What Is Bipolar I?
To meet the criteria for bipolar I, a major depressive episode must occur. During this episode, you must have at least five out of the nine depression symptoms during the same 2-week period. Symptoms include:
- Feeling depressed most of the day, almost every day. This tends to be the biggest indication to people that they are depressed. Having a depressed mood means that you do not feel happy; you feel sad, empty or hopeless. Teenagers with depression may express this mood as irritability and anger. Additionally, men are more likely to show their depressed mood is the form of anger and aggression.
- Less interest or pleasure in activities that were previously enjoyable. Did you always love going for walks or watching the football game with your friends, but now the thought of it is unappealing? Whenever there is less interest and pleasure, people tend to stay at home more because nothing seems worthwhile.
- Losing weight when not dieting. The DSM states that a significant weight loss is more that 5% of your total weight in a month. If you weigh 200 lbs, you would have to lose 10 lbs in a month to meet this criterion. Some people report increased interest in eating and weight gain during depression but the DSM only focuses on the weight loss.
- Insomnia or hypersomnia almost every day. This item can be a bit confusing as it covers both ends of the spectrum. If you are sleeping too much, you might have depression. If you are not sleeping enough, you might have depression. There is no set number of hours given to say how much is too much. The best you can do is look for changes to your typical patterns. If you usually sleep eight hours and now you're sleeping up to 12, take note. Similarly, if you used to sleep 10 hours and now it is down to four, contact a professional. People with depression also tend to have difficulty falling asleep (DFA), difficulty staying asleep (SCD) and early morning awakening (EMA).
- Motor agitation or retardation almost every day. What this means is that your behaviors are either sped up or slowed down. People with psychomotor retardation will feel like they are moving in slow motion while people with psychomotor agitation will experience feelings of restlessness, fidgeting and moving quickly. These changes can affect speech to be faster or slower.
- A loss of energy almost every day. The second item on the list refers to lacking interest to complete activities, where this item involves feeling that you do not have the energy to accomplish the behaviors that you wish. If you find yourself unable to get out of bed or move from the couch while important tasks that you want to complete are left undone, this applies to you.
- Feeling excessively worthless or guilty almost every day. Do you beat yourself up over past behaviors or experiences? Do you think that you do not matter or that other people wouldn’t care if you weren’t alive? Shame is another contributor to this part of the criteria. Guilt is feeling bad for something that you did or did not do. Shame is feeling bad about who you are as a person. Shame is a more dangerous feeling because it is challenging to change. People that do not like themselves or have low self-esteem fit into this category.
- Decreased ability to be decisive, think clearly and maintain concentration. This item becomes difficult when trying to determine between depression and attention-deficit/hyperactivity disorder since poor attention and concentration are present in each. People with depression are usually distracted due to negative thinking and dwelling on issues of the past and this impacts their attention.
- Frequent thoughts of death, thinking you would be better off dead or making a plan to attempt suicide. Again, it can be difficult to know what “frequent” means, but use your best judgment when deciding whether or not to check this box.
If you met at least five of the symptoms, you can move on to the manic symptoms. To meet the criteria for a manic episode, you must experience an elevated or irritable mood, a sharp increase in energy and three of the seven symptoms for at least a week. The symptoms include:
- Inflated self-esteem or feelings of grandiosity. You will feel self-assured, confident and like you are incapable of being wrong.
- Decreased need for sleep. You will sleep less while not being bothered by the decrease. You will feel rejuvenated after only two or three hours rest.
- More talkative. You will find yourself speaking more, being more open with what you say and speaking at a quicker rate.
- Flight of ideas or racing thoughts. Flight of ideas means that your thoughts will bounce from subject to subject quickly with little follow through. Racing thoughts means that your thoughts are circling around quickly in your mind. They are difficult to slow down or understand.
- Your attention will be poor and any new stimulus will divert your actions or thought process.
- Increased goal-directed behaviors. Here, you will do whatever it takes to accomplish the goal. You will study three days straight for an exam, stay at the office for the weekend or go to every bar in town to meet someone to take home.
- Increased involvement in risky behaviors. Mania has a lot to do with pleasure-seeking behaviors. You may spend all of your money, have unsafe sex with strangers, use drugs or other dangerous behaviors in attempts to “have fun.”
An interesting note about bipolar I is that you only need one occurrence of a manic episode to qualify. Even if your last manic episode was 20 years ago, you will still meet these criteria.