Symptoms of Bipolar Disorder (DSM-5 Criteria)

Manic and depressive episodes are among the severe mood fluctuations that define bipolar disorder, a mental health illness. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) distinguishes between three forms of bipolar disorder: cyclothymic disorder, bipolar I disorder, and bipolar II disorder.

The DSM-5 criteria for bipolar disorder, the symptoms of each type, and the diagnosis process will all be covered in this article.

What is Bipolar Disorder?

Bipolar disorder is a long-term mental illness that results in notable changes in behavior, mood, and energy levels. These changes may have an effect on relationships, day-to-day living, and general wellbeing.

Bipolar disorder is divided into various kinds by the DSM-5 according to the intensity and length of mood episodes.

Types of Bipolar Disorder (According to DSM-5)

1. Bipolar I Disorder

characterized by at least one manic episode that necessitates hospitalization or lasts for at least seven days. Although they are not necessary for diagnosis, depressive episodes can also happen.

2. Bipolar II Disorder

includes a minimum of one major depressive episode and one hypomanic episode. Compared to full-blown mania, hypomania is less intense and does not significantly affect functioning. Bipolar II condition does not cause manic episodes.

3. Cyclothymic Disorder (Cyclothymia)

a persistent, milder variant of bipolar disease. For at least two years (one year for children and adolescents), there are many episodes of hypomanic and depressed symptoms. These symptoms do not, however, fully fit the criteria for either serious depression or hypomania.

DSM-5 Criteria for Bipolar Disorder

Manic Episode (Bipolar I Disorder)

A manic episode is defined as a duration of at least seven days (or shorter if hospitalization is necessary) of unusually high, irritable, or expansive mood. At least three of the following symptoms must also be present, or four if the mood is merely irritable:

• Increased energy or activity levels
• Decreased need for sleep (feeling rested after only a few hours)
• Inflated self-esteem or grandiosity (feeling invincible or superior)
• Racing thoughts or flight of ideas
• Talkativeness or pressured speech
• Distractibility (easily losing focus)
• Engaging in risky behaviors (spending sprees, reckless driving, unsafe sex)

The manic episode must seriously affect social interactions, employment, or day-to-day functioning.

Hypomanic Episode (Bipolar II & Cyclothymic Disorder)

The symptoms of a hypomanic episode are similar to those of mania, although they are milder and linger for at least four days. In contrast to complete mania:

• It does not cause significant impairment in social or work life.
• It does not require hospitalization.
• There are no psychotic symptoms (e.g., hallucinations or delusions).

Instead of experiencing full manic episodes, those with bipolar II disease endure hypomanic episodes.

Major Depressive Episode

Five or more of the following symptoms (at least one of which must be a depressed mood or loss of interest) must be present during a major depressive episode, which lasts for at least two weeks:

• Depressed mood (sad, empty, or hopeless feeling most of the day)
• Loss of interest or pleasure in activities once enjoyed
• Significant weight loss or weight gain (without dieting)
• Insomnia or excessive sleeping
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating or making decisions
• Slow or restless movements (psychomotor agitation or retardation)
• Recurrent thoughts of death or suicide

Bipolar I and II disorders are characterized by major depression episodes.

Cyclothymic Disorder Symptoms

Cyclothymic disorder involves chronic mood instability, where a person experiences:

• Hypomanic symptoms that do not meet full criteria for hypomania
• Depressive symptoms that do not meet full criteria for major depression
• Symptoms present for at least 2 years (1 year in children/adolescents)
• Mood swings that occur frequently but never fully stabilize

Unlike Bipolar I or II, cyclothymia does not include full manic or major depressive episodes.

How is Bipolar Disorder Diagnosed?

Bipolar disorder diagnosis follows these key steps:

• Clinical Interview – A psychiatrist or mental health professional evaluates symptoms, mood history, and personal/family mental health history.
• DSM-5 Criteria Check – The clinician determines if symptoms meet the criteria for Bipolar I, Bipolar II, or Cyclothymic Disorder.
• Mood Tracking – Patients may be asked to track their moods over time to identify patterns.
• Medical Tests – Blood work may be done to rule out medical conditions (e.g., thyroid disorders) that could mimic bipolar symptoms.

Commonly Misdiagnosed Conditions

Bipolar disorder is frequently misdiagnosed because its symptoms are similar to those of other mental health disorders. It is occasionally mistaken for:

• Major Depressive Disorder (MDD) – If a doctor only observes depressive symptoms and misses past hypomanic episodes, Bipolar II may be misdiagnosed as depression.
• Borderline Personality Disorder (BPD) – Both involve mood instability, but BPD mood swings are often triggered by external events, whereas bipolar mood episodes occur in cycles.
• ADHD (Attention-Deficit/Hyperactivity Disorder) – Both conditions involve impulsivity and distractibility, but ADHD does not include depressive episodes.

Treatment for Bipolar Disorder

Bipolar disorder cannot be cured, but it can be managed and relapses avoided with the right care.

1. Medications

• Mood stabilizers (e.g., lithium, valproate)
• Antipsychotics (e.g., quetiapine, aripiprazole)
• Antidepressants (in some cases, but used cautiously in Bipolar I)

2. Psychotherapy (Talk Therapy)

• Cognitive Behavioral Therapy (CBT) – Helps manage negative thought patterns.
• Psychoeducation – Helps patients and families understand the disorder.
• Interpersonal and Social Rhythm Therapy (IPSRT) – Helps regulate sleep and daily routines.

3. Lifestyle and Self-Management

• Regular sleep schedule to prevent mood swings.
• Healthy diet and exercise to improve mood stability.
• Avoiding alcohol and drugs, which can trigger episodes.
• Support groups to connect with others who have bipolar disorder.

Conclusion

There are distinct manic, hypomanic, and depressive episodes in bipolar disorder, which is a complex illness. Clinicians can more properly diagnose and distinguish between Cyclothymic Disorder, Bipolar I Disorder, and Bipolar II Disorder by using the DSM-5 criteria.

It’s critical to get expert assistance if you or a loved one is exhibiting bipolar disorder symptoms. People with bipolar disorder can live happy, productive lives if they receive the right care.

FAQs

1. What is the main difference between Bipolar I and Bipolar II?

• Bipolar I includes full manic episodes, while Bipolar II only has hypomanic episodes and requires at least one major depressive episode.

2. How long do manic and depressive episodes last?

• Manic episodes last at least 7 days, while hypomanic episodes last at least 4 days. Depressive episodes typically last at least 2 weeks.

3. Can bipolar disorder be treated without medication?

• While therapy and lifestyle changes help, most cases require medication to manage symptoms effectively.

4. Is bipolar disorder genetic?

• Yes, genetics play a role, but environmental factors also contribute.

5. What should I do if I suspect I have bipolar disorder?

• Consult a mental health professional for an accurate diagnosis and treatment plan.