DSM-5 Criteria for Bipolar Disorder

INSTRUCTIONS

Episode(s) not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

When to Use

Manic episode

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)

Additional required criteria

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)

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

Episode not attributable to a substance (e.g. drug of abuse, medication, other treatment) or other medical condition

Hypomanic episode

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)

Additional required criteria

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)

Episode associated with an unequivocal change in functioning uncharacteristic of person when not symptomatic

Mood disturbance and change in functioning are observable by others

Episode not severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization (if psychotic features present, the episode is manic)

Episode not attributable to a substance (e.g. drug of abuse, medication, other treatment) or other medical condition

Major depressive episode

Depressive symptoms: ≥5 symptoms during the same 2-week period that are a change from previous functioning; depressed mood and/or loss of interest/pleasure 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

Additional required criteria

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Episode not attributable to physiological effects of a substance or another medical condition

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