Previously classified as mood disorders, bipolar disorders are a distinct category of disorder in the DSM-5-TR, characterised by recurrent episodes of mood disturbances.
There are three types of mood disturbance episodes (see Figure 9, Table 5):
- Major depressive episodes.
- Hypomanic episodes.
- Manic episodes.
Figure 9: The spectrum of bipolar episodes
Adapted from Black Dog Institute [153].
The first episode of illness is most commonly a depressive illness and bipolar disorder may not be diagnosed until treatment with antidepressant medication triggers a manic illness. Recognition of bipolar disorders can often be difficult, and many people are not diagnosed until they have experienced a number of years of severe mood swings. People tend to seek treatment for the depressive phases of the disorder but not for the periods of elation, so they are often mistakenly diagnosed as having a depressive disorder. In between episodes, the person is usually completely well. Most people with a bipolar disorder experience their first serious mood episode in their 20s; however, the onset of bipolar disorders may occur earlier or later in life and can be diagnosed in children as well as adults.
Table 5: Types of bipolar episodes
| Major depressive episode |
In a major depressive episode, five or more of the following symptoms are experienced nearly every day for at least two weeks:
- Depressed mood most of the day, nearly every day (e.g., feels sad, empty, hopeless; appears tearful).
- Loss of interest or enjoyment in activities.
- Reduced interest or pleasure in almost all activities.
- Change in weight or appetite.
- Difficulty concentrating or sleeping (e.g., sleeping too much or too little).
- Restlessness and agitation.
- Slowing down of activity.
- Fatigue or reduced energy levels.
- Feelings of worthlessness or excessive/inappropriate guilt.
- Recurrent thoughts of death, suicidal thoughts, attempts, or plans.
|
| Manic episode |
During a manic episode, the person experiences an abnormally or persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy for at least one week. The episode is characterised by the person experiencing some of the following symptoms:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep.
- Increased talkativeness or pressured speech.
- Flight of ideas or racing thoughts
- Distractibility.
- An increase in goal directed activity (e.g., at work, school, or socially).
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., buying sprees, sexual indiscretions, dangerous driving).
|
| Hypomanic episode |
| A hypomanic episode is the same as a manic episode, but is less severe. A hypomanic episode need only last four days and does not require the episode to be severe enough to cause impairment in social or occupational functioning. |