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Diagnosing a Mixed Episode

DSM Criteria


Updated March 30, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

There are three criteria your doctor will review with you to determine if you are having a mixed episode as defined by the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

As the name implies, a mixed episode has features of both mania and depression. As with the other types of episodes associated with bipolar disorder, a mixed episode is a cluster of symptoms. To determine if you are currently having a mixed episode or if you’ve had one in the past, your doctor will determine if:

  1. Your symptoms have lasted long enough to meet the duration requirement of at least one week during which time you also meet the criteria for both a manic episode and a depressive episode,

  2. Your symptoms are severe enough to disrupt your daily life. Do you need to be hospitalized? Or are you experiencing psychotic features?

  3. Your symptoms are not caused by a drug (legal or otherwise) or another medical problem (see Ruling Out Other Physical Conditions).
If your doctor, with your input, determines that all the above criteria are true, your symptoms will most likely be considered to constitute a mixed episode.

As noted above, these criteria have been established through the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is the primary system used to classify and diagnose all mental disorders. NOTE: The diagnostic description of a mixed episode is planned to be substantially changed in the next edition of the DSM.

As per this formal classification system, bipolar disorder is a clinical disorder within the category of mood disorders. The manual recognizes four types of bipolar disorder. Each specific type of bipolar disorder is distinguished by the others through the nature of episodes experienced.

Bipolar Disorder Today. Mixed Episode - DSM-IV Criteria.

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