DSM-5 criteria for bipolar disorder

Need for DSM-5 criteria for bipolar disorder

The purpose of modifications to the category of Mood Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was to increase precision and refine the diagnosing criteria for a manic, hypomanic, and a depressive episode. One of the significant problems in the DSM-IV-TR was a failure to differentiate these episodes from a person’s usual level of activity, sadness, or disturbance. This difficulty has led to an inability to distinguish bipolar disorder from ADHD, which has lead to overdiagnosis of bipolar disorder in children and adolescents. These changes represent a slight but essential improvement and will lead to high specificity.


Definition of Bipolar disorder

Bipolar disorder includes an extreme and very disorderly happening of an exhilarated mood, which may also happen in fluctuation with a major depressive episode. Now, let us try to understand what euphoric mood means. It is a feeling or state that is more cheerful and elated than average, possibly even ecstatic. Mental health professionals diagnose individuals who have manic episodes, despite no experience of a depressive episode, as having bipolar disorder, words that are used instead of manic depression.


Manic episode and its criteria

An individual must experience a manic episode for a clinician to diagnose the person with bipolar disorder according to DSM-5 criteria. It means that we need first to understand the criteria for a manic episode. The criteria of the manic episode are as under:

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep, for example, sleeping only for 3 hours

  • More talkative than usual

  • Feeling the pressure to keep on talking

  • A gush of ideas or personal experience that thinking is very rapid

  • Inattentiveness as accounted or noticed; getting distracted due to unimportant or irrelevant outside stimuli.

  • Rise in aim-oriented action at social settings, workplace or sexually

  • Psychomotor agitation

  • A lot of engagement in actions that have an increased risk for hurtful results

Different duration of abnormally and continuously elated expansive or frustrated mood and unusually and persistently high activeness or energy prevailing at least one week and present mostly whole day, almost every day, or any period of admission in hospital is required. During the period of mood disturbance and increased energy or activity, three or more of the above symptoms or four symptoms, if the mood is irritable, are present to a considerable level and portray an evident alteration from normal conduct. Though this manic episode must represent an observable change in functioning, it is not severe enough to require hospitalization to prevent self or others.


Two major categories of Bipolar Disorder

Were you aware of these categories before? If not, you will be able to know soon. The two categories of bipolar disorder are bipolar I and bipolar II.


A diagnosis of bipolar I disorders explains a medical course in which the person experiences more than one manic episodes with the probability, though not the need, of occurring more than one major depressive episode.


A question will arise as to how bipolar II disorder is different than the description mentioned above of bipolar I disorder. In contrast, a Bipolar II disorder diagnosis means that the individual has had one or more depressive episodes and at least one that we call a hypomanic episode. The criteria for the hypomanic episode are the same as that of the manic episode, as we read above. The only difference is that it needs to last for at least four consecutive days instead of at least one week, to be called a hypomanic episode. It is a period of elated mood not as extreme as a manic episode.


Mixed features

A person who experiences mania, hypomania, or major depressive episode may portray characteristics of the contrary pole, but not to an intense enough level to meet diagnostic criteria. For example, individuals experiencing an episode of mania may account for feeling upset or empty, tired, or suicidal. DSM-5 uses a specified category of ‘mixed features’ to apply to cases of mania or hypomania when depressive features are present and to episodes of depression in the context of major depressive disorder or bipolar disorder when characteristics of mania or hypomania are present (Whitbourne, Abnormal Psychology: Clinical Perspective on psychological disorders). The existence of this extra ‘mixed category’ reports for those individuals whose symptoms may, either together at a time, with or close in time too, portray the contrary mood symptoms.


Bipolar disorder, rapid cycling

Clinicians diagnose people as having bipolar disorder, rapid cycling if they have four or more episodes within the previous year that meet the criteria for manic, hypomanic, or major depressive disorder (Whitbourne, Abnormal Psychology: Clinical Perspective on psychological disorders). The cycling includes earlier onset, higher depression scores, higher mania scores, and lower global assessment of functioning in some individuals. A past of rapid cycling in the last year and usage of antidepressants also envisage rapid cycling. Medical conditions such as disturbances in sleep-wake cycles and the use of antidepressant medications can contribute to the development of rapid cycling.


Cyclothymic disorder

The cyclothymic disorder includes changes between dysphoria and short, less intense, less disorderly elated states called hypomanic episodes. It is more chronic and less severe than those of bipolar disorder. So how would you know regarding its symptoms? Individuals with this disorder have met criteria for an episode of hypomania a couple of times for at least two years and also have several times of depressive symptoms. Still, they do not have a diagnosis of a major depressive episode. However, the only difference in the case of adolescents and children is of a period which is for a year. During their respective periods of duration, grown-ups, kids, or adolescents have experienced these symptoms continuously for two months or more at a time.


Hence, it is necessary to consult a mental health professional if you or your dear ones experience any of these symptoms. One should never hesitate or delay asking for help as it will make their mental health worse.

Image credits: Getty Images

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