Bipolar Disorder Episodes 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).

Manic Episodes

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 an 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.

Hypomanic Episodes

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.

Major Depressive Episodes

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
  • Difficulty concentrating
  • Thinking of death or suicide

Mixed Episodes

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 to Do If You Experience a Bipolar Episode

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.

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Article 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?

  • American Psychiatric Association. What are Bipolar Disorders?

  • 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.