DSM-5 TR Bipolar and other Disorders Criteria

Bipolar - Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood
and abnormally and persistently increased goal-directed 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 (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences
(e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).
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 (e.g., a drug
of abuse, a medication, other treatment) or to another medical condition.

Bipolar - 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 (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful consequences
(e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).
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 (e.g., a drug
of abuse, a medication, other treatment).

Bipolar - 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.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.)
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 (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every
day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia 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 fear 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 or impairment in social, occupational,
or other important areas of functioning.
C. The epis

Bipolar 1 Disorder Criteria

A. Criteria have been met for at least one manic episode (Criteria A-D under "Manic Episode"
above).
B. The occurrence of the manic and major depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum and other psychotic
disorder.

Bipolar 2 - Criteria

A. Criteria have been met for at least one hypomanic episode (Criteria A-F under "Hypomanic
Episode" above) and at least one major depressive episode (Criteria A-C under
"Major Depressive Episode" above).
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not
better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or unspecified 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.

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.

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 elevated, expansive, or irritable mood, with or without 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 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. Such evidence of an independent bipolar or related disorder
could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms persist
for a substantial period of time (e.g., about 1 month) after the cessation of acute
withdrawal or severe intoxication; or there is other evidence suggesting the existence
of an independent non-substance/medication-induced bipolar and related disorder
(e.g., a history of recurrent non-substance/medication-related episodes).
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.

Bipolar and Related Disorder Due to Another Medical Condition

A. A prominent and persistent period of abnormally elevated, expansive, or irritable mood
and abnormally increased activity or energy that predominates in the clinical picture.
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 or 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.

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. This is done by recording "other specified
bipolar and related disorder" followed by the specific reason (e.g., "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).