Bipolar Disorder with Mixed Features

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Bipolar Disorder or Depression with Anxious Distress

This specific manifestation of bipolar disorder is applied when a person has noticeable symptoms of nervousness/anxiety during a related mood episode. A person must have at least 2 of the following symptoms the majority of days during the current or most recent mood episode1:

  1. Feeling irritable, short-fused, or “keyed up”
  2. Feeling unusually restless.
  3. Difficulty concentrating because of worry.
  4. Feeling of dread that something awful may happen.
  5. Feeling that the individual might lose control of himself or herself.

Bipolar Disorder or Depression with Melancholic Features

The specifier “with melancholic features” is applied when an individual is at the depths of a depressive episode. In this state, there is almost no access of capacity for feelings of pleasure. A helpful guideline for determining whether you are in a melancholic state is the inability to react emotionally in a way that is expected given the event. Either mood does not brighten at all, or it brightens only slightly. For example, one may only feel only fleeting positive reactions for 20 to 40 percent of the time to a positive event.

During melancholic depression, individuals exhibit a slower rate and energy level for responding to events (compared to their norm).

Melancholic features are more frequent in inpatients, as opposed to outpatients. These features are also less prevalent in mood episodes of persons who are not diagnosed with a severe mood or psychotic disorder.

Bipolar Disorder or Depression with Atypical Features

This specifier refers to the case when the clinical presentation of a mood episode does not fit the significant majority of those with the same episode. However, these atypical symptoms are prevalent enough in those with mood disorders to be noteworthy. For instance, though chronic low mood is typical major depression, in atypical cases, a person can be “cheered up” to the degree that they no longer feel depressed for a period of time in response to a positive event (for example, an adult receives a visit from children; a person receives compliments or an award).

To be diagnosed with this subtype of depression, 2 symptoms involving changes in sleeping, eating, motor movements, or interpersonal communication must be evident, including:

  1. Significant weight gain or increased appetite.
  2. Hypersomnia (sleeping more/for longer periods than usual).
  3. Feeling heavy or leaden in arms/legs as if one is “weighed down.”
  4. Having constant fear of rejection (this can be consistent with when a person is not depressed, but is exacerbated during a period of depression); this interpersonal sensitivity must interfere at the workplace or in personal life.

Bipolar Disorder or Depression with Psychotic Features

This specifier applies if delusions or hallucinations (auditory or visual) are present at any point during a mood episode. See psychotic disorder for a description of such symptoms.

Bipolar Disorder or Depression with Peripartum Onset

Most commonly referred to as postpartum depression, you can learn more about this disorder and specifier here.

Bipolar Disorder or Depression with Seasonal Pattern

Most commonly referred to as seasonal affective disorder, you can learn more about this disorder and specifier here.

This specifier can be applied to the pattern of major depressive episodes in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent. The essential feature is that periods of depression tend to occur and remit during certain times of the year. In most cases, the episodes begin in fall or winter and remit in spring. Less commonly, there may be recurrent summer depressive episodes.

This pattern of onset and remission of episodes must have occurred during at least a 2-year period, without any nonseasonal episodes occurring during this period. In addition, the seasonal depressed periods must substantially outnumber any nonseasonal depressive episodes over the individual’s lifetime. Younger persons are more at-risk for seasonal depression. This specifier does not apply to those situations in which the pattern is better explained by seasonally linked psychosocial stressors (e.g., seasonal unemployment or school schedule).

  1. Mood episodes include mania, hypomania, or depression []