify as manic episode): Criteria A. Distinct period of mood disturbance. ≥1 week of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy. Present most of the day, nearly every day (or any duration, if hospitalization needed). B. Manic symptoms: during period of mood disturbance and increased energy/activity, ≥3 of the following symptoms (4 if the mood is only irritable) present to a significant degree and are a noticeable change from usual behavior: Inflated self-esteem or grandiosity. Decreased need for sleep (e.g. feels rested after only 3 hrs sleep). More talkative than usual, or pressure to keep talking. Flight of ideas or subjectively racing thoughts. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal directed activity). Excessive involvement in activities with high potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish business investments). C. Mood disturbance sufficiently severe to cause marked impairment in social/occupational functioning, or needs hospitalization to prevent harm to self or others, or there are psychotic features. D. Episode not attributable to a substance (e.g. drug of abuse, medication, other treatment) or other medical condition. Hypomanic episode (must have all A-F to qualify as hypomanic episode): Criteria A. Distinct period of mood disturbance. ≥4 consecutive days of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy. Present most of the day, nearly every day (or any duration, if hospitalization needed). B. Manic symptoms: during period of mood disturbance and increased energy/activity, ≥3 of the following symptoms (4 if the mood is only irritable) present to a significant degree and are a noticeable change from usual behavior: Inflated self-esteem or grandiosity. Decreased need for sleep (e.g. feels rested after only 3 hrs sleep). More talkative than usual, or pressure to keep talking. Flight of ideas or subjectively racing thoughts. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal directed activity). Excessive involvement in activities with high potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish business investments). C. Episode associated with an unequivocal change in functioning uncharacteristic of person when not symptomatic. D. Mood disturbance and change in functioning are observable by others. E. Episode not severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization (if psychotic features present, the episode is manic). F. Episode not attributable to a substance (e.g. drug of abuse, medication, other treatment) or other medical condition. Major depressive episode (must have all A-C to qualify as major depressive episode): Criteria A. Depressive symptoms: ≥5 symptoms during the same 2-week period that are a change from previous functioning. Depressed mood (#1) and/or loss of interest/pleasure (#2) must be present. Exclude symptoms clearly attributable to another medical condition. Depressed mood. Most of the day, nearly every day. May be subjective (e.g. feels sad/empty/hopeless) or observed by others (e.g. appears tearful). In children and adolescents, can be irritable mood. Loss of interest/pleasure. Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day. May be subjective or observed by others. Weight loss or gain. Significant weight loss without dieting, or weight gain (change of >5% body weight in a month), or decreased/increased appetite nearly every day. In children, may be failure to gain weight as expected. Insomnia or hypersomnia. Nearly every day. Psychomotor agitation or retardation. Nearly every day and observable by others (not merely subjectively restless or slow). Fatigue. Or loss of energy, nearly every day. Feeling worthless or excessive/inappropriate guilt. Nearly every day. Guilt may be delusional. Not merely self reproach or guilt about being sick. Decreased concentration. Nearly every day. May be indecisiveness. May be subjective or observed by others. Thoughts of death/suicide. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. Episode not attributable to physiological effects of a substance or another medical condition.