Types of 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.

Episodes in Bipolar Disorder

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
  • Significantly increased activities or motor agitation
  • Engaging in risky behavior like gambling or unprotected sex
  • Racing thoughts

These symptoms are noted by family members and loved ones. They impair a person's ability to function at home, school, and/or work, and may cause psychosis or land someone in the hospital.

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, do not cause psychosis, 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 excessively guilty or worthless
  • Sleeping problems, like too much or too little
  • Feeling agitated or alternatively, feeling slowed down
  • Eating more or less with significant weight changes
  • Fatigue and loss of energy
  • Difficulty concentrating
  • Thinking of death or suicide

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

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. People with mixed features are at higher risk for more co-morbid conditions such as 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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5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Substance Abuse and Mental Health Services Administration. DSM-5 changes: implications for child serious emotional disturbance major depressive episode. 2016.

  4. Vieta E, Valenti M.  Mixed states in DSM-5: Implications for clinical care, education, and research. Journal of Affective Disorders. 2013;(1)15: 28-36.  doi:10.1016/j.jad.2013.03.007

  5. American Psychiatric Association. What are bipolar disorders?. January 2017.

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