Diagnosis Guide

The Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, lists the diagnostic criteria for all mental disorders.

Now in its fourth edition, with a fifth currently in the works, the DSM lays out the specific criteria needed to be diagnosed with bipolar disorder, or its subtypes.

While the DSM addresses numerous specific factors regarding bipolar disorder and its manic and depressive episodes, here is a simplified version of the diagnostic criteria established by the DSM.

Bipolar disorder is a mental condition where a person fluctuates between periods of mania and depression.


The DSM defines a manic episode as a “distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood” that must last for a week, or less if hospitalization is required. The mood must be accompanied with at least three of the following symptoms:

  • Inflated self-esteem
  • Decreased need for sleep
  • Pressure of speech
  • Flight of ideas
  • Distractibility
  • Increased involvement in goal-directed activities or psychomotor agitation
  • Excessive involvement in pleasurable activities with a high potential for painful consequences


The DSM defines a major depressive episode as at least four of the following qualities that must be newly present or recently worsened for a period of at least two weeks:

  • Changes in appetite or weight, sleep, or psychomotor activity
  • Decreased energy
  • Feelings of worthlessness or guilt
  • Difficulty thinking, concentrating, or making decisions
  • Recurrent thoughts of death or suicidal ideation, plans, or attempts

Bipolar I Disorder

The main symptom of bipolar I disorder involves one or more manic episodes or mixed episodes that are not otherwise explained by another medical condition or as a result of medications or other substances.

Bipolar II Disorder

The essential feature of bipolar II disorder is the occurrence of one or more major depressive episodes accompanied by at least one hypomanic episode. The symptoms must cause significant distress or impairment in work, school, or personal endeavors.

It is common that people with bipolar II disorder do not recall the hypomanic episodes and are only aware of them when told by friends or loved ones.


This type of bipolar disorder involves chronic, fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least two years. For adults, a symptom-free period lasts no longer than two months, or one month for children or adolescents.

Bipolar Disorder Not Otherwise Specified

This category refers to bipolar symptoms that do not qualify for other subtypes. These can include rapid mood fluctuations not long enough to qualify for a manic episode or depressive episode, or repeated hypomanic episodes without a major depressive episode.

This information should not be used as a tool to diagnose yourself or someone you know. Only a qualified mental health expert can do that. This information is for education purposes only.