Types of Bipolar Disorder Episodes According to the DSM-5

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 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

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
• A significant increase in activities or motor agitation
• Engaging in risky behavior like gambling or unprotected sex
• Racing thoughts

According to the DSM-5, text revision (DSM-5-TR), the specifiers for manic episodes are as follows:

• Mild: A manic episode is mild if it meets minimum symptom criteria.
• Moderate: A manic episode is moderate if it causes a very significant increase in a person's activity or significantly impairs their judgment.
• Severe: A manic episode is severe if a person requires almost constant supervision while they are experiencing it so that they don't hurt themselves or others.

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 sleeping 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

The severity specifiers for major depressive episodes are the same terms used to label manic episodes (mild, moderate, and severe). However, it's important to note that the criteria for major depressive specifiers are different than those for mania. The specifiers and their definitions for major depressive episodes are:

• Mild: A major depressive episode is mild if few symptoms are in excess of the minimum criteria and if the intensity of symptoms is manageable, resulting in minor impairment.
• Moderate: A major depressive episode is moderate if there are more symptoms present than in a mild case and if the symptoms are greater in intensity (but not as intense as in a severe episode).
• Severe: A person is having a severe major depressive episode when they're exhibiting many more symptoms than the minimum symptom criteria, the symptoms are extremely distressing and impossible to manage, and they cause major impairment in their functioning.

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 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 use 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.