By Candida Fink, Joe Kraynak

Part of Bipolar Disorder For Dummies Cheat Sheet

Bipolar disorder is a physical illness that affects the brain. A bipolar diagnosis requires at least one episode of mania (wired thinking and behaviors that negatively affect one’s ability to function) or hypomania (a less severe form of mania), and the disorder typically includes episodes of depression that alternate with the mania or hypomania. Your specific diagnosis depends on your symptoms.

Bipolar disorder diagnostic categories

In the United States, doctors refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which provides several different categories for bipolar disorder:

  • Bipolar I: The classic form of bipolar disorder involves clear-cut manic episodes, usually alternating with periods of major depression and euthymic (even-mood) periods. A single manic episode, even without depression, is sufficient for a bipolar I diagnosis.

  • Bipolar II: People with bipolar II experience depressive episodes that alternate with hypomanic episodes. If mania enters the picture, the diagnosis changes to bipolar I.

  • Cyclothymic disorder: Multiple depressive and hypomanic episodes over the course of at least two years (or one year in children and adolescents) that are severe enough to disrupt life but not extreme enough, in intensity or duration, to warrant a diagnosis of bipolar I or II characterize this form of bipolar.

  • Substance/medication-induced bipolar disorder: Bipolar symptoms can be attributed to intoxication or withdrawal from drugs or alcohol or medication side effects.

  • Bipolar and related disorder due to another medical condition: Bipolar symptoms can be attributed to another medical condition, such as hyperthyroidism (overactive thyroid).

  • Other specified bipolar and related disorder: Introduced in DSM-5, this diagnosis enables doctors to diagnose bipolar disorder when symptoms characteristic of bipolar disorder significantly impair normal function or cause considerable distress, but don’t quite meet the full diagnostic criteria for the other bipolar diagnostic classes.

  • Unspecified bipolar disorder: This form of bipolar involves variations of cycling moods that resemble manic or depressive episodes and interfere with daily routines but don’t fulfill the complete diagnostic requirements for the other classifications of bipolar disorder in this list. This diagnosis is used instead of other specified bipolar and related disorder when a doctor, for whatever reason, doesn’t want to go into detail about why the criteria for a specific bipolar diagnosis hasn’t been met — for example, in emergency room settings.

Bipolar disorder specifiers

The DSM-5 provides specifiers that enable doctors to more fully describe the person’s condition:

  • Current or most recent episode: Manic, hypomanic, or depressed.

  • Severity of illness: Mild, moderate, or severe.

  • Presence or absence of psychosis: Delusional thinking, paranoia, or hallucinations that may accompany depression or mania.

  • Course of illness: Active (with or without psychosis), in partial remission, or in full remission.

  • With anxious distress: If symptoms include anxiety.

  • With mixed features: For example, mania with symptoms of depression, such as guilt, hopelessness, or suicidal thoughts; or depression with symptoms of mania, such as physical agitation and racing thoughts.

  • With rapid cycling: Four or more mood episodes in a 12-month period.

  • With melancholic features: Extreme depression.

  • With atypical features: Symptoms that used to be considered less typical of depression but are now recognized as frequent features of depression.

  • With mood-congruent psychotic features: Hallucinations or delusions that reflect the mood — for example, delusions of grandiosity and power during a manic episode or delusions of guilt and hurting other people during depressed periods.

  • With catatonia: A state of minimal responsiveness to the environment and abnormal movement.

  • With peripartum onset: The bipolar mood episode occurs any time during pregnancy or in the four weeks after delivery.

  • With seasonal pattern: Mood episodes follow a pattern corresponding to the seasons or specific times of year.