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Subtypes Mania
(minimum duration)Major Depression
(minimum duration)Associated Features Associated Disorders Bipolar I Pure manic or mixed manic episode(s) required (1 week†) May occur (2 weeks) Recurrent in 90% of individuals, completed suicide in 10% to 15%, violent behavior, school/occupational failure, divorce, episodic antisocial behavior Anorexia nervosa, bulimia nervosa, attention deficit/hyperactivity disorder (ADHD), panic disorder, social phobia, substance-related disorder Bipolar II Hypomania (4 days) One or more episodes required (2 weeks) Completed suicide in 10% to 15%, school/occupational failure, divorce Substance abuse or dependence, anorexia nervosa, bulimia nervosa, ADHD, panic disorder, social phobia, borderline personality disorder Cyclothymia Hypomania cycling with depressive symptoms, without manic, mixed, or major depressive episodes (2 years‡ with symptom-free intervals less than 2 months) 15% to 50% risk of developing bipolar I or II disorder Substance-related and sleep disorders Bipolar not otherwise specified Rapid (days) alternation between manic and depressive symptoms without manic, mixed, or major depressive episodes; may include hypomanic episodes (but less than 4 days) without intercurrent depression; may be diagnosed when clinician determines a bipolar disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced *From Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, 2000.
†Shorter duration allowed if hospitalization is required.
‡One-year minimum duration for children/adolescents.
Prominent and persistent disturbance in mood predominates and is characterized by either or both:
- Depressed mood or markedly diminished interest or pleasure in all or almost all activities
- Elevated, expansive, or irritable mood
Evidence that the disturbance is the physiologic consequence of a general medical condition The disturbance is not better accounted for by another mental disorder, such as adjustment disorder with depressed mood in response to the stress of having a general medical condition The disturbance does not occur exclusively during the course of a delirium The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning From Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, 2000.
Prominent and persistent disturbance in mood predominates and is characterized by either or both:
- Depressed mood or markedly diminished interest or pleasure in all or almost all activities
- Elevated, expansive, or irritable mood
Evidence that the symptoms developed during, or within a month of, substance intoxication or withdrawal and that medication use is etiologically related to the disturbance The disturbance is not better accounted for by a mood disorder that is not substance induced (eg, symptoms preceded medication use; symptoms persist for 1 month or more after drug discontinuation) The disturbance does not occur exclusively during the course of a delirium The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning From Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, 2000.
Required (Criterion A) Additional Symptoms for Diagnosis† Elevated, expansive, or irritable mood Inflated self-esteem or grandiosity
Decreased need for sleep
Pressure to talk
Flight of ideas
Distractibility
Increase in goal-directed activity (social, work, school, sexual) or psychomotor agitation
Excessive involvement in pleasurable activities with potential for painful consequences*From Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, 2000.
†At least 3 symptoms must accompany Criterion A symptoms (or 4 if Criterion A is irritable mood).
Two-year history (1-year in children and adolescents) of numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode During this 2-year period (1-year in children and adolescents), person has not been without symptoms of hypomania or depression for more than 2 months at a time No major depressive episode, manic episode, or mixed episode has been present during this 2-year period The hypomanic and depressive symptoms are not better accounted for by schizoaffective disorder and not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified The symptoms are not due to the physiologic effects of medication or drug abuse or to a general medical condition, such as hyperthyroidism The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning From Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, 2000.