Bipolar Disorder Diagnostic features DSM-IV

[MSBLUE]

The definitions given below are from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (American Psychiatric Association, 1400 K Street NW, Suite 1101, Washington, DC 20005-2403 USA).

Bipolar I Disorder--Diagnostic Features (DSM-IV, p. 350)
The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.


Bipolar II Disorder--Diagnostic Features (DSM-IV, p. 359)
The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode. Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode. Episodes of Substance- Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Criteria for Major Depressive Episode (DSM-IV, p. 327)
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 due to a general medical condition, or mood-incongruent delusions or hallucinations.

depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.
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 made by others)
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 gains.
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
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 do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Criteria for Manic Episode (DSM-IV, p. 332)
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for Mixed Episode (DSM-IV, p. 335)
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A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Criteria for Hypomanic Episode (DSM-IV, p. 338)
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable 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 person 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, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

DSM-IV
(Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). The DSM-IV is the reference book used by mental health professionals in the United States and in other countries to diagnose mental health disorders. Because of this, we used it as the basis for our descriptions of the various mental health disorders on this site. The diagnoses in DSM-IV were coordinated with those in the International Classification of Diseases-10 (ICD-10) in order to facilitate communication between mental health professionals in different countries.


PSYCHOSIS
Most definitions of psychosis require a diagnosis of severe functional impairment that follows a more normal adjustment; schizophrenia is the classical form of psychosis, but delirium and the dementias would also be included as psychotic reactions according to most definitions. Mental retardation, although it may involve severe functional impairment, is not regarded as a psychosis unless it is accompanied by psychotic symptoms like hallucinations or delusions.

http://healthinmind.com/english/schizetc.htm

SCHIZOPHRENIA
Schizophrenia is a severe form of psychosis whose symptoms often include hallucinations, delusions, disorganized speech and behavior, illogical thought, social withdrawal, and inappropriate affect. To be diagnosed with schizophrenia, the person must have been disturbed for at least 6 months, and not be the result of drug induced psychosis or psychosis NOS.

[me123]

why cant someone break the dsm criteria down into plain english, too many big words for a thicko like me.

[Ms.Jolene]

why cant someone break the dsm criteria down into plain english, too many big words for a thicko like me.

Ditto

[ManicPixi]

SYMPTOMS OF A MAJOR DEPRESSIVE EPISODE:

5+ symptoms must be present in the span of two weeks. These symptoms must be a change from the normal mood or personality. One of the five symptoms MUST BE either depression* or lost of interest/pleasure**.
(* and ** to be found in the symptoms)
Symptoms caused by another medical condition, medication, or delusions/hallucinations (drugs) do not count.

~(depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.)*
This means that you feel empty or sad for most of your day. If you are told that you look sad/empty most of your day, this counts too. For children or teens, this symptom may be replaced by unusual irritability or bad temper.

~(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 made by others))**
This means that you have lost interest in your daily activities or things you usually find interesting. Also counts if you are told by others that you look uninterested.

~(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 gains)
This means that you have lost or gained weight while not dieting. A noticeable change must be present in the span of a month. If you have an unusually low or high appetite every day, that counts as well. In children, if they do not gain the weight as expected (e.g., Same weight at four that they were at two) that counts as well.

~(insomnia or hypersomnia nearly every day)
This means you are unable to fall asleep or you sleep more than is necessary/normal nearly every day. Also counts if you feel excessive fatigue every day (hypersomnia).

~(psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down))
This does not mean you feel retarded in the sense of the disability. This means others have said you are moving very slowly or that you look agitated/jumpy during every day. Does not count if you merely feel it. Others must be able to account for it as well.

~(fatigue or loss of energy nearly every day)
This is a symptom of hypersomnia (above).

~(feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick))
This means you feel worthless or guilty for no reason. If you have made up a reason to be guilty, that counts too. Does not count if you are feeling bad about being sick or for another wrong, but valid reason.

~(diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others))
This means you find it difficult to make decisions or concentrate on one thing nearly every day. If you are told by others that you look indecisive or off task every day, that counts as well.

~(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)
This means you think about killing yourself often. If you don't try to carry it out or even have a clear idea of how to do it, that counts as well. Being afraid of dying doesn't count.

If you experience these symptoms with the symptoms of a manic episode or by themselves, see a psychiatrist or therapist who can refer you to one if necessary. They will tell you whether or not you are experiencing a mixed episode.

If you have recently had a death in your family or other social network, these symptoms do not count.

Other reasons to see a doctor:

Experience of these symptoms has caused stress on your home life, work life, social life, or school life.

These symptoms are caused by drugs, medication, or a medical condition.

These symptoms are present for longer than two months (e.g., If you feel these symptoms on and off for a month and then never again, it does not count.)

They are paired with inability to function the way you are used to, an obsession with your own worth(lessness), thoughts of suicide, or a slowing in your daily routines.



SYMPTOMS OF A MANIC EPISODE:

Your mood may be elevated (very happy) or broad (very irritable or other 'high(not drug-related)' mood) in a way that is different from normal. (e.g., If you are normally optimistic or happy, an elevated mood is not a change from normal. The same with irritability or other high moods.)

During the span of time in which you feel these symptoms, three of them must be noticeably present. If you do not feel an elevated mood and you simply feel irritable, four symptoms must be noticeably present.

~(inflated self-esteem or grandiosity)
This means you have an inflated ego (e.g., Feel self-important, think you're better than others.) or you think (perhaps due to delusions) that you are more important than you really are in your workplace, school, or home.

~(decreased need for sleep (e.g., feels rested after only 3 hours of sleep))
This means you rarely feel tired or need very little sleep to function. May be characterized by a feeling of 'hyper'-ness.

~(more talkative than usual or pressure to keep talking)
This means you feel the need to talk or you talk more than you usually do. "Talking a mile a minute" may be used to describe it. May be accompanied by 'fast' talking. (e.g., If you are a normally talkative person, this symptom does not count unless it is elevated to an unusual degree.)

~(flight of ideas or subjective experience that thoughts are racing)
This means your thoughts change quickly, perhaps without cause. If you feel (uncomfortably or not) that your thoughts are racing, this counts as well.

~(distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli))
This means you feel interested in things that don't matter or are not relevant to what you are doing or what others are saying. You may feel distracted easily.

~(increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation)
This means you work towards things more than usual. You may work harder or more often on a project for school or work. You may have an increased desire to make friends or have sex (Find people to have sex with, convince people to have sex with you, or just an increased appetite for sex).

~(excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments))
This means you have a "need" to engage in things that may have bad reactions without regard for them. You may have unprotected or foolish sex (Cheating on your partner, sex outside your orientation (If you are straight, it may be a desire to have sex with someone of the same sex)***), go on shopping sprees when you can't afford it, or invest in/buy stupid things.
*** This may be because you are indeed homosexual. It's not a bad thing. It's not a symptom of a disease. If you feel this way for longer than a two-month period, you may have a change in your sexual orientation. It's alright! It's normal! Don't feel wrong or bad or broken. Accept who you are and don't beat yourself up about it. If you still have a desire for the opposite sex, that's okay too. Hell, Lady Gaga is bisexual. ^_^

Again, if you experience these symptoms with or without the symptoms of a major depressive episode, see a psychiatrist or therapist who can refer you to one if necessary. They will tell you whether or not you are experiencing a mixed episode.

Other reasons to see a doctor:

These changes in mood or life have a noticeable effect on your daily life and activities.

If these symptoms are not associated with any drugs, medications, or medical conditions.


NOTE: If your symptoms are not as severe, but still noticeable, do not discount. They may be symptoms of Cyclothymic Disorder. Still see a psychiatrist or therapist who can recommend one to you if it is necessary.


I hope this helped you to understand better what all the confusing terminology means. That's basically all you need to know before seeing a doctor. I would highly recommend seeing a doctor. Do NOT self-medicate or ignore these symptoms.

Cheers

[jessicaborthwick]

why cant someone break the dsm criteria down into plain english, too many big words for a thicko like me.

very true its hard to read

[confused_stranger]

If anyone is listening, could maybe someone asnwer a question for me ? ( I didnt want to start a thread)

Ive been diagnosed bipolar and borderline

Is is possible for manic episodes to last for a really really long time ? Like a week or more ? I am very manic-ey most of the time but I do occasionally hae long periods ( also weeks long) or sever depression even suicidal ideations.

Because my moods dont "swing", but I go days and days without sleep and racing thoughts and constant sexual thoughts ( Im a sex addict, but that is a different story)

I was also wondering if bipolar can mimic antisocial personality disorder

I have all the symptoms - no goals, no responsibility, shoplifting, no morals

but I dont like hurting people and I dont want to scam anyone, so i dont think it is antisocial personality disorder

could these things have somethign to do with BPD or manic bipolar?

[jessicaborthwick]

If anyone is listening, could maybe someone asnwer a question for me ? ( I didnt want to start a thread)

Ive been diagnosed bipolar and borderline

Is is possible for manic episodes to last for a really really long time ? Like a week or more ? I am very manic-ey most of the time but I do occasionally hae long periods ( also weeks long) or sever depression even suicidal ideations.

Because my moods dont "swing", but I go days and days without sleep and racing thoughts and constant sexual thoughts ( Im a sex addict, but that is a different story)

I was also wondering if bipolar can mimic antisocial personality disorder

I have all the symptoms - no goals, no responsibility, shoplifting, no morals

but I dont like hurting people and I dont want to scam anyone, so i dont think it is antisocial personality disorder

could these things have somethign to do with BPD or manic bipolar?

no bipolar dose not mimic antisocial personality disorder they are diffrent bpd is more like bipolar then aspd

[Kings_n_Princesses]

I had heard reading the DSM was difficult, but upon reading it I realized I could have understood it in 3rd grade. Then again I went to public school and was home schooled by my Mom in some very advanced technical stuff - I excelled in science in school and could comprehend some college level books by 4th grade. My Mom most likely suffered from at least OCD so she was very persistent that I learned big words or defined them if I asked their meanings.
I denied the possibility of being BP for awhile when it was mentioned to me and in my cognitions I rationalized I only had SAD. That was until I studied up on Bipolar and its accompanying symptoms.
I have had all 7 of the criteria for manic episodes, as well as all the criteria for mixed episodes and hypomanic episodes. I have even (reluctantly) studied the criteria for Schizophrenia, the big scary word I heard as a kid whispered in shadows or in a few rock songs. I also seemed to have had some of those episodes as well, which seemed to me to almost mimic bipolar.

[DanielB1974]

I've tried to put together an ordinary language summary here:

http://www.bipolartoday.com/bipolar-disorder-symptoms/

I hope people find that helpful.