Often times when I meet with a new client who is experiencing exaggerated mood swings that they feel unable to control, we will investigate whether the client has met diagnostic criteria for a manic episode, a hypomanic episode, and/or a major depressive episode.

Sections of the following descriptions of mania, hypomania, and depression are referenced from the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision), which is a diagnostic manual used by psychologists. Italics indicate that the words have been copied directly from the DSM-IV-TR. The text presented, however, is only a partial reproduction. Full criteria are not presented in this blog for the sake of simplicity and brevity.

A manic episode can be described as a distinct period of abnormally and persistently elevated expansive or irritable mood, energy or irritability, lasting at least 1 week (or any duration if hospitalization is necessary).

There are several symptoms that characterize a manic episode. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep talking
4. flight of ideas of subjective experience that thoughts are racing
5. distractibility
6. increase in goal-directed activity
7. excessive involvement in pleasurable activities that have a high potential for painful consequences.

In addition, the mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

Hypomania is another mood state than can occur that is similar to mania but lesser in intensity and possibly duration. The seven symptoms listed for mania can all occur during a hypomanic episode. However, unlike a manic episode, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. 

A major depressive episode can be diagnosed when five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1. depressed mood most of the day, nearly every day
2.  markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. diminished ability to think or concentrate, or indecisiveness, nearly every day
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

In addition, the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Read more about Bipolar Disorder.

— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta