Diagnosing a Manic Episode

Marcia Purse Health Guide
  • Note: In putting this together, I've taken most of the material from the working version of the DSM-V, which is the forthcoming new edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Society. The criteria for a manic episode are still subject to revision, but the basics are solid.


    Criterion A: A distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least a week and is present most of the day, nearly ever day during that time. It can last less than a week if hospitalization is necessary.


    Criterion B: At the same time, 3-4 or more of these symptoms are present:

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    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • Lots of talking or pressured speech
    • Flight of ideas (skipping from one subject to another rapidly) or racing thoughts
    • Easily distracted
    • Increase in goal-directed activity (socially, at work or school, or sexually), or physical agitation
    • Risky behavior (like spending sprees, sexual indiscretions, foolish decisions about money)

    Criterion C: The mood disturbance is severe enough to cause marked impairment in day-to-day function, or hospitalization is required, or there are psychotic features.


    Criterion D: The symptoms aren't cause by drug or alcohol use, medication or treatment, or another medical condition. The exception to this is when a full manic episode happens while a person is being treated for depression.


    Note that contrary to popular opinion, feeling "high" or euphoric (elevated) isn't the only possible diagnostic mood state of a manic episode. An expansive mood is one where a person is "lacking restraint in the expression of feelings, especially in having delusions of grandeur or being inclined to overvalue oneself or one's work" (which seems to me to cover the criteria of "inflated self esteem or grandiosity" pretty well, too). And excessive and unusual irritability that persists day after day along with at least four of the other symptoms listed in Criterion B can also be the main presentation of mania.


    Also, this doesn't mean other symptoms can't be present as well. Anxiety is a common additional symptom, but it isn't in the criteria for bipolar disorder because it's all too possible to have an anxiety disorder and bipolar disorder at the same time.


    What else do you want to know about mania? Leave me a comment.



Published On: March 26, 2010