BIPOLAR

AND RELATED
 • Bipolar and Related
• Bipolar I Disorder Disorder Due to
Another Medical
• Bipolar II Disorder Condition

• Cyclothymic Disorder • Other Specified

Bipolar and Related
• Substance/Medication- Disorder
Induced Bipolar and
Related Disorder • Unspecified Bipolar
and Related Disorder
 Bipolar disorder is a mental disorder
characterized by extreme shifts in mood,
as well as fluctuations in energy and
activity levels. During these abnormal
shifts, the patient commonly finds it
difficult to complete everyday tasks.
The most important distinctions between bipolar I and II are:

A person with Bipolar I has Manic

Episodes, while someone with Bipolar
II has Hypomanic Episodes.
 The main
difference
between
mania and
hypomania is
a matter of
severity.
 DIGFAST
D istractible
Increased activity/psychomotor agitation
Grandiosity/Super-hero mentality
Flight of ideas or racing thoughts
Activities that are dangerous or hypersexual
Sleep decreased
Talkative or pressured speech
 CAUSES
Brain-chemical
imbalance

Genetics 

Hormonal problems

Environmenta Biological
l factors traits
The Case Study of Susie

Susie is a 20-year-old sophomore at a small

Midwestern college.  For the past five days she has
gone without any sleep whatsoever and she has spent
this time in a heightened state of activity which she
herself describes as “out of control.” For the most
part, her behavior is characterized by strange and
grandiose ideas that often take on a mystical or sexual
tone.  For example, she recently proclaimed to a
group of friends that she did not menstruate because
she was a “of a third sex, a gender above the human
sexes.”  When her friends questioned her on this, she
explained that she is a “superwoman” who can
avoid human sexuality and still give birth.  That is,
 Some of Susie’s bizarre thinking centers on the
political, such as believing that she had somehow
switched souls with the senior senator from her
state.  From what she believed were his thoughts
and memories, she developed six theories of
government that would allow her to single-
handedly save the world from nuclear
destruction.  She went around campus, explaining
these theories to friends and even to her
professors and began to campaign for an elected
position in the U.S. government (even though no
elections were scheduled at the time).  She feels
that her recent experiences with switching souls
with the senator would make her particularly well
 Susie often worries that she will forget some of her
thoughts and has begun writing notes to herself
everywhere; in her notebooks, on her computer---even on
the walls of her dormitory.  Susie’s family and friends,
who have always known her to be extremely tidy and
organized, have been shocked to find her room in total
disarray with frantic and incoherent messages written all
over the walls and furniture. These messages reflect her
disorganized, grandiose thinking about spiritual and
sexual themes. 
Susie has experienced two previous episodes of wild
and bizarre behavior similar to what she is experiencing
now; both alternated with periods of intense
depression.  When she was in the depressed state, she
could not bring herself to attend classes or any campus
activities; she suffered from insomnia, poor appetite, and
 Some background information; Susie grew
up on what she terms a “traditional Irish
home” with overprotective and demanding
parents.  Of the five children in her family, she
was the one who always obeyed her parents
and played the role of the good girl of the
family, a role she describes as being “Little
Miss Perfect.”  Susie describes herself as being
quite dependent on her parents, who treated
her as if she were much younger than she
actually was.  In contrast to their passive
obedience, Susie describes her siblings as
rebellious.  For example, her older sister told
Susie describes her parents as exceptionally strict with
respect to sexual matters; they never discussed issues related
to sex except to make it clear that their children were to
remain virgins until they were married.  Throughout high
school, Susie’s mother forbade her to wear makeup.  She
remembers being shocked and frightened when she began
menstruating; she was very distressed at the loss of control
that this entailed.  Susie never dated in high school and has
never had a steady boyfriend.
Susie’s family history shows evidence of mood disorders; her
maternal grandfather received electroconvulsive therapy
(ECT) for depression and her father’s aunt was diagnosed
with depression when she went through menopause.
Bipolar I disorder is defined as
being present if the person
experiences one or more lifetime
episodes of mania and usually
episodes of depression. 
 Mania often involves sleeplessness,
sometimes for days, along with
hallucinations, psychosis, grandiose
delusions, or paranoid rage.
 A manic episode is a mood state characterized
by period of at least one week where an
elevated, expansive or unusually irritable mood
exists. A person experiencing a manic episode is
usually engaged in significant goal-directed
activity beyond their normal activities.
 DIAGNOSTIC
CRITERIA
MANIC
EPISODE
A. A distinct period of abnormally and
persistently elevated, expansive, or irritable
mood and abnormally and persistently increased
goal-directed activity or energy, lasting at least 1
week and present most of the day, nearly every
day (or any duration if hospitalization is
necessary).
 B. During the period of mood
disturbance and increased energy or
activity, three (or more) of the
following symptoms (four if the mood
is only irritable) are present to a
significant degree and represent a
noticeable change from usual behavior:
 1. Inflated self-
3. More talkative
esteem or
than usual or
grandiosity.
pressure to keep
talking.

2.
Decreas
ed need
4. Flight of ideas or
for
subjective
sleep
experience that
thoughts are racing.
 7. Excessive
5. Distractibility
involvement in
(i.e., attention too
activities that
easily drawn to
have a high
unimportant or
potential for
irrelevant external
painful
stimuli), as
consequences
reported or
(e.g., engaging
observed.
in unrestrained
buying sprees,
sexual
indiscretions,
or foolish
business
investments). 6. Increase in goal-
directed activity (either
socially, at work or
school, or sexually) or
psychomotor agitation
(i.e., purposeless non-
goal-directed activity).
 C. The mood disturbance is
sufficiently severe to cause
marked impairment in social or
occupational functioning or to
necessitate hospitalization to
prevent harm to self or others, or
there are psychotic features.
D. The episode is not attributable
to the physiological effects of a
substance (e.g., a drug of abuse, a
medication, other treatment) or to
another medical condition.
 HYPOMANIC
EPISODE

A. A distinct period of abnormally and

persistently elevated, expansive, or
irritable mood and abnormally and
persistently increased activity or
energy, lasting at least 4 consecutive
days and present most of the day,
nearly every day.
 B. During the period of mood
disturbance and increased energy and
activity, three (or more) of the
following symptoms (four if the
mood is only irritable) have
persisted, represent a noticeable
change from usual behavior, and
have been present to a significant
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only
3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts
are racing.
5. Distractibility (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli), as
reported or observed.
6. Increase in goal-directed activity (either socially, at
work or school, or sexually) or psychomotor
agitation.
7. Excessive involvement in activities that have a high
potential for painful consequences (e.g., engaging in
C. The episode is associated with an
unequivocal change in functioning
that is uncharacteristic of the
individual when not symptomatic.

D. The disturbance in mood and the

change in functioning are observable
by others
E. The episode is not severe enough to
cause marked impairment in social or
occupational functioning or to necessitate
hospitalization. If there are psychotic
features, the episode is, by definition,
manic.

F. The episode is not attributable to the

physiological effects of a substance (e.g.,
a drug of abuse, a medication, other
MAJOR DEPRESSIVE
EPISODE

A. Five (or more) of the following

symptoms have been present during the
same 2-week period and represent a
change from previous functioning; at
least one of the symptoms is either (1)
depressed mood or (2) loss of interest or
pleasure.

Note: Do not include symptoms that are

 2. Markedly diminished interest or
pleasure in all, or almost all,
activities most of the day, nearly
every day (as indicated by either
subjective account or
observation).

1. Depressed mood most of the

day, nearly every day, as
indicated by either subjective
report (e.g., feels sad, empty, or
hopeless) or observation made
by other (e.g., appears tearful).
(Note: In children and
adolescents, can be irritable
mood.
3. Significant weight 4. Insomnia or
loss when not dieting
or weight gain (e.g., a
hypersomnia nearly
change of more than every day.
5% of body weight in
a month), or decrease
or increase in appetite
nearly every day.
(Note: In children,
consider failure to
make expected weight
gain.)

5. Psychomotor agitation or
retardation nearly every day
(observable by others; not
merely subjective feelings of
restlessness or being slowed
down).
 8. Diminished
6. ability to think
or concentrate,
Fatigue
or
or loss indecisiveness,
of nearly every
energy day (either by
nearly subjective
account or as
every
observed by
day. others).
9. Recurrent
thoughts of death
7. Feelings of
(not just fear of
worthlessness or
dying), recurrent
excessive or
suicidal ideation
inappropriate guilt
with­
(which may be
out a specific plan,
delusional) nearly
a suicide attempt,
every day (not
or a specific plan
merely self-
for committing
reproach or guilt
suicide.
about being sick).
B. The symptoms cause clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.

C. The episode is not attributable to

the physiological effects of a
substance or another medical
condition.
Bipolar II disorder is defined
as being present if the person
experiences episodes of
both hypomania and depression
but no manic episodes.
 DIAGNOSTIC
CRITERIA
HYPOMANIC EPISODE

A. A distinct period of abnormally and

persistently elevated, expansive, or irritable
mood and abnormally and persistently
increased activity or energy, lasting at least 4
consecutive days and present most of the day,
nearly every day.
B. During the period of mood disturbance
and increased energy and activity, three
(or more) of the following symptoms
have persisted (four if the mood is only
irritable), represent a noticeable change
from usual behavior, and have been
present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only
3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts
are racing.
5. Distractibility (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli), as reported
or observed.
6. Increase in goal-directed activity (either socially, at
work or school, or sexually) or psychomotor agitation
(i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high
potential for painful consequences (e.g., engaging in
C. The episode is associated with an
unequivocal change in functioning
that is uncharacteristic of the
individual when not symptomatic.

D. The disturbance in mood and the

change in functioning are observable
by others.
E. The episode is not severe enough to cause
marked impairment in social or occupational
functioning or to necessitate hospitalization.
If there are psychotic features, the episode is,
by definition, manic.

F. The episode is not attributable to the

physiological effects of a substance (e.g., a
drug of abuse, a medication or other
treatment).
Major Depressive Episode
A. Five (or more) of the following
symptoms have been present during the
same 2-week period and represent a
change from previous functioning; at
least one of the symptoms is either (1 )
depressed mood or (2) loss of interest or
pleasure.

Note: Do not include symptoms that are

 1. Depressed mood 3. Significant weight
most of the day, nearly 2. Markedly loss when not dieting
every day, as indicated diminished interest or or weight gain (e.g., a
by either subjective pleasure in all, or change of more than
report (e.g., feels sad, almost all, activities 5% of body weight in a
empty, or hopeless) or most of the month), or decrease or
observation made by day, nearly every day increase in appetite
other (e.g., appears (as indicated by either nearly every
tearful). (Note: In subjective account or day. (Note: In children,
children and observation). consider failure to
adolescents, can be make expected weight
irritable mood. gain.)

5. Psychomotor agitation or retardation nearly

4. Insomnia or
every day (observable by others; not
hypersomnia
merely subjective feelings of restlessness or
nearly every day.
being slowed down).
 7. Feelings of
worthlessness or
excessive or 8. Diminished ability to think
inappropriate guilt or concentrate, or
6. Fatigue or loss
(which may be indecisiveness, nearly every
of energy nearly
delusional) nearly day (either by subjective
every day.
every day (not account or as observed by
merely self-reproach others).
or guilt about being
sick).

9. Recurrent thoughts of death (not just fear

of dying), recurrent suicidal ideation with­
out a specific plan, a suicide attempt, or a
specific plan for committing suicide.
B. The symptoms cause clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.

C. The episode is not attributable to

the physiological effects of a
substance or another medical
Cyclothymia
Also known
as cyclothymic
disorder, is a rare
mood disorder.
Cyclothymia causes
emotional ups and
downs, but they're
not as extreme as
those in bipolar I or
II disorder.
Hypomanic Symptoms
Irritable or
agitated Talking more
behavior than usual

An exaggerated
feeling of happiness
or well-being
(euphoria)
Depressive Symptoms
Thinking of
death or suicide

Loss of
interest in
activities 

Tearfulne
ss

Problems
concentrating
 DIAGNOSTIC
CRITERIA

A. For at least 2 years (at least 1 year in

children and adolescents) there have been
numerous periods with hypomanic
symptoms that do not meet criteria for a
hypomanic episode and numerous periods
with depressive symptoms that do not meet
criteria fo a major depressive episode.
B. During the above 2-year period (1
year in children and adolescents), the
hypomanic and depressive periods
have been present for at least half the
time and the individual has not been
without the symptoms for more than
2 months at a time.
C. Criteria for a major depressive, manic,
or hypomanic episode have never been
met.

D. The symptoms in Criterion A are not

better explained by schizoaffective
disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other
specified or unspecified schizophrenia
E. The symptoms are not attributable
to the physiological effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition (e.g., hyperthyroidism).
 DIAGNOSTIC
CRITERIA

A. A prominent and persistent disturbance

in mood that predominates in the clinical
picture and is characterized by elevated,
expansive, or irritable mood, with or
without depressed mood, or markedly
diminished interest or pleasure in all, or
almost all, activities.
 B. There is evidence from the history,
physical examination, or laboratory
findings of both
(1)and (2):

1. The symptoms in Criterion A developed

during or soon after substance
intoxication or withdrawal or after
exposure to a medication.
2. The involved substance/medication is
C. The disturbance is not better
explained by a bipolar or related
disorder that is not
substance/medication-induced.
Such evidence of an independent
bipolar or related disor­der could
include the following:
The symptoms precede the onset of the
substance/medication use; the symptoms
persist for a substantial period of time
(e.g., about month) after the cessation of
acute Withdrawal or severe intoxication;
or there is other evidence suggesting the
existence of an independent non-
substance/medication-induced bipolar
and related disorder (e.g., a history of
recurrent non substance/medication-
 D. The disturbance does not occur
exclusively during the course of a delirium.

E. The disturbance causes clinically

significant distress or impairment in social,
occupational, or other important areas of
functioning.
 DIAGNOSTIC
CRITERIA

A. A prominent and persistent period

of abnormally elevated, expansive, or
irritable mood and abnormally
increased activity or energy that
predominates in the clinical picture.
B. There is evidence from the history,
physical examination, or laboratory
findings that the disturbance is the
direct pathophysiological
consequence of another medical
condition.
 C. The disturbance is not better
explained by another mental disorder.

D. The disturbance does not occur

exclusively during the course of a
delirium.
 E. The disturbance causes clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning, or necessitates
hospitalization to prevent harm to self or
others, or there are psychotic features.