A.  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, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 

NOTE : In children and adolescents, irritability may be observed.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. 

NOTE:  In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(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

C.  The symptoms cause clinically significant distress or impairment in social, 
      occupational, or other important areas of functioning.

D.  The symptoms are not due to the direct physiological effects of a substance 
      (e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
      hypothyroidism).

E.  The symptoms are not better accounted for by Bereavement, i.e., after the
      loss of a loved one, the symptoms persist for longer than 2 months or are
      characterized by marked functional impairment, morbid preoccupation with
      worthlessness, suicidal ideation, psychotic symptoms, or psychomotor
      retardation.

Criteria for Manic Episode

A.   A distinct period of abnormally and persistently elevated, expansive, or
       irritable mood, lasting at least one week (or any duration if hospitalization is
       necessary).

B.   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 (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

D.   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.

E.   The symptoms are not due to the direct physiological effects of a substance
       (e.g., a drug of abuse, a medication, or other treatment) or a general medical
       condition (e.g., hyperthyroidism).

Criteria for Mixed Episode

A.  The criteria are met both for a Manic Episode and for a Major Depressive 
      Episode (except for duration) nearly every day during at least a 1-week 
      period.

B.  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.

C.  The symptoms are not due to the direct physiological effects of a substance
      (e.g., a drug of abuse, a medication, or other treatment) or a general medical
      condition (e.g., hyperthyroidism).

    NOTE:  Mixed-like episodes caused by somatic antidepressant treatment
     (e.g., medication, electroconvulsive therapy, light therapy) should not count
     toward a diagnosis of Bipolar I Disorder.

Criteria for Hypomanic Episode

A.   A distinct period of persistently elevated, expansive, or irritable mood, 
       lasting throughout at least 4 days, that is clearly different from the usual 
       nondepressed mood.

B.   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 (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

D.   The disturbance in mood and the change in functioning are observable by 
       others.

E.   The episode is not severe enough to cause marked impairment in social or
       occupational functioning, or to nesessitate hospitalization, and there are no
       psychotic features.

F.   The symptoms are not due to the direct physiological effects of a substance
       (e.g., a drug of abuse, a medication, or other treatment) or a general
       medical condition (e.g., hyperthyroidism).

     NOTE: Hypomanic-like episodes caused by somatic antidepressant
      treatment (e.g., medication, electroconvulsive therapy, light therapy) should
      not count toward a diagnosis of Bipolar II Disorder.

Criteria for Major Depressive Disorder

A.    Presence of a single (two or more) Major Depressive Episode.

B.    The Major Depressive Episode (Episodes) is not better accounted for by
      Schizoaffective Disorder and is not superimposed on Schizophrenia,
      Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
      Not Otherwise Specified.

C.    There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
        Episode. 

Criteria for Dysthymic Disorder

A.    Depressed mood for most of the day, for more days than not, as indicated
        either by subjective account or observation by others, for at least 2 years. 

(1) poor appetite or overeating

(2) insomnia or hypersomnia

(3) low energy or fatigue

(4) low self-esteem

(5) poor concentration or difficulty making decisions

(6) feelings of hopelessness

D.    No Major Depressive Episode has been present during the first 2 years of
        the disturbance (1 year for children and adolescents); i.e., the disturbance
        is not better accounted for by chronic Major Depressive Disorder, or Major
        Depressive Disorder, In Partial Remission.

E.    There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
        Episode, and criteria have never been met for Cyclothymic Disorder.

F.     The disturbance does not occur exclusively during the course of a chronic
       Psychotic Disorder, such as Schizophrenia or Delusional Disorder.

G.    The symptoms are not due to the direct physiological effects of a substance
        (e.g., a drug of abuse, a medication) or a general medical condition (e.g., 
        hypothyroidism).

H.    The symptoms cause clinically significant distress or impairment in social, 
        occupational, or other important areas of functioning.

Criteria for Bipolar I Disorder 
    (Most Recent Episode Unspecified)

A.    Criteria, except for duration, are currently (or most recently) met for a 
      Manic, a Hypomanic, a Mixed, or a Major Depressive Episode.

B.    There has previously been at least one Manic Episode or Mixed Episode.

C.    The mood symptoms cause clinically significant distress or impairment in
        social, occupational, or other important areas of functioning.

D.    The mood symptoms in Criteria A and B are not better accounted for by
      Schizoaffective Disorder and are not superimposed on Schizophrenia,
      SchizophreniformDisorder, Delusional Disorder, or Psychotic Disorder
      Not Otherwise Specified.

E.    The mood symptoms in Criteria A and B are not due to the direct
        physiological effects of a substance (e.g., a drug of abuse, a medication, or
        other treatment) or a general medical condition (e.g., hyperthyroidism).

Criteria for Bipolar II Disorder

A.    Presence (or history) of one or more Major Depressive Episodes.

B.   Presence (or history) of at least one Hypomanic Episode.

C.   There has never been a Manic Episode or a Mixed Episode.

D.   The mood symptoms in Criteria A and B are not better accounted for by 
       Schizoaffective Disorder and are not superimposed on Schizophrenia,
     Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
     Not Otherwise Specified.

E.   The symptoms cause clinically significant distress or impairment in social,
       occupational, or other important areas of functioning.

Criteria for Cyclothymic Disorder

A.   For at least 2 years, the presence of numerous periods with hypomanic
       symptoms and numerous periods with depressive symptoms that do not meet
       criteria for a Major Depressive Episode. 

B.   During the above 2-year period (1 year in children and adolescents), the
       person has not been without the symptoms in Criterion A for more than 2
      months at a time.

C.   No Major Depressive Episode,Manic Episode, or Mixed Episode has been 
       present during the first 2 years of the disturbance.

D.   The symptoms in Criterion A are not better accounted for by
       Schizoaffective Disorder and are not superimposed on Schizophrenia,
       Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
       Not Otherwise Specified.

E.   The symptoms are not due to the direct physiological effects of a substance
      (e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
      hyperthyroidism).

F.   The symptoms cause clinically significant distress or impairment in social, 
       occupational, or other important areas of functioning.

Copyright ^© 1994 American Psychiatric Association.