Bipolar Disorder Episodes

Episodes Definitions According to the DSM-V

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Wherever you see something written about bipolar disorder, the term episode is usually encountered. An episode refers to a collection of symptoms that describe a person's overall mood and behavior. 

Let's take a closer look at episodes in bipolar disorder, according to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-V).

What is a Manic Episode?

During a manic episode, a person has a sustained and abnormally elevated, expansive, or irritable mood for at least one week, and at least three of the following symptoms:

  • grandiosity or inflated sense of self
  • little need for sleep
  • feeling pressured to speak, talking loudly and rapidly
  • easily distracted
  • engaging in multiple tasks at one time — more than can be realistically accomplished in one day
  • engaging in risky behavior like gambling or unprotected sex
  • racing thoughts 

These symptoms are exaggerated and noted by family members and loved ones. They impair a person's ability to function at home, school, and/or work. 

What is a Hypomanic Episode?

During a hypomanic episode, the symptoms of mania only need to last four days in a row. The symptoms do not impair everyday functioning like they do in a manic episode, and they are not severe enough to necessitate hospitalization.

What is a Major Depressive Episode?

A major depressive episode must last at least two weeks and is characterized by either a severe sadness or feeling of hopelessness and/or a loss of interest or pleasure in activities that the person once enjoyed.

Other symptoms that may occur in a major depressive episode include:

  • feeling guilty
  • sleeping problems, like too much or too little
  • feeling agitated or alternatively, feeling slowed down
  • eating more or less
  • fatigue and loss of energy
  • difficult concentrating
  • thinking of death or suicide

​What is a Mixed Episode?

In the DSM-5, the term mixed episode was changed to mixed features.

Mixed features mean that a person may either be experiencing a manic episode with at least symptoms of depression or on the contrary, a major depressive episode with at least three symptoms of mania.

Basically, a person is having both symptoms of mania and depression at the same time. 

If a person if simultaneously having both a manic and depressive episode, the diagnosis is technically categorized as "manic episode with mixed features."

People with depression and mixed features are at a particularly high risk for developing substance abuse disorders.

What Should I Do?

Remember a bipolar episode is a distinct period of time when specific symptoms are present that, taken together, classify a person's mood as manic, hypomanic, or depressive.

If you are concerned you are experiencing symptoms of a bipolar episode, please seek care from a mental health professional. 

Sources

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 

American Psychiatric Association. Help with Bipolar Disorders: What is a mixed episode? Retrieved November 1st 2015. 

American Psychiatric Association. What are Bipolar Disorders? Retrieved November 1st 2015. 

Hu J, Mansur R, & McIntyre RS. Mixed Specifier for Bipolar Mania and Depression:Highlights of DSM-5 Changes and Implications for Diagnosis and Treatment in Primary Care. Prim Care Companion CNS Disord. 2014;16(2): Pcc. 13r01599

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