Conditions for Further Study 787
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 dec rease or increase in appetite nearly every
day. ( Note:  In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not
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 delu-
sional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (ei-
ther by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with-
out a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance or an-
other medical condition.
D. The disturbance is not better explained by schizoaffective disorder and is not superim-
posed on schizophrenia, schizophreniform disorder , delusional disorder, or other spec-
ified or unspecified schizophrenia spectrum and other psychotic disorder.
At least two lifetime episodes of hypomanic periods that involve the required crite-
rion symptoms below but are of  insufficient duration (a t least 2 days but less than
4 consecutive days) to meet criteria fo r a hypomanic episode. The criterion symp-