Mood disorders: diagnostic criteria

Psychology A2 · Clinical Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Mood disorders are diagnosed from the type of mood episode a person has had. A depressive episode means low mood or loss of interest and pleasure, most of the day, nearly every day, for at least two weeks, with other symptoms such as changed sleep, tiredness and feelings of worthlessness. If the person has only ever had depressive episodes, the disorder is unipolar.

Bipolar disorders also include high episodes. A manic episode is extreme elevated or irritable mood with high energy for about a week or more, and it badly disrupts life. A hypomanic episode is a milder form. The Beck depression inventory (BDI) measures how severe depressive symptoms are; it does not diagnose.

Rules to remember

Depressive disorder (unipolar): one or more depressive episodes and no history of mania or hypomania.
Bipolar type I: at least one manic episode.
Bipolar type II: at least one hypomanic episode and at least one depressive episode, and no manic episode.
Mania: elevated mood, little need for sleep, rapid speech, reckless behaviour, marked impairment; hypomania has no marked impairment and no psychosis.
BDI: 21 items, each scored 0 to 3, total 0 to 63; a higher score means more severe symptoms.
BDI strengths: quick, standardised, quantitative data; weaknesses: self-report (social desirability bias) and possible cultural bias.
Concurrent validity: a new scale agrees with an established scale taken at the same time.

Common mistake

Students diagnose bipolar disorder whenever mood changes are mentioned. Look for a manic episode (type I) or a hypomanic episode with depression (type II); without either, it is unipolar.

Worked example

Nadia has had three depressive episodes. Last year she also had four days of unusually high mood and energy, slept little and talked fast, but kept working normally. Which ICD-11 diagnosis fits?

She has had depressive episodes, so depressive disorder or a bipolar disorder is possible.
The high period was mild and did not impair her work, so it was hypomania, not mania.
Hypomania rules out unipolar depression; no manic episode rules out bipolar type I.

Answer: Bipolar disorder type II.

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