Changes in mood are natural as you go throughout your day. But if you feel heightened emotions for one week, such as euphoria or agitation, and unbearably sad the next without a clear reason, it might be time to talk to your doctor about bipolar disorder.

Bipolar disorder is a mood disorder, formerly referred to as manic-depressive disorder, that affects 2.8% of the U.S. adult population each year. It’s characterized by severe mood swings. The disorder can impact your everyday life by making it difficult to complete your daily responsibilities and maintain healthy interpersonal relationships.

An assessment for bipolar disorder involves a comprehensive evaluation by a health care professional that considers various factors beyond just alignment with DSM-5 criteria. These factors may include symptoms, medical history, family history, and other relevant information. Not all bipolar disorder diagnoses are the same; there are three distinct types.

Depressive episodes for bipolar disorder

While bipolar disorder usually involves switching back and forth between depressive episodes and manic (or hypomanic) episodes, the diagnosis of bipolar 1 disorder does not require the presence of major depressive episodes/major depression. 

Here’s a quick rundown of what a major depressive episode looks like before we dive into the specific diagnostic criteria for the three bipolar disorder types:

• Five or more symptoms in a two-week period
• At least one symptom being a depressed mood or decreased pleasure in activities
• Symptoms that cause significant distress and impact important functioning
• Not attributable to substance use or medical conditions
• Symptoms that occur nearly every day:
  • Depressed mood for most of the day
  • Decreased pleasure or interest in activities 
  • Significant weight or appetite changes without dieting
  • Insomnia or hypersomnia 
  • Movements that objectively serve no purpose
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Concentration or decision-making issues
  • Thoughts of death, recurrent suicidal ideation, suicidal attempt or plan to end one’s life

Diagnostic criteria for bipolar 1

Bipolar 1 has the highest level of acuity with fast shifts between depressive and mania episodes. As we mentioned earlier, major depressive episodes are common in people with bipolar disorder 1, but they aren’t always present.

The DSM-5 bases a bipolar 1 diagnosis on the presence of a manic episode, as detailed in the following criteria:

• Persistently elevated or irritable mood with heightened levels of energy that lasts most of the day, nearly every day, for at least one week
• The mood disturbance interferes with social or occupational functioning; requires hospitalization to reduce risk of harm to oneself or others or there are psychotic features
• The episode isn’t related to substance use or a medical condition
• The manic episode may be preceded by or followed by a major depressive episode
• Three or more of the following symptoms are present, or four if the mood is irritability:
• Inflated self-esteem
• Low need for sleep
• Talking more than usual
• Racing thoughts or jumping from one idea to the next
• Distractibility
• Increase in goal-directed activity 
• Risky or dangerous behavior

Diagnostic criteria for bipolar 2 disorder

Bipolar 2 disorder involves episodes of hypomania, which are less intense than the manic episodes seen in bipolar 1 disorder. It also features longer periods of emotional stability between episodes. The DSM-5 criteria for diagnosing bipolar 2 disorder include:

• At least one hypomanic episode and one major depressive episode
• There’s never been a manic episode
• The episodes aren’t related to a schizophrenia spectrum disorder or other psychotic disorder
• The frequent switch between hypomanic and depressive episodes causes distress

The criteria of a hypomanic episode includes:

• Persistently elevated or irritable mood with heightened levels of energy that lasts most of the day, nearly every day, for at least one week
• Three or more of the manic symptoms are present, or four if the mood is irritability, to a significant extent
• The symptoms result in a change in daily functioning in a way that’s out of character when the person is not symptomatic
• The mood and functioning changes are noticeable by others
• The symptoms aren’t severe enough to interfere with social or occupational functioning or require hospitalization
• There aren’t any psychotic features
• The episode isn’t related to substance use or medical condition

Diagnostic criteria for cyclothymic disorder

Cyclothymic disorder refers to having general symptoms that don’t meet the criteria for either bipolar 1 or bipolar 2. It consists of hypomanic and depressive episodes that can each last over a year. The diagnostic criteria is:

• For at least two years, there have been multiple periods of hypomanic symptoms and depressive symptoms that don’t meet criteria for major depressive disorder. The time frame is one year for children and adolescents.
• During the above time frame, the person has not been without symptoms for at least two months at a time
• No major depressive, manic or mixed episodes
• The symptoms don’t stem from a psychotic disorder, substance use or medical condition
• The symptoms cause significant distress or impact functioning

Lightfully Behavioral Health can support you after a bipolar disorder diagnosis

If you think you may have bipolar disorder, talk to your primary care doctor about a bipolar disorder assessment. If required, they will refer you to a specialist, such as a psychiatrist or psychotherapist.

If you’re looking for a bit more support on your mental health journey as you navigate a bipolar disorder diagnosis, our evidence-based, whole-person-centered care is available throughout our four levels of care: Residential Treatment, Virtual Intensive Outpatient Program (vIOP), Partial Hospitalization Program and Intensive Outpatient Program.

If you believe that you align with the diagnostic criteria of bipolar disorder, visit the Contact Us page to ask about an assessment. We’ll take the next steps together, toward the fullest, brightest version of you.