With Mixed Features
This specifier describes people whose symptoms do not fit into the expected mold of manic episodes and depressive episodes. Instead, their symptoms seem to be jumbled in different, unpredictable combinations presenting during mood episodes. People with mixed features may have difficulty receiving the appropriate diagnosis because their symptoms being hard to assess.
With Rapid Cycling
People are generally familiar with this specifier, but there continues to be some misunderstanding with it. Some people think that rapid cycling means that they are manic one minute and then depressed the next. In actuality, you only can receive the “with rapid cycling” specifier if you have had four or more distinct mood episodes over the last year. You can have any combination of depressive, manic or hypomanic episodes as long as they equal four in total.
Another important distinction is that the mood episodes must be separated by two months of partial remission in between symptoms. This means that you have a period of 60 days that your symptoms are low and do not meet criteria for any mood episodes. After this period, you can begin counting a new episode. Forget the idea of having multiple episodes in one day.
In bipolar disorder with rapid cycling, it should be noted that the actual intensity of the episodes of depression, mania or hypomania are not different from someone with normal cycling. The only difference is the frequency and duration of the episode.
With Psychotic Features
Psychotic features are potentially present in bipolar disorder just as they are in major depressive disorder. When your bipolar symptoms are extreme, you can hear things that are not there and see things that are not there. Some people can even feel, taste and smell things that are not there. These are called hallucinations. Delusions are also common with this specifier. With delusions, you begin to think in ways that have no evidence to confirm your thinking. You may become paranoid and suspicious. These are called delusions of persecution. People with delusions of grandeur believe that they are very important and have connections to powerful, successful people.
These psychotic features will only occur during periods of extreme bipolar symptoms. If the features are present during a period of mild symptoms, there may be a psychotic disorder like schizophrenia involved. As with all information included, be sure to follow up with your treatment team to find the diagnosis and treatment that fits you best.
