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
  • 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

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.

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 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
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.
  1. Substance Abuse and Mental Health Services Administration. DSM-5 changes: implications for child serious emotional disturbance manic episode. 2016.

  2. Substance Abuse and Mental Health Services Administration. Impact of the DSM-iv to DSM-5 changes on the national survey on drug use and health hypomania. 2016.

  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.

Additional Reading
  • 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.