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DSM-5 Criteria for Bipolar Disorder

DSM-5 Criteria - Bipolar

Defines diagnostic criteria for bipolar spectrum disorders

DSM-5 Criteria for Bipolar Disorder

DSM-5 Criteria - Bipolar

Defines diagnostic criteria for bipolar spectrum disorders

DSM-5 Criteria for Bipolar Disorder
Assesses criteria for Bipolar I and Bipolar II disorders based on history of manic, hypomanic, and major depressive episodes.
Manic Episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
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
Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Episode lasted at least 1 week (or any duration if hospitalization was necessary)
Mood disturbance caused marked impairment in social or occupational functioning or necessitated hospitalization to prevent harm to self or others, or there are psychotic features
Episode is not attributable to the physiological effects of a substance or another medical condition
Hypomanic Episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
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
Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Episode lasted at least 4 consecutive days and was present most of the day, nearly every day
The episode represents a noticeable change from the person's baseline
The episode is not associated with marked impairment in social or occupational functioning
Episode is not attributable to the physiological effects of a substance or another medical condition
Major Depressive Episode
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
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
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
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
Symptoms present during at least 2 weeks and represent a change from previous functioning
Symptoms represent a change from previous functioning
// Note: duration includes change, but separate if needed
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Episode is not attributable to the physiological effects of a substance or another medical condition
Negative
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Instructions

Use the DSM-5 criteria to evaluate the presence of manic, hypomanic, and depressive episodes. Assess symptom duration, severity, and functional impact before confirming a diagnosis.

Overview
When to use
Why use
Evidences

Interpretation

Episode Type

Duration

Key Symptoms

Functional Impact

Manic Episode

≥ 1 week (or any if hospitalization)

≥ 3 manic symptoms (elevated mood, decreased sleep, grandiosity, pressured speech, etc.)

Marked impairment, hospitalization, or psychosis

Hypomanic Episode

≥ 4 days

≥ 3 manic symptoms

Noticeable change in functioning, but not severe impairment or hospitalization

Major Depressive Episode

≥ 2 weeks

≥ 5 depressive symptoms (including mood or anhedonia)

Clinically significant distress or impairment

Cyclothymic Disorder

≥ 2 years

Subthreshold hypomanic and depressive symptoms

Fluctuating mood disturbance without meeting full episode criteria

Regier DA et al. DSM‑5 field trials in the United States and Canada, Part II: Test–retest reliability of selected categorical diagnoses. Am J Psychiatry. 2013;170(1):59–70. Moderate interrater reliability reported for bipolar spectrum diagnoses in real‑world settings, supporting operational utility while noting diagnostic complexity.
https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2012.12070999 

Hirschfeld RMA et al. Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873–1875. MDQ is widely used to screen for bipolar spectrum in patients presenting with depression; positive screens require clinical confirmation.
https://psychiatryonline.org/doi/10.1176/appi.ajp.157.11.1873

Carvalho AF, Firth J, Vieta E. Bipolar disorder. N Engl J Med. 2020;383:58–66. Highlights medical/substance‑induced differentials (e.g., hyperthyroidism, corticosteroids, stimulants) that can mimic hypomania/mania, reinforcing DSM‑5 exclusion criteria.
https://www.nejm.org/doi/full/10.1056/NEJMra1906193 

NIMH (NIH): Bipolar Disorder—symptoms, diagnosis (DSM‑aligned), specifiers, and treatments; patient‑facing and clinician‑relevant overviews.https://www.nimh.nih.gov/health/topics/bipolar-disorder

Overview
When to use
Why use
Evidences

Bipolar Disorder is a chronic psychiatric condition characterized by recurrent episodes of mood elevation (mania or hypomania) and depression. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines structured diagnostic criteria to ensure reliable and consistent identification of the disorder.

A diagnosis requires meeting specific episode-based criteria. A manic episode is defined as a distinct period of abnormally elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary), accompanied by three or more symptoms such as inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, or risky behavior. The mood disturbance must cause marked impairment, hospitalization, or psychotic features.

A hypomanic episode involves similar symptoms but lasts at least four consecutive days and is not severe enough to cause marked functional impairment or require hospitalization. In contrast, a major depressive episode requires at least five symptoms present during the same two-week period, with at least one being depressed mood or loss of interest/pleasure.

Bipolar I Disorder is diagnosed with at least one manic episode, with or without depressive episodes. Bipolar II Disorder requires at least one hypomanic episode and one major depressive episode, without any manic episodes. Cyclothymic Disorder involves chronic fluctuating mood disturbances with subthreshold hypomanic and depressive symptoms lasting at least two years.

Overview
When to use
Why use
Evidences

Interpretation

Episode Type

Duration

Key Symptoms

Functional Impact

Manic Episode

≥ 1 week (or any if hospitalization)

≥ 3 manic symptoms (elevated mood, decreased sleep, grandiosity, pressured speech, etc.)

Marked impairment, hospitalization, or psychosis

Hypomanic Episode

≥ 4 days

≥ 3 manic symptoms

Noticeable change in functioning, but not severe impairment or hospitalization

Major Depressive Episode

≥ 2 weeks

≥ 5 depressive symptoms (including mood or anhedonia)

Clinically significant distress or impairment

Cyclothymic Disorder

≥ 2 years

Subthreshold hypomanic and depressive symptoms

Fluctuating mood disturbance without meeting full episode criteria

Regier DA et al. DSM‑5 field trials in the United States and Canada, Part II: Test–retest reliability of selected categorical diagnoses. Am J Psychiatry. 2013;170(1):59–70. Moderate interrater reliability reported for bipolar spectrum diagnoses in real‑world settings, supporting operational utility while noting diagnostic complexity.
https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2012.12070999 

Hirschfeld RMA et al. Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873–1875. MDQ is widely used to screen for bipolar spectrum in patients presenting with depression; positive screens require clinical confirmation.
https://psychiatryonline.org/doi/10.1176/appi.ajp.157.11.1873

Carvalho AF, Firth J, Vieta E. Bipolar disorder. N Engl J Med. 2020;383:58–66. Highlights medical/substance‑induced differentials (e.g., hyperthyroidism, corticosteroids, stimulants) that can mimic hypomania/mania, reinforcing DSM‑5 exclusion criteria.
https://www.nejm.org/doi/full/10.1056/NEJMra1906193 

NIMH (NIH): Bipolar Disorder—symptoms, diagnosis (DSM‑aligned), specifiers, and treatments; patient‑facing and clinician‑relevant overviews.https://www.nimh.nih.gov/health/topics/bipolar-disorder

Frequently Asked Questions

Features and Services FAQs

Discover the full range of features and services we offer and how to use them.

How is Bipolar I different from Bipolar II?+
How long must mania last for diagnosis?+
Can hypomania alone diagnose bipolar disorder?+
How is cyclothymic disorder different?+
Can antidepressants trigger mania in bipolar disorder?+
Is family history relevant in bipolar disorder diagnosis?+

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