Bipolar and Related Disorders & Depressive Disorders

Bipolar I Disorder for Manic Episode

For a diagnosis of Bipolar I disorder, it is necessary to meet the following criteria for a manic episode.
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from 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.
6. Increase in goal-directed activity.
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 or occupational functioning or to necessitate 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 another medical condition.

Bipolar I Disorder for Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
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.
6. Increase in goal-directed activity.
7. Excessive involvement in activities that have a high potential for painful consequences.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance or another medical condition

Bipolar I Disorder for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure:
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (feels sad, empty, or hopeless) or observation made by others.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
4. Insomnia or hyperinsomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may by delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just feat of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress of impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Bipolar I Disorder

A. Criteria have been met for at least one manic episode.
B. At least one manic episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Bipolar II Disorder for Hypomanic Episode

For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode.
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:
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.
6. Increase in goal-directed activity.
7. Excessive involvement in activities that have a high potential for painful consequences.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance.

Bipolar II Disorder for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated by either 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 (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
4. Insomnia or hyperinsomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just feat of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress in impairment in social occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Bipolar II Disorder

A) Criteria have been met for at least one hypomanic episode and at least one major depressive episode
B) There has never been a manic episode.
C) At least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective disorder, delusional disorder, or other specified or unspecified psychotic schizophrenia spectrum and other psychotic disorder.
D) The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify current or most recent episode:
If current episode is hypomanic:
With anxious distress
With mixed features
With rapid cycling
With peripartum onset
With seasonal pattern
If current episode is depressed:
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal onset
- Specify course if full criteria for a mood episode are not currently met:
In partial remission
In full remission
- Specify severity level if full criteria for a major depressive episode are currently met:
Mild
Moderate
Severe

Cyclothymic Disorder

A) For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B) During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C) Criteria for a major depressive, manic, or hypomanic episode have never been met.
D) The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
E) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify if:
With anxious distress

Substance/Medication-Induced Bipolar and Related Disorder

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy.
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
C. The disturbance is not better explained by a bipolar or related disorder that is not substance/medication induced.
D. The disturbance does not occur exclusively during the course of delirium.
E. The disturbance causes clinically significant distress of impairment in social, occupational, or other important areas of functioning.
- Specify:
With onset during intoxication
With onset during withdrawal
With onset during medication use

Bipolar and Related Disorder Due to Another Medical Condition

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress of impairment in social, occupational, or other important areas of functioning, or necessitates hospitalization to prevent harm to self or others, or there are psychotic features.
- Specify if:
With manic features: Full criteria are not met for a manic or hypomanic episode
With manic- or hypomanic-like episode: Full criteria are met except Criterion D for a manic episode except for Criterion F for a hypomanic episode.
With mixed features: Symptoms of depression are also present but do not predominate in the clinical picture.

Other Specified Bipolar and Related Disorder

This category applies to presentations in which symptoms characteristic of a bipolar and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the bipolar and related disorders diagnostic class. The other specified bipolar and related disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific bipolar and related disorder. Examples include short-duration hypomanic episodes, hypomanic episode without prior depressive episode, and short-duration cyclothymia.

Unspecified Bipolar and Related Disorder

This category applies to presentations in which symptoms characteristic of a bipolar and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the bipolar and related disorders diagnostic class. The unspecified bipolar and related disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific bipolar and related disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

Unspecified Mood Disorder

This category applies to presentations in which symptoms characteristic of mood disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but DO NOT at the time of the evaluation meet the full criteria for any of the disorders in either the bipolar or the depressive disorders diagnostic classes in which it is difficult to choose between unspecified bipolar and related disorder and unspecified depressive disorder

Disruptive Mood Dysregulation Disorder

A. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others.
E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in A-D.
F. Criteria A and D are present in at least two of three settings (home, school, and peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history, or observation, the age at onset of Criteria A-E is before 10 years old.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode has been met.
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.
K. The symptoms are not attributable to the physiological effects of a substance or another medical or neurological condition.

Major Depressive Disorder

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others.
2. Markedly diminished interest or pleasure in all, or almost all activities most of the day, nealry every day.
3 Significant weight loss.
4. Insomnia or hyerinsomnia nealry 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.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
D. At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
- Specify if:
With anxious distress
With mixed features
With melancholic features
With atypical features
With mood=congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern

Persistent Depressive Disorder

This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder.
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
- In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify if:
With anxious distress
With atypical features
- Specify if:
In partial remission
In full remission
- Specify if:
Early onset: If onset is before age 21 years.
Late onset: If onset is after age 21 years or older.
- Specify if (for most recent 2 years of persistent depressive disorder):
With pure dysthymic syndrome: Full criteria for a major depressive episode have not met in at least the preceding 2 years.
With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode.
With intermittent major depressive episodes

Premenstrual Dysphoric Disorder

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset on menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
1. Marked affective lability (mood swings, feelings suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities.
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain.
- The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.
D. The symptoms cause clinically significant distress of interference with work, school, usual social activities, or relationships with others.
E. The disturbance is not merely an exacerbation of the symptoms of another disorder, a personality disorder, panic disorder, persistent depressive disorder, or a personality disorder.
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.
G. The symptoms are not attributable to the physiological effects of a substance or another medical condition.

Substance/Medication-Induced Depressive Disorder

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
C. The disturbance is not better explained by a depressive disorder that is not substance/medication-induced.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance cases clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify:
With onset during intoxication: If criteria are met for intoxication with the substance and the symptoms develop during intoxication.
With onset during withdrawal: If criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, withdrawal.
With onset after medication use: If symptoms developed at initiation of medication, with a change in use of medication, or during withdrawal of medication.

Depressive Disorder Due to Another Medical Condition

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another mental disorder.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Other Specified Depressive Disorder

This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The other specified depressive disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific depressive disorder.

Unspecified Depressive Disorder

This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The unspecified depressive disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis.

Unspecified Mood Disorder

This category applies to presentations in which symptoms characteristic of mood disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but DO NOT at the time of the evaluation meet the full criteria for any of the disorders in either the bipolar or the depressive disorders diagnostic classes in which it is difficult to choose between unspecified bipolar and related disorder and unspecified depressive disorder.

Specifiers

-Depressive Disorders
With anxious distress (and severity)​
With mixed features​
With melancholic features​
With atypical features​
With psychotic features (mood congruent or incongruent)​
With catatonia​
With peripartum onset​
With seasonal pattern​
In partial remission​
In full remission​
Severity - mild, moderate, severe​
-Bipolar Disorders
With anxious distress (and severity)​
With mixed features​
With melancholic features​
With atypical features​
With psychotic features (mood congruent or incongruent)​
With catatonia​
With peripartum onset​
With seasonal pattern​
In partial remission​
In full remission​
Severity - mild, moderate, severe
With rapid cycling​
Mixed features is categorized based on whether the episode is primarily:​
Manic episode with mixed features​
Hypomanic episode with mixed features​
Depressive episode with mixed features​

Anxious Distress Specifier

-Bipolar and depression
The presence of at least two of the following symptoms during the majority of the days of the current manic, hypomanic, or major depressive episode in bipolar I or II disorder; or during the majority of the symptomatic days in cyclothymic disorder:
1. Feeling keyed up or tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of himself or herself.
- Specify current severity:
Mild: Two symptoms.
Moderate: Three symptoms.
Moderate - Severe: Three to four symptoms.
Severe: Four to five symptoms with motor agitation.

Mixed Features Specifier

- Bipolar
Applies to the current manic, hypomanic, or major depressive episode in bipolar I disorder or to the current hypomanic or major depressive episode in bipolar II disorder
Manic or hypomanic episode, with mixed features:
A. Full criteria are met for a manic episode or hypomanic episode, and at least three of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania:
1. Prominent dysphoria or depressed mood as indicated by either subjective report or observation made by others.
2. Diminished interest or pleasure in all, or almost all, activities.
3. Psychomotor retardation nearly every day.
4. Fatigue or loss of energy.
5. Feelings of worthlessness or excessive or inappropriate guilt.
6. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. Mixed symptoms are observable by others and represent a change from the person's usual behavior.
C. For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features, due to the marked impairment and clinical severity of full mania.
D. The mixed symptoms are not attributable to the physiological effects of a substance
- Depression
A. At least three of the following manic/hypomanic symptoms are present during the majority of days of the current major depressive episode:
1. Elevated, expansive mood.
2. Inflated self-esteem or grandiosity.
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experiences that thoughts are racing.
5. Increase in energy or goal-directed activity.
6. Decreased need for sleep
B. Mixed symptoms are observable by others are represent a change from the person's usual behavior.
C. For individuals whose symptoms meet full criteria for either mania or hypomania, the diagnosis should be bipolar I or bipolar II disorder.
D. The mixed symptoms are not attributable to the physiological effects of a substance.

Rapid Cycling Specifier

- Bipolar
Prescence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode in bipolar I or II disorder.

Melancholic Features Specifier

- Bipolar and depression
A. One of the following is present during the most severe periods of the current major depressive episode:
1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli
B. Three (or more) of the following:
1. A distinct quality f depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
2. Depression that is regularly worse in the morning.
3. Early-morning awakening.
4. Marked psychomotor agitation or retardation.
5. Significant anorexia or weight loss.
6. Excessive or inappropriate guilt.

Atypical Features Specifier

- Bipolar and depression
This specifier is applied when these features predominate during the majority of days of the current major depressive episode:
A. Mood reactivity
B. Two (or more) of the following:
1. Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis
4. A long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment.
C. Criteria are not met for "with melancholic features" or "with catatonia" during the same episode.

Psychotic Features Specifier

- Depression and bipolar
Delusions and hallucinations are present at any time in the current manic or major depressive episode in bipolar I disorder or in the current major depressive episode in bipolar II disorder. If psychotic features are present, specify if mood-congruent or mood-incongruent:
With mood-congruent psychotic features: The content of all delusions and hallucinations is consistent with the typical manic themes of grandiosity, invulnerability, etc., but may also include themes of suspiciousness or paranoia, especially with respect to others' doubts about the individual's capabilities, accomplishments, and so forth
With mood-incongruent psychotic features: The content of the delusions and hallucinations does not involve typical manic themes as described above, or the content is a mixture of mood-congruent and mood-congruent themes.

- Bipolar
When applied to current or most recent major depressive episode:
With mood-congruent psychotic features: The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment.
With mood-incongruent psychotic features: The content of the delusions and hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes.

Catatonia Specifier

-Bipolar and depression
This specifier is applied to the current manic or major depressive episode in bipolar I or II if catatonia features are present during most of the episode.

Peripartum Onset Specifier

- Bipolar and depression
This specifier is applied to the current manic or major depressive episode in bipolar I or to the current hypomanic or major depressive episode in bipolar II disorder if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

Seasonal Pattern Specifier

- Bipolar and depression
This specifier applies to the lifetime pattern of mood episodes. This essential feature is a regular pattern of at least one type of episode. The other types of episodes may not follow this pattern.
A. There has been a regular temporal relationship between the onset of manic, hypomanic, or major depressive episodes and a particular time of the year in bipolar I or II disorder.
B. Full remissions also occur at a characteristic time of the year.
C. In the last 2 years, the individual's manic, hypomanic, or major depressive episodes have demonstrated a temporal seasonal relationship, as defined above, and no nonseasonal episodes of that polarity have occurred during that 2-year period.
D. Seasonal manias, hypomanias, or depressions substantially outnumber any nonseasonal manias, hypomanias, or depressions that may have occurred over the individual's lifetime.

In Partial and Full Remission Specifier

-Bipolar and depression
In partial remission: Symptoms of the immediately previous manic, hypomanic, or major depressive episode are present but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a manic, hypomanic, or major depressive episode following the end of such an episode.
In full remission: During the past few months, no significant signs or symptoms of the disturbance were present.

Severity Specifier

Manic episode:
Mild: Minimum symptom criteria are met for a manic episode.
Moderate: Very significant increase in activity or impairment in judgement.
Severe: Almost continual supervision is required in order to prevent physical harm to self or others.

Major depressive episode:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
Moderate: The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for "mild" and "severe."
Severe: The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.

What is the difference between a manic episode and a hypomanic episode?

A manic episode must last at least 1 week while a hypomanic episode must last at least 4 consecutive days. In a manic episode, the mood disturbance is sufficiently severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to others or there are psychotic features. Meanwhile, in a hypomanic episode, the episode is not severe enough to cause marked impairment in social and occupational functioning or to necessitate hospitalization.