DSM-IV Mood Disorders and Hypersexuality Due to Bipolar Disorder

DSM-IV Mood Disorders and Hypersexuality Due to Bipolar Disorder

Written by DM
Friday, 21 May 2010 12:38

Bipolar Disorder is associated with Hypersexuality. To look at the main mood disorders in DSM-IV we cite the Mood Disorder Criteria for DSM-IV. Following is the summary of DSM-IV Mood Disorder symptoms. For details see:

http://www.a-silver-lining.org/BPNDepth/dsmiv.html

MOOD DISORDERS-DSM IV

http://www.a-silver-lining.org/BPNDepth/dsmiv.html

ABOUT THE DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)[2] defines the criteria for a wide array of mental illnesses. Most psychiatrists use it as a basis for diagnosing patients since insurance companies and hospitals like nice, orderly forms. Yet, they tend to focus more on alleviating symptoms with medication and other therapy than on attempting to fit people into strictly defined categories.

Researchers frequently use the criteria as defined in the DSM-IV to ensure consistency across clinical trials. However, some researchers wanting more flexibility use a modified form of the DSM-IV criteria, such as creating a new diagnostic category. (You may see some people mention Bipolar III, IV, etc. and other categories not part of the DSM-IV).

The DSM-IV chapter on Mood Disorders begins with a list of episodes. It then defines the various diagnoses in terms of these episodes. Finally, it defines a set of specifiers which further detail a patient's current state and how they cycle. Throughout the DSM-IV, the authors give diagnostic codes (e.g. 296.40) for each possible diagnosis.
We have provided a summary of the information provided in the Mood Disorders chapter to allow someone diagnosed with a mood disorder or a loved one to better understand the terminology and concepts.

DISORDERS

See the page containing DSM-IV Mood Disorders Criteria.

The DSM-IV specifies a number of mood disorders. For example, someone with the mental illness manic depression (bipolar) can be diagnosed with Bipolar I Disorder or Bipolar II Disorder. For each of these disorders, the person must have experienced one or more mood episodes to qualify for the diagnosis (except Dysthymic Disorder, for which there is no corresponding DSM-IV episode). The DSM-IV criteria include enough detail to contrast one disorder from another

The following table summarizes the relationship between episodes and DSM-IV disorders. Episodes are indicated on the outer border, while disorders are in the internal rectangle. For example, a person experiencing hypomanic episodes and major depressive episodes would be diagnosed with Bipolar II Disorder. Click on the disorders and episodes to jump to a full description of the item selected. Click on items in quotes for some relevant notes.

Unipolar Mania (part of DSM-IV Bipolar I Disorder)

Research has found scant evidence for the existence of "unipolar mania," in which a patient has only manic episodes and no depression or mixed states. For almost all examples (1) only a short history exists since onset, so over time depression may occur; or (2) patients do not recognize their own depression, though others do. [3] Other sources claim that unipolar mania exists, but is extremely rare. 90% of people who experience one manic episode go on to have further mood episodes.

In general, the manic episodes of "unipolar mania" seem to be the same as manic episodes of typical Bipolar I Disorder (mania and depression). The DSM-IV criteria for Bipolar I Disorder requires only manic episodes, so "unipolar mania" is classified as Bipolar I Disorder.

Hyperthymia (not part of DSM-IV)

A person may experience hypomanic episodes, with no depressive episodes or symptoms and not fall under any DSM-IV disorder criteria (except, possibly Bipolar Disorder, Not Otherwise Specified (NOS) or Mood Disorder, NOS). Goodwin and Jamison classify this as hyperthymia or "chronic" hypomania, a subset of cyclothymia. [4] In one study, 10% of cyclothymic patients were classified as hyperthymic. [5]
Euthymia (not part of DSM-IV)

This is the "normal" state for moods. The term euthymia is generally used to describe the mood of a patient who has stopped experiencing manic or depressive symptoms, either due to medication or during the general course of their illness.

Major Depressive Disorder
DSM-IV Diagnoses:
Major Depressive Disorder, Single Episode
Major Depressive Disorder, Recurrent

A person with Major Depressive Disorder (MDD) suffers from the worst type of depression, without any (hypo)manic episodes. This is often called unipolar depression, or just unipolar, when there are multiple episodes.
This illness is more common among women (10% to 25% over a lifetime) than among men (5% to 12% over a lifetime).

Those with MDD may have a family history of bipolar disorder (1.5 to 3 times as likely as the general population). This has led some researchers to hypothesize that unipolar depression and bipolar disorder are the same illness, in different forms. [6] Research has not yet found a simple genetic link.

Dysthymic Disorder
DSM-IV Diagnosis:
Dysthymic Disorder

Noteworthy DSM-IV Specifiers:
Early Onset
Late Onset

People with Dysthymic Disorder suffer from mild depression, without any (hypo)manic episodes.Previously known as depressive neurosis, dysthymia could be considered a minor depression, except the depressive symptoms last for at least two years without a break. Approximately 6% of the population will have Dysthymic Disorder in their lifetimes.
When someone has had Dysthymic Disorder for two years, he or she may be diagnosed as having Dysthymic Disorder and Major Depressive Disorder, at the same time, if the criteria are met. This is sometimes called double depression, as the patient suffers from the worst severity and longest duration of both.

Cyclothymic Disorder

DSM-IV Diagnosis:
Cyclothymic Disorder

Cyclothymic Disorder involves alternating hypomania and depressive episodes. Like bipolar, cyclothymia involves cycling between highs and lows, but it never reaches full mania or major depression. It was previously called cycloid personality. Over a lifetime, the chances of having Cyclothymic Disorder are from 0.4% to 1%.
Since it can be so mild, it frequently goes undiagnosed. Quite often, people diagnosed as Bipolar II recall cyclic symptoms before their diagnosis which could qualify as cyclothymia. Clinical trials show a tendency for those with Cyclothymic Disorder, particularly those with an early onset, to develop bipolar disorder over time.[4] From 15% to 50% will develop bipolar disorder.

Bipolar II Disorder

DSM-IV Diagnosis:
Bipolar II Disorder

Noteworthy DSM-IV Specifiers:

Hypomanic
Depressed

Bipolar II Disorder involves Major Depressive Episodes and Hypomanic Episodes. Since a significant portion of those suffering manic depression did not have full manic episodes, the classification was divided into Bipolar I and Bipolar II. However, Bipolar II is often a first step to Bipolar I. Over 5 years, between 5% and 15% of those will Bipolar II will change diagnosis to Bipolar I. Approximately 0.5% of people will develop Bipolar II in their lifetimes.

Bipolar I Disorder

DSM-IV Diagnoses:
Single Manic Episode
Most Recent Episode Hypomanic
Most Recent Episode Manic
Most Recent Episode Mixed
Most Recent Episode Depressed
Most Recent Episode Unspecified

Bipolar I Disorder is the classic form of manic depression, with full Manic Episodes and Major Depressive Episodes. (A person does not need to experience depression to qualify as Bipolar I : see Unipolar Mania.) The lifetime occurrence of Bipolar I Disorder is estimated between 0.4% and 1.6%.

CRITERIA FOR EPISODES

Major Depressive Episode

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.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
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, can be irritable mood.
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 mad 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, no 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
B. The symptoms do not meet criteria for a Mixed Episode.
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 long than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 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)
C. The symptoms do not meet the criteria for a Mixed Episode.
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).
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

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 that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

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)
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
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 necessitate 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 that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.
• Major Depressive Disorder
o Single Episode
o Recurrent
• Dysthymic Disorder
• Cyclothymic Disorder
Bipolar II Disorder
• Bipolar I Disorder
o Single Manic Episode
o Most Recent Episode
 Hypomanic
 Manic
 Mixed
 Depressed
Unspecified
Mood Disorder Due to
General Medical Condition
Substance-Induced Mood Disorder

Major Depressive Disorder, Single Episode
A. Presence of a single Major Depressive Episode.
B. The Major Depressive Episode 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. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Major Depressive Disorder, Recurrent
A. Presence of a two or more Major Depressive Episodes.
B. The Major Depressive Episodes are 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. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

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. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
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
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
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.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be give when the criteria are met for a Major Depressive Episode
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.
I.
Early Onset. This specifier should be used if the onset of the dysthymic symptoms occurs before age 21 years. Such individuals are more likely to develop subsequent Major Depressive Episodes.
Late Onset. This specifier should be used if the onset of the dysthymic symptoms occurs at age 21 or older.

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. Note: In children and adolescents, the duration must be at least 1 year.
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.
Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
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.

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.
Hypomanic. This specifier is used if the current (or most recent) episode is a Hypomanic Episode.
Depressed. This specifier is used if the current (or most recent) episode is a Major Depressive Episode.

Bipolar I Disorder, Single Manic Episode
A. Presence of only one Manic Episode and no past Major Depressive Episodes.
Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.
B. The Manic Episode is not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Hypomanic
A. Currently (or most recently) in a Hypomanic 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, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Manic
A. Currently (or most recently) in a Manic Episode.
B. There has previously been at least one Major Depressive Episode, Manic Episode or Mixed Episode.
C. 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.

Bipolar I Disorder, Most Recent Episode Mixed
A. Currently (or most recently) in a Mixed Episode.
B. There has previously been at least one Major Depressive Episode, Manic Episode or Mixed Episode.
C. 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.
Bipolar I Disorder, Most Recent Episode Depressed
A. Currently (or most recently) in a Major Depressive Episode.
B. There has previously been at least one Manic Episode or Mixed Episode.
C. 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.

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, Schizophreniform disorder, 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).

Mood Disorder Due to General Medical Condition
A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
2. elevated, expansive, or irritable mood
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Depressed Mood in response to the stress of having a general medical condition).
D. The disturbance does not occur exclusively during the course of a delerium.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important area of functioning.

With Depressive Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode.
With Major Depressive-Like Episode: if the full criteria are met (except Criterion D) for a Major Depressive Episode.
With Manic Features: if the predominant mood is elevated, euphoric, or irritable.
With Mixed Features: if the symptoms of both mania and depression are present but neither predominates.

Substance-Induced Mood Disorder
A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
2. elevated, expansive, or irritable mood
B. There is evidence from history, physical examination, or laboratory findings of either (1) or (2):
1. the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal
2. medication use is etiologically related to the disturbance
C. The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive Episodes).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
With Depressive Features: if the predominant mood is depressed
With Manic Features: if the predominant mood is elevated, euphoric, or irritable
With Mixed Features: if symptoms of both mania and depression are present and neither predominates.
With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome
With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome