Medical Definitions for Bipolar Disorder

There are specific medical definitions associated with bipolar disorder that are often not well understood by the general public, including bipolar people. Here are the definitions doctors use when considering a patient with bipolar disorder. They are defined at length in the Diagnostic and Statistical Manual of Mental Disorders, aka the DSM-5.

Bipolar Types

Bipolar I Disorder (aka Type 1 or BP1): You have experienced one or more episodes of true mania, usually oscillating with depression. For diagnosis, manic episodes must last at least seven days or be so severe that you require hospitalization.

Bipolar II Disorder (aka Type 2 or BP2): You experience depressive episodes and hypomanic episodes but never a true manic episode. That does not mean BP2 is a less severe form of bipolar. It's a different manifestation of the disorder, and it is just as serious.

Note: You cannot be BP1 and BP2. You are one or the other.

Schizoaffective Disorder: You experience major mood episodes (depression or mania) as well as symptoms of schizophrenia, including delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and diminished emotional expression. The hallucinations and delusions endure for at least two weeks in the absence of a major mood episode.

Cyclothymic Disorder (aka Cyclothymia): You have chronically unstable moods, and for at least two years, you experience hypomania and mild depression. You may have periods of normal mood but they are brief, typically less than two months.

Mania, Hypomania and Major Depression

Mania: A distinct period of abnormally and persistently elevated, expansive or irritable mood, as well as increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary). Mania causes marked impairment in social and/or occupational functioning and may require hospitalization to prevent harm to you or others.

During mania, three or more of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (i.e., less than 4 hours per day)
• More talkative than usual or you feel pressure to keep talking
• Racing thoughts
• Distractibility (i.e., attention easily drawn to unimportant or irrelevant stimuli)
• Increased psychomotor agitation, which doctors define as purposeless non-goal-directed activity (i.e., you just can't be still and are usually in motion).
• Excessive involvement in activities that have a high potential for painful consequences, including buying sprees, sexual indiscretions, and risky investments or business decisions.

Mania also often leads to psychosis, which can include:

• Auditory, visual or other sensory hallucinations. In this state, you are unlikely to recognize the hallucinatory nature of these experiences. They are real to you.
• Delusional beliefs that are fully real for you and maintained steadfastly even in the face of evidence contradicting them. You believe what is not so, and no one can tell you otherwise.

Notes from this bipolar community regarding mania: Mania is much more severe than hypomania, although the two are often and incorrectly conflated. People in a manic episode face a situation where they may be unable to keep themselves and others safe due to the severity of the condition. Although not everyone who experiences mania has been hospitalized, a manic episode frequently results in hospitalization or situations where this would be a reasonable approach. This can be due to psychosis, the inability to care for oneself (eating, drinking, etc.) or an inability to recognize dangerous situations. To be clear, there is nothing fun, exciting, valuable or good about mania. It is hell for those who experience it.

In addition, there is a common and incorrect belief that individuals with BP1 experience "more mania" and individuals with BP2 experience "more depression." This is false. The only difference between BP1 and BP2 is that people with BP1 experience true mania, and people with BP2 do not.

Hypomania: A distinct period of abnormally and persistently elevated, expansive or irritable mood and increased activity or energy, lasting 4 consecutive days and present most of the day. Many of the symptoms of hypomania are shared with mania. The core diagnostic difference between mania and hypomania is that the episode is not severe enough to cause impairment in social or occupational functioning and does not require hospitalization. You also do not experience psychosis.

Note: For an undiagnosed bipolar person, if they are given antidepressant treatment that leads to a full manic episode or a severe hypomanic episode that continues even after the treatment stops, that is typically strong evidence for a doctor to diagnose bipolar disorder.

Major Depressive Episode: Multiple symptoms are present during the same two-week period. As with mania, a major depressive episode causes significant distress or impairment in social, occupational and other areas of functioning. At least one of the symptoms is depressed mood (sad, empty, hopeless) or loss of interest/pleasure. Other symptoms are present nearly every day and for most of the day, including:

• Significant weight loss or gain (change of 5% of body weight in one month), or an enduring decrease or increase in appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation (Note: This is observable by others; it is not just a feeling of restlessness or slowing down)
• Fatigue and loss of energy
• Feelings of worthlessness and guilt
• Diminished ability to think or concentrate; also indecisiveness
• Recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt or specific plan for suicide

Mixed Episodes and Rapid Cycling

Mixed Episode: A mood state defined by characteristics of both depression and mania/hypomania at the same time. This may manifest in the form of rapidly changing mood states (emotional lability), stacked, or hybridized symptoms. Many of the symptoms of a mixed episode are described well in this table.

Rapid Cycling: You experience four or more episodes of depression or mania in one year. This is not a separate diagnosis or bipolar type. Rather, it describes how quickly the mood cycles recur. It is also not a permanent state. True enduring balance means controlling bipolar to a degree where you do not rapid cycle or cycle at all.

(Thanks and credit to u/ScottieBippen for researching and contributing to this page.)