DSM-5 Diagnostic Criteria
Bipolar I disorder
For a diagnosis of bipolar I disorder, the following criteria for a manic episode need to be met. Before or after the manic episode there may have been hypomanic episodes or episodes of major depression.
manic episode.
A. A well-defined period of abnormally and persistently elevated, expansive or irritable mood, and an abnormal and persistent increase in
objective, which lasts at least a week and is present most of the day, almost every day (or any duration if hospitalization is needed).
B. During the period of altered mood and increased energy or activity, three (or more) of the following symptoms (four if the mood is irritable only) exist to a significant degree and represent a noticeable change in mood. usual behavior:
1. Increased self-esteem or feeling of greatness.
2. Decreased need for sleep (e.g., you feel rested after only three hours of sleep).
3. More talkative than usual or pressure to keep the conversation going.
4. Flight of ideas or subjective experience that thoughts are going at high speed.
5. Ease of distraction (i.e., attention shifts too easily to unimportant or irrelevant external stimuli), as reported or observed.
6. Increased goal-directed activity (social, at work or school, or sexual) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive participation in activities that have a high potential for painful consequences (e.g., engaging in unrestrained shopping, carousing, sexual indiscretions, or reckless money investments).
C. The mood disturbance is severe enough to cause significant impairment in social or occupational functioning, to require hospitalization to avoid harm to self or others, or because psychotic features are present.
D. The episode cannot be attributed to the physiological effects of a substance (e.g., a drug, medication, other treatment) or another medical condition.
Note: A full-blown manic episode that appears during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists to a fully syndromic degree beyond the physiological effect of that treatment is sufficient evidence of a manic episode and, therefore, a diagnosis of
bipolar I disorder.
Note: Criteria A–D constitute a manic episode. At least one manic episode in a lifetime is needed for a diagnosis of bipolar I disorder.
Hypomanic episode.
A. A well-defined period of abnormally and persistently elevated, expansive, or irritable mood, and an abnormal and persistent increase in activity or energy, lasting for at least four consecutive days and present for most of the day, almost every day. the days.
B. During the period of altered mood and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is irritable only), represent a noticeable change in usual behavior, and have been present to a significant degree:
1. Increased self-esteem or feeling of greatness.
2. Decreased need for sleep (e.g., you feel rested after only three hours of sleep).
3. More talkative than usual or pressure to keep the conversation going.
4. Flight of ideas or subjective experience that thoughts are going at high speed.
5. Ease of distraction (i.e., attention shifts too easily to unimportant or irrelevant external stimuli), as reported or observed.
6. Increased goal-directed activity (social, at work or school, or sexual) or psychomotor agitation.
7. Excessive participation in activities that have a high potential for painful consequences (e.g., engaging in unrestrained shopping, carousing, sexual indiscretions, or reckless money investments).
C. The episode is associated with an unequivocal change in functioning that is not characteristic of the individual when no symptoms are present.
D. The alteration in mood and change in functioning are observable by other people.
E. The episode is not severe enough to cause significant impairment in social or occupational functioning, or require hospitalization. If psychotic features are present, the episode is, by definition, manic.
F. The episode cannot be attributed to the physiological effects of a substance (e.g., a drug, medication, other treatment).
Note: A full-blown hypomanic episode that occurs during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists to a fully syndromic degree beyond the physiologic effect of that treatment is sufficient evidence of a hypomanic episode. However, it is recommended
caution because one or two symptoms (particularly increased irritability, nervousness, or agitation after use of antidepressants) are not considered sufficient for the diagnosis of a hypomanic episode, nor does it necessarily indicate a bipolar diathesis.
Note: Criteria A–F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not necessary for the diagnosis of bipolar I disorder.
Episode of major depression.
A. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.
Note: Does not include symptoms that can be clearly attributed to
other medical condition
1. Depressed mood most of the day, almost every day, as derived from subjective information (e.g., you feel sad, empty, or hopeless) or from observation by other people (e.g. (e.g., he looks tearful). (Note: In children and adolescents, mood may be irritable.)
2. Significant decrease in interest or pleasure in all or almost all activities most of the day, almost every day (as indicated by subjective information or observation).
3. Significant weight loss without dieting or weight gain (e.g., change of more than 5% of body weight in a month) or decrease or increase in appetite almost every day. (Note: In children, consider failure to gain expected weight.)
4. Insomnia or hypersomnia almost every day.
5. Psychomotor agitation or retardation almost every day (observable by others; not simply the subjective feeling of restlessness or slowing down).
6. Fatigue or loss of energy almost every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) almost every day (not simply self-reproach or guilt for being ill).
8. Decreased ability to think or concentrate, or make decisions, almost every day (based on subjective accounts or observations by other people).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, suicide attempt or a specific plan to carry it out.
B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode cannot be attributed to the physiological effects of a substance or another medical condition.
Note: Criteria A–C constitute a major depressive episode. Episodes of major depression are common in the disorder
bipolar I but are not necessary for the diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., grief, financial ruin, losses due to a natural disaster, serious illness, or disability) may include feeling intense sadness, ruminating about the loss, insomnia, lack of of appetite and weight loss described in Criterion A, which can mimic a depressive episode. Although these symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires clinical judgment based on the individual’s history and cultural norms for expressing distress in the context of loss.
Bipolar II disorder 296.89 (F31.81)
For a diagnosis of bipolar II disorder, the following criteria need to be met for a current or past hypomanic episode and the following criteria for a current or past major depressive episode:
Hypomanic episode.
A. A well-defined period of abnormally and persistently elevated, expansive, or irritable mood, and an abnormal and persistent increase in activity or energy, lasting for at least four consecutive days and present for most of the day, almost every day. the days.
B. During the period of altered mood and increased energy and activity, three (or more) of the following symptoms have persisted (four if mood is irritable only), represent a noticeable change in usual behavior and have been present to a significant degree:
1. Increased self-esteem or feeling of greatness.
2. Decreased need for sleep (e.g., you feel rested after only three hours of sleep).
3. More talkative than usual or pressure to keep the conversation going.
4. Flight of ideas or subjective experience that thoughts are going at high speed.
5. Ease of distraction (i.e., attention shifts too easily to unimportant or irrelevant external stimuli), as reported or observed.
6. Increased goal-directed activity (social, at work or school, or sexual) or psychomotor agitation.
7. Excessive participation in activities that have a high potential for painful consequences (e.g., engaging in unrestrained shopping, carousing, sexual indiscretions, or reckless money investments).
C. The episode is associated with an unequivocal change in functioning that is not characteristic of the individual when no symptoms are present.
D. The alteration in mood and change in functioning are observable by other people.
E. The episode is not severe enough to cause significant impairment in social or occupational functioning or require hospitalization. If psychotic features are present, the episode is, by definition, manic.
F. The episode cannot be attributed to the physiological effects of a substance (e.g., a drug, medication, or other treatment).
Note: A complete hypomanic episode that appears during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists to a fully syndromic degree beyond the physiological effect of…