rent severity, presence of psychotic features, course, and other specifiers cannot be
coded but should be indicated in writing (e.g., 296.89 [F31.81] bipolar II disorder, current
episode depressed, moderate severity, with mi xed features; 296.89 [F31.81] bipolar II dis-
order, most recent episode depressed, in partial remission).
Specify current or most recent episode: 
Hypomanic  
Depressed
Specify if:
With anxious distress (p. 149)
With mixed features (pp. 149–150)
1In distinguishing grief from a major  depressive episode (MDE), it is useful to consider that in grief
the predominant affect is feelings of emptiness an d loss, while in a MDE it is persistent depressed
mood and the inability to anticipate happiness or  pleasure. The dysphoria in grief is likely to
decrease in intensity over days to weeks and occurs in waves, the so-called pangs of grief. These
waves tend to be associated with thoughts or re minders of the deceased. The depressed mood of a
MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may
be accompanied by positive emotions and humor th at are uncharacteristic of the pervasive unhap-
piness and misery characteristic of a MDE. The thought content associated with grief generally fea-
tures a preoccupation with thoughts and memories of the deceased, rather than the self-critical or
pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a
MDE feelings of worthlessness and self-loathing ar e common. If self-derogatory ideation is present
in grief, it typically involves pe rceived failings vis-à-vis the deceased (e.g., not visiting frequently