Bipolar I Disorder 129
neously. Some individuals write excessive letters , e-mails, text messages, and so forth, on
many different topics to friends,  public figures, or the media. 
The increased activity criterion can be diffic ult to ascertain in children; however, when
the child takes on many tasks simultaneously, starts devising elaborate and unrealistic
plans for projects, develops previously abse nt and developmentally inappropriate sexual
preoccupations (not accounted for by sexual abuse or exposure  to sexually explicit mate-
rial), then Criterion B might be met based on clinical judgment. It is essential to determine
whether the behavior represents a change from the child’s baseline behavior; occurs most
of the day, nearly every day for the requisite time period; and occurs in temporal associa-
tion with other symptoms of mania. 
The expansive mood, excessive optimism, gr andiosity, and poor judgment often lead
to reckless involvement in activities such as spending sprees, giving away possessions,
reckless driving, foolish business investments,  and sexual promiscuity that is unusual for
the individual, even though these activities ar e likely to have catastrophic consequences
(Criterion B7). The individual may purchase  many unneeded items without the money to
pay for them and, in some cases, give them  away. Sexual behavior may include infidelity
or indiscriminate sexual encounters with strangers, often disregarding the risk of sexually
transmitted diseases or in terpersonal consequences.
The manic episode must result in marked impairment in social or occupational func-
tioning or require hospitalizatio n to prevent harm to self or others (e.g., financial losses, il-
legal activities, loss of employment, self-injur ious behavior). By definition, the presence of
psychotic features during a manic episode also satisfies Criterion C.