MDCalc

DSM-5 Criteria for Bipolar Disorder

Diagnostic criteria for bipolar disorder (BD).

Episode(s) not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Manic episode

Manic symptoms: during period of mood disturbance and increased energy/activity, ≥3 of the following symptoms (4 if the mood is only irritable) present to a significant degree and are a noticeable change from usual behavior

Additional required criteria

≥1 week of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy; present most of the day, nearly every day (or any duration, if hospitalization needed)

Hypomanic episode

Manic symptoms: during period of mood disturbance and increased energy/activity, ≥3 of the following symptoms (4 if the mood is only irritable) present to a significant degree and are a noticeable change from usual behavior

Additional required criteria

≥4 consecutive days of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy; present most of the day, nearly every day (or any duration, if hospitalization needed)

Major depressive episode

Depressive symptoms: ≥5 symptoms during the same 2-week period that are a change from previous functioning; depressed mood and/or loss of interest/pleasure must be present; exclude symptoms clearly attributable to another medical condition

Most of the day, nearly every day; may be subjective (e.g. feels sad/empty/hopeless) or observed by others (e.g. appears tearful); in children and adolescents, can be irritable mood
Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others
Significant weight loss without dieting, or weight gain (change of >5% body weight in a month), or decreased/increased appetite nearly every day; in children, may be failure to gain weight as expected
Nearly every day
Nearly every day and observable by others (not merely subjectively restless or slow)
Or loss of energy, nearly every day
Nearly every day; guilt may be delusional; not merely self reproach or guilt about being sick
Nearly every day; may be indecisiveness; may be subjective or observed by others
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide

Additional required criteria

Diagnostic Result

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Advice

For patients who meet criteria for bipolar disorder:

  • Consider referring to or consulting with a psychiatrist for complex cases or confirmation of diagnosis.
  • Begin mood stabilizers or other appropriate pharmacologic therapy following evidence-based guidelines.
  • Recommend psychotherapy options.
  • Schedule regular follow-ups to monitor symptom progression, treatment efficacy, and side effects.
  • Educate the patient and family about bipolar disorder, emphasizing the importance of adherence to treatment and monitoring for signs of relapse.

For patients who do not meet criteria:

  • Explore other potential diagnoses or types of bipolar disorder (e.g., due to a medication or medical condition, cyclothymic disorder, unspecified bipolar disorder) that may explain the patient’s symptoms.
  • Conduct thorough history and physical examination to rule out physiological factors or substance use that might mimic or exacerbate psychiatric symptoms.
  • Provide guidance on recognizing early warning signs of mood disturbances and the importance of seeking help early.
  • Schedule follow-up appointments to reassess symptoms periodically, as some psychiatric conditions develop or manifest more clearly over time.
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