Bipolar disorder (also known as “manic depression”) is a disorder that is often not recognized or misdiagnosed as simply depression by the patient, relatives, friends, and even physicians. An early sign of bipolar disorder may be hypomania — a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior for at least 4 days. Hypomania may feel good, thus, even when family and friends learn to recognize the mood swings, the individual often may deny that anything is wrong.

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, or poor school or work performance.

If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged manic episodes and depressive episodes.

One of the usual differential diagnoses for bipolar disorder is that the symptoms (listed below) are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or other Psychotic Spectrum Disorders

And as with nearly all mental disorder diagnoses, the symptoms of manic depression must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.

Specific symptoms of the various types of bipolar disorder:

Bipolar I Disorder

  • Essential feature of Bipolar I is that the person experiences one full manic episode (though the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes).
    • manic episode is a distinct period during which there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least one week (or any duration if hospitalization is necessary), accompanied by at least three additional symptoms of mania.
  • The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Bipolar II Disorder

In both Bipolar I and II disorders, a person can have a mood episode (i.e., primarily manic or depressed) with mixed features, wherein a manic/hypomanic episode there are significant depressive symptoms, and in a depressive episode there are some manic/hypomanic symptoms.

Additionally, both bipolar and unipolar depression (i.e., in major depressive disorder) can occur with anxious distress, with a seasonal pattern, with psychotic features, with peripartum onset, with melancholia, and with atypical features. See additional information on these DSM-5 specifiers here.

This post has been updated for DSM-5 criteria.

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