Symptoms meet the disorder threshold with limited excess symptoms, distress, and functional impairment.
Deciding signal
Severity describes the whole episode: symptom burden, intensity, risk, and functional impact.
Ask this
Is the current episode genuinely lower in burden and impairment while still meeting the diagnostic threshold?
Typical language
“I can still function, but it takes much more effort”
Clinically meaningful symptoms of the opposite mood pole occur during the predominant mood episode.
Deciding signal
The presentation crosses mood poles rather than being explained by anxiety, irritability, or agitation alone.
Ask this
Are there distinct opposite-pole symptoms during this episode that change diagnostic and treatment reasoning?
Typical language
“I am depressed but my thoughts are racing”
Delusions or hallucinations occur during a severe mood episode and require explicit risk and diagnostic review.
Deciding signal
Psychosis is present, and its relationship to the mood episode determines the diagnostic wording.
Ask this
Do psychotic symptoms occur within the mood episode, and are they mood-congruent, mood-incongruent, or independent?
Typical language
“I know I have ruined everyone”