Symptoms of Bipolar Disorder

Bipolar Disorder (also known as manic depression), is characterized by alternating episodes of mania or hypomania and depression.

Bipolar disorder is often not recognized by the person suffering from the disorder, and sometimes may not be recognized by relatives, friends, or even physicians of the individual. In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, sleeplessness, or poor school or work performance.

If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.

An early sign of manic-depressive illness may be hypomania–a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.

Mood Episode Types

To help you sort out the symptoms of Bipolar disorder it is important to understand that there are four types of mood episodes that a person can experience as part of Bipolar Disorder. These mood episodes include major depressive episode, manic episode, mixed episode, and hypomanic episode.

Major Depressive Episode

A major depressive episode is not a disorder in itself, but is a part of another disorder, most often major depressive disorder or bipolar disorder. A major depressive episode includes the following symptoms such as either a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood.

A major depressive episode is also characterized by the presence of a majority of these symptoms:

• 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). (In children and adolescents, this may be characterized as an irritable mood.)
• markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• 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.
• insomnia or hypersomnia nearly every day
• psychomotor agitation or retardation nearly every day
• fatigue or loss of energy nearly every day
• feelings of worthlessness or excessive or inappropriate guilt nearly every day
• diminished ability to think or concentrate, or indecisiveness, nearly every day
• 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

Manic Episode

A manic episode is not a disorder in and of itself, but instead is a part of other disorders, most usually bipolar disorder. A manic episode is defined by the following symptoms such as a period of an elevated, expansive or notably irritable mood, lasting for at least one week. This disorder must be sufficiently severe to cause difficulty or impairment in occupational, social, educational or other important functioning and can not be better explained by a mixed episode. Symptoms also can not be the result of substance use or abuse (alcohol, drugs, medications) or caused by a general medical condition.

A majority of the following symptoms are also present:

• 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
• attention is easily drawn to unimportant or irrelevant items
• 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)

Mixed Episode

A mixed episode is not a disorder, but rather a part of a mental disorder, most commonly bipolar disorder. A mixed episode consists of meeting the criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.

Like all mental disorders, the disturbance must be severe enough to cause distress or impairment in social, occupational, education or other important functioning and is not better accounted for by the physiological effects of substance use or abuse (alcohol, drugs, medications) or a general medical condition.

Hypomanic Episode

A hypomanic episode is defined by the following:

• A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood.
• 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., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic. The disturbance in mood and the change in functioning are observable by others. 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. 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).

The Diagnoses

Now, on to the diagnosis of the Bipolar Disorders. Bipolar diagnoses are made by noting particular combinations of mood episodes, both present at the time of diagnosis, and based on historical considerations.

Bipolar I Disorder

Bipolar I Disorder actually is a number of separate diagnoses, depending upon the type of mood most recently experienced. Specific symptoms of various types of this disorder follow.

Bipolar I Disorder, Single Manic Episode

Presence of only one (present) Manic Episode and no past Major Depressive Episodes.

Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.

Bipolar I Disorder, Most Recent Episode Hypomanic

Currently (or most recently) in a Hypomanic Episode. There has previously been at least one Manic Episode or Mixed Episode.

Bipolar I Disorder, Most Recent Episode Manic

Currently (or most recently) in a Manic Episode. There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode.

Bipolar I Disorder, Most Recent Episode Mixed

Currently (or most recently) in a Mixed Episode. There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode.

Bipolar II Disorder

Presence (or history) of one or more Major Depressive Episodes and at least one Hypomanic Episode. Additionally, there has never before been a true Manic Episode or a Mixed Episode. Bipolar II Disorder is a milder form of Bipolar disorder (compared with Bipolar I Disorder) as it involves only hypomanic episodes and not full manic episodes.

References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
National Institutes of Health, National Institute of Mental Health, NIH Publication No. 95-3679 (1995) Last update was 2001.