picture. Bipolar and related disorder due to another medical condition would not be diag-
nosed when the manic or hypomanic episodes definitely preceded the medical condition,
since the proper diagnosis would be bipolar disorder (except in the unusual circumstance
in which all preceding manic or hypomanic episodes—or, when only one such episode has
occurred, the preceding manic or hypomanic episode—were associated with ingestion of
a substance/medication). The diagnosis of bipolar and related disorder due to another
medical condition should not be made during the course of a delirium (Criterion D). The
manic or hypomanic episode in  bipolar and related disorder due to another medical con-
dition must cause clinically significant dist ress or impairment in social, occupational, or
other important areas of fu nctioning to qualify for this diagnosis (Criterion E).
Associated Features Supporting Diagnosis
Etiology (i.e., a causal relationship to anothe r medical condition based on best clinical ev-
idence) is the key variable in this etiologically  specified form of bipolar disorder. The list-
ing of medical conditions that are said to be able to induce mania is never complete, and
the clinician’s best judgment is the essence of  this diagnosis. Among the best known of the
medical conditions that can cause a bipolar manic or hypomanic co ndition are Cushing’s
disease and multiple sclerosis, as well as stroke and traumatic brain injuries. 
Development and Course 
Bipolar and related disorder due to another me dical condition usually has its onset acutely
or subacutely within the firs t weeks or month of the onset of the associated medical con-
dition. However, this is not always the case, as a worsening or later relapse of the associ-
ated medical condition may precede the onset of the manic or hypomanic syndrome. The