To be diagnosed with bipolar disorder, a person must meet the criteria detailed in theAmerican Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Mental health providers use this manual to diagnose mental conditions, including the types of bipolar disorder.
General Diagnostic Criteria
To determine symptoms in a patient, a mental health specialist will conduct a psychological evaluation and ask about thoughts, feelings, and mood changes the person might be having. The patient may be asked to create a mood chart—a daily record of the person’s mood, sleep patterns, and other factors that can help with diagnosis. Briefly, here are the diagnostic criteria for each type of bipolar disorder:
Bipolar I Disorder
To be diagnosed with bipolar I, a person needs to have had at least one manic episode or one mixed episode and may or may not have had a major depressive episode.
Bipolar II Disorder
To be diagnosed with bipolar II, a person needs to have had at least one major-depressive episode and at least one hypomanic episode, in which symptoms are not as severe as in full-blown mania.
This type is characterized by mood swings that are less severe and episodes shifting from hypomania to mild depression. For a diagnosis of cyclothymic disorder, mood shifts must occur—without extended periods of being symptom free—for at least two year in adults and at least one year in children and adolescents.
Bipolar Disorder Not Otherwise Specified
Someone may be diagnosed with this classification of bipolar disorder when they have too few symptoms or have symptoms that do not last long enough to meet the diagnostic criteria for either bipolar disorder I or II, or cyclothymia.
Rapid-Cycling Bipolar Disorder
This is the diagnosis given when a person has had rapid changes in mood—with four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. Some people experience more than one episode in a week or even within one day. Rapid cycling seems to be more common in people who have their first episode at a younger age, and it affects more women than men. Although most studies indicate that only 10 to 20 percent of patients with bipolar disorders have the rapid-cycling form, it is of great concern to psychiatrists because it is often more difficult to treat than other types of bipolar disorder.
Criteria for Mania
In a manic episode, an individual will be in an abnormally and persistent elevated or irritated mood that lasts at least one week (or less than one week if hospitalization is necessary).
During the period of elevated mood, three or more of the following symptoms must be present (or four symptoms if the main mood is elevated irritability):
- inflated self-esteem
- decreased need for sleep
- racing thoughts
- easy distractibility
- unusual talkativeness (pressure speech)
- participation in hedonistic activities that are risky (such as spending sprees or promiscuous sex)
To be considered a manic episode, the mood disturbance must be unusually severe and disruptive, which is characterized by the following:
- severe enough to cause obvious difficulty at school, work, or in relationships
- severe enough to cause a hospitalization
- severe enough to cause a psychotic break from reality
Criteria for Depression
In a major depression episode, a person must have five (or more) of the following symptoms during a two-week period:
- feeling sad, empty, or tearful most of the day nearly every day
- loss of interest in activities most of the day nearly every day
- excessive sleeping or insomnia nearly every day
- fatigue nearly every day
- feelings of worthlessness nearly every day
- diminished ability to think or concentrate nearly every day
- significant unintended weight loss or weight gain
- decreased or increased appetite nearly every day
- recurrent thoughts of suicide or a suicide attempt
To be considered a major depression episode, symptoms must be severe enough to disrupt daily life. It must be severe enough to cause obvious difficulty in school, at work, or in relationships. The sadness or depression cannot be due to grieving or the direct effects of something else—such as substance abuse or a medical condition like hypothyroidism or fibromyalgia.
Criteria for Hypomania
A hypomanic episode is a period of elevated or irritable mood that is distinctly different from the usual non-depressed mood and that lasts at least four days. The same symptoms as mania are present, but in hypomania, the mood change isn’t severe enough to cause significant difficulty in school, at work, or in relationships, and it is not severe enough to require a hospitalization or trigger a psychotic break. The change in mood may only be noticeable enough to cause an uncharacteristic change in a person’s behavior and functioning. The change in mood must clearly not be caused by medication side effects, illicit substances, or a medical condition.
Criteria for Mixed Episodes
To be diagnosed with having had a mixed episode, criteria must be met for both a manic episode and a major depressive episode during the same day nearly every day for at least one week. The mood disturbance must be severe enough to cause obvious difficulty at school, work, or in relationships; require hospitalization to prevent self-harm or harm to others; or cause a break from reality.