Bipolar Disorder Signs and Symptoms

Bipolar disorder, also known as manic-depressive illness, is a psychiatric disorder that causes unusual and significant shifts in mood, energy, activity levels, and the ability to carry out everyday tasks. This page provides information about bipolar disorder signs and symptoms and bipolar statistics, along with the DSM-IV criteria for bipolar I and bipolar II disorder.

Bipolar disorder is more than the normal ups and downs that everyone goes through from time to time and if undiagnosed and untreated can result in damaged relationships, poor job or school performance, and even suicide. Fortunately, with appropriate treatment, sufferers can lead full and productive lives.

Bipolar disorder statistics: Bipolar disorder affects both sexes equally in all age groups and its worldwide prevalence is estimated to be between 3-5%. It often develops in a person's late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.

For many sufferers and their families, Bipolar disorder is not always easy to identify when it starts and therefore some people can suffer for years before they are properly diagnosed and treated.

Bipolar disorder is characterised by a combination of the following episodes:

1.     Manic episode

2.     Major depressive episode

3.     Mixed episode

4.     Hypomanic episode

DSM-IV (diagnostic manual for psychiatric conditions) categorises bipolar disorder into 4 types, with the 2 major types being, Bipolar I and Bipolar II. Bipolar II is the more common form, although is by no means less severe.

Bipolar Disorder Signs and Symptoms:

Bipolar I Disorder Diagnostic features (based on DSM-IV)

To be diagnosed with Bipolar I Disorder a person must be suffering from one or more manic episodes or mixed episodes.  Although a depressive episode is not required for a diagnosis of Bipolar I disorder, the overwhelming majority of people with Bipolar I do suffer from them. Details about the signs and symptoms of manic and mixed episodes are detailed below:

Criteria for Manic Episode (based on DSM-IV)

A.    A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalisation is necessary).

B.    During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) 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)

6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C.    The symptoms do not meet criteria for a Mixed Episode.

D.    The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E.    The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).

Criteria for Mixed Episode (based on DSM-IV)

  A.    Except for duration, the criteria are met both for a Manic Episode and for a Major Depressive Episode nearly every day during at least a 1-week period.

  B.  The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

  C.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Bipolar Disorder Signs and Symptoms:

Bipolar II Disorder Diagnostic features (based on DSM-IV)

Bipolar II Disorder is characterised by the occurrence of one or more major depressive episodes accompanied by at least one hypomanic episode. The signs and symptoms of each episode are detailed below:

Criteria for Major Depressive Episode (based on DSM-IV)

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.

1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.

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 made by others)

3. significant weight loss when not dieting or weight gain (e.g., a change of more than 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 gains.

4. insomnia or hypersomnia nearly every day

5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. fatigue or loss of energy nearly every day

7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Criteria for Hypomanic Episode (based on DSM-IV))

  A.    A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

  B.    During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) 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)

6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C.    The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person 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, and there are no psychotic features.

F.    The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

This page provides an overview of bipolar disorder signs and symptoms and specifically of the symptoms of bipolar I versus bipolar II disorder. It is provides some bipolar statistics. If you or a family member is suffering from many of the symptoms described, do seek professional assistance.

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