Bipolar Disorder Symptoms from the DSM V

The following list of Bipolar Disorder Symptoms are derived from the DSM V. They may prove helpful if you feel that you or a loved one might be suffering from this disorder. After considering the information presented below, you may wish to speak with your doctor or therapist to discuss this possibility further.

Bipolar Disorder is characterized by:

A) A distinct period of an abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal–directed activity or energy, lasting at least one week and present most of the day, nearly every day during this time.

B) During the period of mood disturbance and increased energy or activity, three or more of the following symptoms are present to a significant degree and represent a noticeable change from a person's usual behavior.

  1. Inflated self–esteem or grandiosity.
  2. Decreased need for sleep.
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Distractibility as reported or observed.
  6. Increase in goal–directed activity or psychomotor agitation.
  7. Excessive involvement in activities that have a high potential for painful consequences.

C) The mood disturbance is sufficiently severe to cause marked impairment in social and/or occupational functioning or necessitates hospitalization to prevent harm to self or others, or there are psychotic features.

D) The episode is not attributable to the physiological effects of a substance or to another medical condition.

These criteria constitute a manic episode and at least one lifetime manic episode is required for the diagnosis of bipolar 1 disorder. A hypomanic episode is similar except that the mood lasts at least four consecutive days and is present most of the day nearly every day. Although the episode may not be as severe, it is still an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. These changes in mood and functioning are clearly seen by others. A hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization nor cause psychosis. Again, this mood is not attributable to the physiological effects of a substance. Antidepressants can cause such symptomatology and the diagnosis hypomanic episode is given when the symptoms outlast the physiological effects of the antidepressant.

Although Bipolar 1 disorder needs to be characterized by a single episode of mania, more often the illness is characterized by shifting moods from mania to depression or from depression to
mania.

A major depressive episode is characterized by five or more of the following symptoms that have been present during the same two-week period and represent a change from previous functioning. At least one of these symptoms is either depressed mood or loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day as indicated by her subjective report or observation made by others.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or a decrease or increase in appetite nearly every day.
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day.
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  9. Recurrent thoughts of death, recurrent suicidal idealization without a specific plan, or suicide attempt or a specific plan for committing suicide.

These symptoms cause clinically significant distress or impairment in social, occupational, and other important areas of functioning. This episode is not attributable to the physiological effects of a substance or another medication.

This illness is highly variable person-to-person. Because of this, additional specifier’s can be used to help communicate the type and severity of the illness.

If there is anxious distress. This would include at least two of the following five symptoms. Feeling keyed up or tense. Feeling unusually restless. Difficulty concentrating because of worry. Fear that something awful might happen. Feeling that an individual might lose control of himself or herself.

If there are mixed features. This specifier could be added to either a manic or hypomanic episode and include at least three of the following symptoms. Predominant dysphoria or depressed mood as indicated by either subjective report or observation made by others. Diminished interest or pleasure in all, or almost all, activities. Psychomotor retardation nearly every day. Fatigue or loss of energy. Feelings of worthlessness or excessive or inappropriate guilt. Recurrent thoughts of death. If all depressive and manic symptom criteria are met the diagnosis manic episode with mixed features should be made.

If there is rapid cycling. Presence of at least four mood episodes in the previous 12 months that meet criteria for manic, hypomanic, or major depressive episode.

If there are melancholic features. One of the following is present during the most severe of the current episode. Loss of pleasure in all or almost all activities. Lack of reactivity to usually pleasurable stimuli. Additionally, there needs to be three or more of the following criteria. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood. Depression that is regularly worse in the morning. Early morning awakening. Marked psychomotor agitation or retardation, significant anorexia or weight loss.

Excessive or inappropriate guilt.

If there are atypical features. This specifier can be applied when the following features predominate during the majority of days of the current or most recent depressive mood. Mood reactivity and to more the following. Significant weight gain or increased appetite. Hypersomnia. Letter and paralysis. A long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment.

If there are mood congruent psychotic features. During the manic episode, the content of all delusions and hallucinations is consistent with the typical manic themes.

If there are mood incongruent psychotic features. The content of delusions and hallucinations is inconsistent with the episode polarity themes as described.

If catatonia is present. This specifier can apply to an episode of mania or depression if catatonic features are present during most of the episode. Catatonia includes lack of psychomotor activity, passive maintenance of the posture held against gravity, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypic, agitation, grimacing, echolalia, and echopraxia. Echopraxia is the mimicking of another’s movements.

If present from peripartum onset. This specifier can be applied to the current episode if symptoms occur during pregnancy or in the four weeks following delivery.

If there is a seasonal pattern. There has been a regular temporal relationship between the onset of manic, hypomanic, or major depressive episode and a particular time of year. Full remissions also come at a characteristic time of year. In the last two years the individual’s mood events have demonstrated a temporal seasonal relationship. Seasonal mood events substantially outnumber any known seasonal mood events.

As you can tell, this particular “symptom collection” can be quite severe. As we reviewed above, it can take many years to make the appropriate diagnosis. This is because many times this disorder begins with an apparent simple depression. Another diagnostic hint is the greater incidence of postpartum depression and winter depression in Bipolar Disorder over Major Depressive Disorder.

These distinctions are important as treatment of bipolar disorder with antidepressants without mood stabilizers is contraindicated. Not infrequently, use of unopposed antidepressants can slowly increase the cycling of bipolar disorder. If a person has been treated with several antidepressants without response, strong consideration needs to be given to the possibility of another diagnosis.

Although medications are a portion of the treatment of bipolar disorder a wide variety of other types of therapy are available and take into consideration all aspects of who you are as a person.

Please also consider becoming a member of the Patients seeking Oneness to augment the support you desire.

Take Care!

My Friend Took their Life: Coping with Difficult Feelings
Healthy Habits and Psychotherapy for Bipolar Disorder
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