Dsm 5 Bipolar 2 Criteria And Bipolar 2 Symptoms
To be diagnosed with bipolar 2 according to criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , someone must experience A) a hypomanic episode, and B) a major depressive episode. These can occur at any point over the course of a lifetime.
A. What qualifies as a hypomanic episode? An episode of bipolar 2 hypomania requires at least four days of elevated mood change, which might include feelings of increased energy, irritability, and expansiveness. During this time, you must have at least three of the following symptoms. If your mood has been exclusively irritable, you must have four of the following symptoms.
Bipolar Disorder Dsm 5 Criteria: Diagnosis And Treatment Options
Bipolar disorder is a complex mental health condition characterized by severe shifts in mood accompanied by changes in energy and activity levels. The condition affects an individual’s mood, thoughts, and behaviors. A person experiencing this life-altering disorder may quickly shift from feeling incredibly happy and hopeful to intensely sad and hopeless.
Who Can Diagnose Bipolar Disorder From Dsm
There is a variety of mental health professionals who can diagnose bipolar disorder using the DSM-5. These include:
- Psychiatrists: Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental disorders.
- Psychologists: Psychologists are trained in the assessment and diagnosis of mental disorders.
- Licensed Clinical Social Workers: Licensed clinical social workers are trained in the assessment and diagnosis of mental disorders.
- Counselors: Counselors are trained in the assessment and diagnosis of mental disorders.
The above professionals can use the DSM-V to diagnose bipolar disorder, however, only a psychiatrist can prescribe medication. If you think you or someone you know may have bipolar disorder, it is important to seek professional help. Early intervention and treatment can often prevent the development of more severe symptoms and improve long-term outcomes.
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Bipolar 1 Vs Bipolar 2
The most significant contrast between bipolar 1 and bipolar 2 is that the former tends to gravitate toward mania while the latter tends to gravitate toward depression. If someone with bipolar 2 has a single manic episode, they can no longer be diagnosed with bipolar 2. They have another type of bipolar disorder.
Even though hypomanias are a milder form of mania, its not true that bipolar 2 is a milder version of bipolar 1. By definition, hypomanias dont cause impairment, but the major depressions that characterize bipolar 2 can be brutal. These depressive episodes also tend to happen more frequently than in bipolar 1. And the persistent, unreliable mood swings of bipolar 2 can cause significant harm to someones life.
What Are Bipolar Disorders
Bipolar disorder is a brain disorder that causes changes in a person’s mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic or depressive . People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.
People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behavior change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes. Bipolar disorder can disrupt a persons relationships with loved ones and cause difficulty in working or going to school.
Bipolar disorder is a category that includes three different diagnoses: bipolar I, bipolar II, and cyclothymic disorder.
People with bipolar I disorder frequently have other mental disorders such as anxiety disorders, substance use disorders, and/or attention-deficit/hyperactivity disorder . The risk of suicide is significantly higher among people with bipolar I disorder than among the general population.
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How Is Bipolar 2 Diagnosed
Bipolar 2 can be diagnosed according to the DSM-5 criteria mentioned above, though different mental health professionals may have different perspectives on how to think about the disorder. Some clinicians may mark that distinct boundary between type 1 and type 2, while others may take a more dimensional approach, and think of the diagnostic boundaries as more fluid.
Bipolar 2 is often misdiagnosed as major depressive disorder . This is because a depressive episode precedes a hypomanic episode, or multiple depressive episodes occur before a hypomanic episode. In addition, people with bipolar 2 and MDD can both have irritability as a symptom. And because hypomanic episodes arent extreme or functionally impairing, they may go unrecognized.
Diagnosis can also be challenging because over half of people with bipolar 2 disorder have at least three additional disorders , particularly anxiety disorders, substance use disorders, personality disorders, and eating disorders.
Is there a bipolar 2 test or a bipolar 2 checklist? Mental health professionals will have different ways of evaluating clients for bipolar disorder. A comprehensive test or screening often includes a physical assessment, a family history, a full psychiatric assessment, a mood disorder questionnaire , and mood charting, which is when you keep a careful record of your daily emotions.
Preventing Bipolar 2 Episodes
Many people with bipolar disorder find that a straighter lifestyle can also help flatten the peaks and valleys of their mood swings. This means they stick to a healthy sleep schedule, exercise regularly, eat well, avoid abusing drugs and alcohol, monitor caffeine intake, and try to minimize the stress in their lives.
If their daily habits change, they might start noticing changes in their mood. These can serve as warning signs so the person knows they need to reset their routine or or take other steps to stabilize. This kind of self-awareness and self-monitoring can also lead someone with bipolar 2 to know when they need extra support from friends and family, or from a mental health professional.
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Bipolar Disorders In Dsm
The main lines of the DSM-5 definition of major depressive episodes , basic to the diagnoses of both bipolar I and bipolar II disorders, are similar to those of DSM-IV: presence of five of nine diagnostic symptoms with a minimum duration of 2 weeks and a change from previous functioning. However, it is now possible to specify both depressive disorders and bipolar disorders with mixed features.
The definitions of both manic and hypomanic episodes have been radically revised, which will impact on both bipolar diagnoses. The main changes are three: a problematic change concerning the gate questions , a welcome reduction in the number of exclusion criteria and a vigorous effort to operationalize bipolar subthreshold syndromes, hitherto unified under the NOS heading.
What Are The Symptoms
The standard diagnostic criteria from the American Psychiatric Association states that to be diagnosed with cyclothymia, you must meet all of the following:
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Multiple periods of hypomanic symptoms that do not meet criteria for a hypomanic episode and multiple periods of depressive symptoms that do not meet criteria for a major depressive episode for at least two years
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Throughout the two year time frame, symptoms of hypomania and depression have been present for at least half the time, with no more than two consecutive months showing no symptoms
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Criteria for a major depressive episode, manic episode, or hypomanic episode have never been met
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Other mental disorders have been ruled as the contributing factor to hypomanic and depressive symptoms
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Hypomanic and depressive symptoms are not related to medications, substance abuse, or other medical conditions
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Hypomanic and depressive symptoms cause significant disruption in social, occupational, or other functional areas
If you or someone you know is suffering from cyclothymia, depressive signs and symptoms may include the following:
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Feelings of sadness, emptiness, and hopelessness
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Risk Factors For Bipolar 1 Disorder
Bipolar disorder is more common in high-income countries than in low-income ones.
Research shows that the chances of bipolar 1 disorder increase by 10-fold if there is a family history of the illness.
Those chances increase further with closer relationships. For instance, if a biological mother or father had bipolar 1 disorder then the chances of getting diagnosed with the disorder are higher.
What Else Could It Be
Given how bipolar disorder symptoms can look similar to other mental health conditions, bipolar disorder can be confused with the following conditions:
- Borderline personality disorder . Notable symptoms in BPD include impulsivity, emotional instability, and chronic feelings of emptiness. These characteristics can look like mood episodes, such as mania and depression, which are common features of bipolar disorder.
- Depression. Depressive episodes are featured in bipolar disorder. Relief from depression can mirror a mood shift towards mania or hypomania.
- Substance use disorder. Ongoing substance use can cause extreme mood shifts that appear similar to bipolar disorder.
- Schizoaffective disorder. Mood episodes, such as mania and depression, are present with schizoaffective disorder. A person experiencing delusions or hallucinations, other symptoms of schizoaffective disorder, may receive a diagnosis of bipolar disorder with psychotic features.
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Bipolar Disorder With Peripartum Onset
Commonly known as postpartum depression, this form means that you experience an extreme mood shift and become very depressed following childbirth.
If youre experiencing postpartum depression, you may believe youre feeling normal baby blues, or sadness, after childbirth. But postpartum depression is more intense than this.
Symptoms of postpartum depression include:
- symptoms of depression, such as changes in appetite, depressed mood, loss of energy, and other indicators
- fear that youre not a good caretaker
- severe anxiety or panic attacks
- thoughts of harming yourself or your baby
Bipolar Disorder With Seasonal Pattern
Mood episodes with a seasonal pattern are also found under the umbrella of seasonal affective disorder.
A seasonal pattern specifier is when depression or extreme mood shifts are triggered by the change in seasons. Its more common during fall and winter but can also arise in the summer.
This pattern can be applied to how depression manifests in bipolar I disorder, bipolar II disorder, or reoccurring major depressive disorder.
The essential main feature of this specifier is that depression tends to occur and temporarily go away during certain times of the year.
To be diagnosed with this specifier, you must experience a pattern of depressive episode onset and remission during at least a 2-year period, without any nonseasonal episodes occurring during this time.
In addition, the seasonal depressive periods should significantly outnumber any nonseasonal depressive episodes over your lifetime.
Its important to note that this specifier doesnt apply to situations where the depressive episode pattern is better explained by seasonally linked psychosocial stressors, such as seasonal unemployment or school schedules.
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What Is The First
The first-line treatment for bipolar 2 is medication. More specifically, the first-line medications prescribed to manage bipolar 2 are often quetiapine , lithium, and lamotrigine . They are all monotherapies, meaning you take them exclusively. The second-line monotherapy treatments for bipolar 2 disorder are often venlafaxine , an SNRI, and fluoxetine , an SSRI. Anyone starting a new bipolar 2 medication should be monitored closely for side effects and adverse reactions like agitation or hypomania.
Other Specified Bipolar And Related Disorder
DSM-5 has fortunately replaced DSM-IV’s vague group NOS by defining MDE with several subthreshold conditions of bipolarity, for instance, allowing a duration of 2 to 3 days for hypomanic episodes, as suggested by child psychiatrists, or fewer than four symptoms of hypomania during 4 days, or, for cyclothymia, specifying shorter manifestations . A further important step is the recognition that dysthymia can co-occur with hypomania which is considered as a co-morbid condition, but why – one might ask – is it not allocated to cyclothymic disorder?
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Making A Diagnosis Of Mixed Features
Presence of mixed features worsen the prognosis
To diagnose MF, it is critical to obtain a careful past history, said Professor Goldberg, together with corroborative accounts from relatives and associates, if possible. Ask about symptoms of depression, mania and hypomania systematically:
- symptoms of depression in relation to Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor activity, Suicidal ideation
- symptoms of mania and hypomania in terms of Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness
The severity of the illness can be determined and monitored using a variety of measurement scales, including MADRS, HAMD, and the Patient Health Questionnaire for MDD, and YMRS for mania.
Avoid antidepressants for bipolar I or II and major depressive episode with mixed features
Adverse events of medications such as antidepressant withdrawal symptoms, akathisia and insomnia, can be confused with affective symptoms and need to be excluded, cautioned Professor Goldberg, as do other potential causes such as substance misuse, steroid intake and thyroid disease.
Bipolar I Disorder Diagnosis Criteria
To be diagnosed with bipolar I disorder, an individual must meet the full criteria of a manic episode, which includes three of the following symptoms:
- Increased talkativeness
- Lack of energy or fatigue
- Loss of interest and pleasure in activities he or she previously enjoyed
- Feelings of restlessness or slowing down
- Feelings of guilt or worthlessness
- Difficulty concentrating or making decisions
- Suicidal thoughts
If you think you may have bipolar II disorder, be sure to tell your doctor about all of your symptoms, including hypomanic symptoms, such as elevated mood. Clinicians sometimes diagnose patients with major depression instead of bipolar II disorder if the patient does not disclose information regarding his or her hypomanic episodes.
Cyclothymic Disorder Criteria
While the diagnosis of bipolar I and bipolar II disorders is somewhat straightforward when it comes to telltale symptoms, the cyclothymic disorder is often more difficult to diagnose. Patients must experience the following symptoms for diagnosis:
Note: The two year time period noted above is for adult patients only. Diagnosis of cyclothymic disorder in children and adolescents requires one year of hypomanic and depressive periods.
Substance-Induced Bipolar Disorder Criteria
Bipolar Disorder Associated With Another Medical Condition Criteria
Bipolar Disorder Not Elsewhere Classified Criteria
Treatment Options For Bipolar Disorder
Psychotherapy, Support Groups, And Psychoeducation
Medications
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Bipolar 1 Disorder With Mood
Around 50% of patients with bipolar 1 disorder will exhibit mood-congruent psychotic features.
Individuals who have mood-congruent psychosis will have hallucinations and delusions that are consistent with their current mood.
For instance, a patient going through a manic episode might believe that they are friends with the Queen of England and have had tea with her on many occasions when they clearly have not.
On the other hand, the patient might experience deep feelings of guilt over something that was completely out of their control when they are going through the depressive phase.
Doctors and researchers are still not sure what causes these psychotic features.
You can take a look at the DSM 5 Guided Film Preview Bipolar I Disorder with Mood-Congruent Psychotic Features to get an up close look of how Bipolar 1 disorder presents itself in a patient.
If youre interested in more DSM 5 Guided Film Previews, Symptom Media provides a free trial that you can redeem now.
Recommendations For Trials With Antidepressants
Non-response to ADs in MDD is correlated with hidden bipolarity . Systematic screening for hypomanic symptoms during the selection of patients for controlled antidepressant trials would have several benefits. It would identify bipolarity in patients with major depressive episodes and increase the homogeneity of the samples, increase the responder rates and the power of placebo-controlled trials, and finally reduce the sample sizes required. Systematic measures of hypomanic symptoms by rating scales during the trials would help to identify the development of mixed states and switches into hypomania.
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Symptoms Of Bipolar 1 Disorder
In bipolar 1 disorder, a person will experience mania or hypomania.
Mania/Hypomania
Three or more of the following symptoms need to be present for a diagnosis of mania.
- Inflated self-esteem and grandiosity the patient feels they are unusually important or talented
- The patient may have a decreased need for sleep and state that they feel rested and energetic even when they have only slept for three hours.
- They are more talkative than usual and may speak in a hurried fashion. This will make their speech sound confused.
- Flight of ideas
- Easily distracted by irrelevant external stimuli.
- During manic episodes, the patient might also be engaged in activities that have high stakes or painful consequences. For instance, they might engage in indiscriminate sexual activity, make risky business investments, or go on uncontrolled buying sprees.
Mania and hypomania share the same symptoms.
The difference is in the length of time an individual experiences the symptoms.
Three or more of the above symptoms need to be present for at least 7 days for it to be diagnosed as mania.
If the symptoms last for 4 consecutive days, it is considered hypomania.
In both mania and hypomania, the symptoms are not related to or better explained by schizoaffective disorder or do not overlap with other mood disorders, such as schizophrenia, delusional disorder, or another medical condition.
Diagnostic And Statistical Manual Of Mental Disorders 5th Edition
In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders . There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 and 296.4x , the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety , with suicide risk severity, with seasonal pattern, and with postpartum onset. Bipolar I Disorder 296.5x will include all of the above specifiers plus the following: with melancholic features and with atypical features. The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia. For Bipolar I Disorder 296.7 , the listed specifiers will be removed.
The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include “and present most of the day, nearly every day”, and criterion B will include “and represent a noticeable change from usual behavior”. These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.
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