126 Bipolar and Related Disorders
sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Cri-
terion A, which may resemble a depressive episode. Although such symptoms may be un-
derstandable or considered appropriate to the loss, the presence of a major depressive
episode in addition to the normal response to a significant loss should also be carefully
considered. This decision inevitably requires the exercise of clinical judgment based on
the individual’s history and the cultural norms for the expression of distress in the context
of loss.1
Bipolar I Disorder
A. Criteria have been met for at least one manic episode (Criteria A–D under “Manic Ep-
isode” above).
B. The occurrence of the manic and major depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional dis-
order, or other specified or unspecified schizophrenia spectrum and other psychotic
disorder.
Coding and Recording Procedures
The diagnostic code for bipolar I disorder is based on type of current or most recent epi-
sode and its status with respect to current severity, presence of psychotic features, and
remission status. Current severity and psychotic features are only indicated if full criteria
are currently met for a manic or major depressive episode. Remission specifiers are only
indicated if the full criteria are not current ly met for a manic, hypomanic, or major depres-
sive episode. Codes are as follows:
1In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in
grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent
depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is