Diagnosing BD: Bipolar Disorder DSM-5 Criteria

Reviewed by Tanya Harrell, PhD, LPC, NCC

Published 01/07/2021

Many people go through life wondering if they have a mood disorder. It's natural to wonder if you have intense cycling moods. Yet not everyone who has these thoughts actually has a disease like bipolar. Fortunately, you can find out. A psychiatrist or therapist can offer a diagnosis based on the bipolar diagnostic criteria found in the DSM-5.

What Is Bipolar Disorder?

Bipolar disorder, simply put, is a mood disorder that includes both high moods and low moods. There are several common variations of bipolar disorder, though. So, even if you have some version of this disorder, a mental health professional must be specific about the type you need or want a diagnosis.

What Is The Purpose Of A Diagnosis?

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The truth is that there's no rule in life that you have to have a diagnosis. You can get therapy and other types of help without an official diagnosis of bipolar. DSM 5 can be used to discover your mental health issues, but the diagnosis doesn't necessarily have to be a part of any permanent record in some cases.

There are a few exceptions, though. If you want your insurance to pay for treatment, you'll likely need your doctor's office to submit the right bipolar disorder DSM 5 code. For those with severe bipolar disorder, a diagnosis based on the DSM5 bipolar disorder criteria might be necessary to receive disability benefits.

What Is The DSM-5?

The Diagnostic and Statistical Manual (DSM-5) is a book that mental health professionals use to diagnose mental illnesses. This reference has gone through several editions over the years, changing with the scientific community's evolving understanding of psychology. It is available in a hard-back book and digital forms, such as a DSM 5 bipolar disorder criteria pdf.

DSM 5 Bipolar Disorder Criteria

In the DSM, bipolar is covered thoroughly, including both bipolar I disorder and bipolar II disorder. DSM 5 lists each condition's defining characteristics and explains how to evaluate their symptoms, how often they happen, how long an episode lasts, and how severe the symptoms are. It also offers recommendations of scientifically sound treatments for each type and phase of bipolar.

DSM 5 Bipolar 1

The DSM V bipolar section describes the three types of episodes: manic, depressive, and hypomanic. The manic phase is essential to the diagnosis. A hypomanic or depressive episode may come before or after the manic phase. Here are the criteria for each type of episode. You must meet each of these criteria to have the diagnosis.

Manic Episode

  • A persistent and extreme mood that lasts at least one week for most of the day, almost every day. The mood in mania may be abnormal:

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  • Elevated
  • Expansive
  • Irritable
  • Energetic
  • With increased goal-oriented activity
  • While the mood described above is going on, you have three or more of the following symptoms. But if the mood is irritable, the diagnosis requires four of these symptoms.
    • Inflated self-esteem
    • Little need for sleep
    • Overly talkative; pressured speech
    • Flight of ideas or racing thoughts
    • Easily distracted
    • Increased goal-directed activity
    • Engaging in risky behaviors
  • The elevated or irritable mood is so severe that you have trouble functioning in social situations or work. Or it's so disruptive that you need to be hospitalized to prevent harm to yourself or others or because there are psychotic features to the episode.
  • The episode is not caused by the effects of drug use, medications, treatments, or medical conditions.

Major Depressive Episode

Depressive episodes can happen in both bipolar I and bipolar II. Depression is a part of bipolar II disorder, but it doesn't always happen in bipolar I. Your doctor or therapist will check to ensure you meet each of the following criteria before giving you a bipolar diagnosis.

  • You have at least five of the following symptoms within a two-week period.
    • Your mood is depressed most of the day, nearly every day.
    • Loss of interest in most or all activities, most of the day, nearly every day.
    • Unexplained weight loss or weight gain.
    • Sleeping too much or too little most days.
    • Noticeably physically agitated or slowed down.
    • Loss of energy almost every day.
    • Feelings of worthlessness or unearned guilt nearly every day.
    • Trouble concentrating or being indecisive almost every day.
    • Thoughts of death or suicide, suicide attempts, or suicide plans.
  • The symptoms cause you enough distress that you can't function and usual in social situations, the workplace, or other areas.
  • The symptoms aren't due to a medical condition or drugs or alcohol abuse.

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Hypomanic Episode

Whether you have bipolar 1 or DSM-5 bipolar 2 disorder descriptions, include the hypomanic phase. A hypomanic phase is similar to a manic phase, but it's a bit milder. It also tends to be less destructive. A diagnosis involves checking off each of the following criteria.

  • A period of elevated, expansive, or irritable mood, with increased activity and energy, similar to in mania. But in hypomania, it lasts four or more days in a row, most of the day, every day.
  • While this mood is going on, you have three of the following symptoms, or five if the mood is irritable.
    • Grandiosity and inflated self-esteem
    • Less need for sleep
    • Increased talkativeness and pressured speech
    • Flights of ideas and racing thoughts
    • Being easily distracted
    • Increased goal-directed activity
    • Engaging in risky behaviors
  • During the episode, your functioning changes so that it's different from your usual functioning.
  • Others can notice the changes.
  • The episode is not related to drug or alcohol use, medications, treatments, or medical conditions.

DSM 5 Bipolar 2

The types of episodes are described the same in bipolar II as they were in bipolar I. However, if you have bipolar II, you have not had a manic episode. The criteria for this disorder must all be met. They are:

  • You've had at least one hypomanic episode and one major depressive episode.
  • You've never had a manic episode.
  • You don't have another mental illness causing the hypomanic episode.
  • The symptoms of depression or the quick and dramatic changes between the hypomanic and depressive phases disrupt your ability to function at work, at school, and socially.

How To Diagnose Bipolar

Diagnosing any mental illness takes not only knowledge of the DSM 5 bipolar disorder section, but it also takes skill and intense thought. Diagnosis is a specific, well-established process that's best left to professionals. So, how do they make their diagnosis? They gather and consider the evidence and put it together with what they know from the DSM bipolar pages.

Testing For Bipolar

Many psychologists will test you before treatment begins. Others will do that during or after your first session. You can take a bipolar test online to check yourself for symptoms of bipolar disorder. After you start seeing a therapist, you can show them your results. They might also do some additional testing after you begin with them.

Medical, Personal, And Family History

At your first appointment, your psychiatrist or counselor may take a medical history from you. Remember that some conditions and medications can affect your mental health. They might take a personal history to find out what your life has been up until that point. They may add more pages to each of these histories to tie your family and ancestors in with your own medical and personal history. They might also ask your family to join you for a session if it would help reconnect with your family or discover hidden issues.

The Diagnostic Interview

A diagnostic interview is just a talk between you and your provider. They ask questions about your life, your activities, and your thoughts and feelings. They ask questions that will help them recognize symptoms of bipolar disorder and how they're affecting you.

This conversation will give them some facts, or at least guesses, about the nature of your condition. The other part of the interview involves the therapist observing you, watching for physical and mental signs of bipolar. By taking note of your gestures, mannerisms, appearance, and apparent mood, they have more information to make their assessment. But it's important to remember that they make these assessments to help you. It might feel strange knowing that someone is paying such close attention to you, but it's a necessary part of the evaluation.

Making The Diagnosis

Once the psychiatrist or therapist has gathered all the information about your bipolar, they compare it to the bipolar disorder DSM 5 description. If you meet all the required criteria in the DSM-5 bipolar disorder section, they give you a diagnosis. It might be bipolar 1, bipolar 2, or cyclothymic disorder. They might add a more specific description, such as "bipolar II with mixed features." They note the severity of your condition and possibly indicate the time or age of onset. If you need a specific diagnosis, they also add the code that corresponds to the complete diagnosis.

What Happens Next?

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After you get a diagnosis of bipolar disorder, the next step is learning more about the condition. Psychoeducation is a type of therapy in which you get information about your mental illness, how it can affect you, and things you can do to relieve or manage your symptoms.

Most people with bipolar disorder need to take medications. Common types of medications used include mood stabilizers, antidepressants, and second-generation antipsychotic medications.

Therapy can help you deal with your condition, manage symptoms, and set up your life in ways that make a living with bipolar easier. You can talk about your thoughts and feelings, not only about your diagnosis but also about your symptoms and any other challenges you're facing in your life.

Conclusion

Diagnosing bipolar requires extensive knowledge of the DSM-5 criteria for the condition. The person making the diagnosis needs to gather information about you and your symptoms and compare them to the criteria. If you receive a diagnosis, there are many steps you can take to manage your symptoms and live a more stable, fulfilling life.