Specifiers in Bipolar Disorder

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Specifiers are extensions to a diagnosis that further clarify the course, severity, or special features of a disorder or illness. There are many different types of specifiers for bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), all of which help describe aspects of a person's experience with bipolar disorder.

Learn more about what the specifiers are for bipolar disorder, their definitions, as well as diagnostic criteria for each specifier.

Specifiers for Mood Disorders

The fifth edition of the DSM (DSM-5) uses specifiers extensively in the diagnosis of mood disorders. Any number of applicable specifiers can be used for the same episode.

For bipolar disorder, there are two categories of specifiers: those for defining the current or most recent mood episode, and those concerning the course of recurrent, or repeating, mood episodes.

The first category, defining current or recent episodes, includes mixed features, anxious distress, melancholic features, atypical features, psychotic features, and catatonic features. The second category, defining recurrent episodes, includes rapid cycling, peripartum onset, and seasonal pattern.

In addition, there are severity specifiers that are used to describe mania. The purpose of these specifiers is to identify how much impairment a person experiences during a manic episode.

Mixed Features Specifier

Bipolar disorder with mixed features means that you have both manic/hypomanic symptoms and depressive symptoms in the same mood episode, rather than one or the other. To be diagnosed with this specifier, your mood episodes (whether defined as manic, hypomanic or depressive) must meet all the criteria for that particular episode and have at least three symptoms that belong to the opposite type.

For instance, if you have a mood episode that meets all the criteria for a manic/hypomanic episode, yet you also have at least three symptoms of a depressive episode, the mixed features specifier would apply.

Anxious Distress Specifier

Bipolar disorder with anxious distress means your mood episode includes at least two symptoms of anxiety. These symptoms can be restlessness, lack of concentration, worry, feeling tense, and fear of losing control.

Melancholic Features Specifier

Bipolar with melancholic features usually happens if you have severe depressive symptoms. It's defined as severe depression that includes symptoms like:

Atypical Features Specifier

Bipolar disorder with atypical features means during your depressive episodes, you have atypical (uncommon) symptoms of depression including:

With atypical features, you also may feel your depressive symptoms lessen when you experience something positive.

Psychotic Features Specifier

Bipolar disorder with psychotic features can include mood-congruent or mood-incongruent features. Psychotic features involve hallucinations and/or delusions. However, the characteristics of the psychotic features specifier also vary based on whether your most recent episode was manic or depressive.

Catatonic Features Specifier

Bipolar with catatonic features is diagnosed if you experience catatonia along with your mood episodes.

Catatonia symptoms can include not responding to anything, not being able and/or willing to talk, rigid muscles, repeating what someone just said, grimacing, moving around with no purpose, and resisting movement.

Rapid Cycling Specifier

The rapid cycling specifier means that your mood episodes have occurred a minimum of four times in the past year. In between mood episodes, you must have had a stable mood or switched completely to the opposite kind of mood episodes (for example, from hypomanic to depressive mood).

Seasonal Pattern Specifier

The seasonal pattern specifier is indicated if your mood episodes only occur at certain times of the year—usually fall and/or winter. This can happen because of light deprivation.

Peripartum Onset Specifier

Peripartum onset can be diagnosed if your mood episode, usually depressive, occurs during your pregnancy or up to four weeks after you give birth. These episodes can be accompanied by anxiety or panic attacks

Severity Specifiers

The fifth edition of the DSM-5, text revision (DSM-5-TR) updated severity specifiers for manic episodes in bipolar disorder. It's important to note that a manic episode, by definition, will always cause impairment to a person's function. The specifiers help label a manic episode based on how much impairment it has caused. The specifiers are:

  • Mild: A person's manic episode meets minimum symptom criteria.
  • Moderate: A person's manic episode causes a very significant increase in activity or impairment in judgment.
  • Severe: A person's manic episode requires supervision so that they don't harm themselves or others.
1 Source
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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. American Psychiatric Publishing.

Additional Reading
  • Cutler JL. Psychiatry: Third Edition. Oxford University Press.

  • Janicak PG, Esposito J. An update on the diagnosis and treatment of bipolar disorder. Psychiatric Times. 2015;32(11).

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.