During the course of a Bipolar and Related Disorder, a specifier of “With Anxious Distress” can be made if the majority of days during the current or most recent manic, hypomanic, or major depressive episode (or the majority of symptomatic days in cyclothymic disorder), show the presence of at least two of the following symptoms:
1. Feeling keyed up or tense
2. Feeling unusually restless
3. Difficulty concentrating because of worry
4. Fear that something awful may happen
5. Feeling that the individual might lose control of themself


The DSM-5-TR outlines certain specifiers to help specify the condition of Bipolar and Related Disorders according to the different states and condition of the individual. These specifiers are broken down as followed:

Specify if:
- With Anxious Distress
- With Mixed Features
- With Rapid Cycling
- With Melancholic Features
- With Atypical Features
- With Psychotic Features
- With Catatonia
- With Peripartum Onset
- With Seasonal Patterns

Specify if:
- In Partial Remission
- In Full Remission

Specify current severity of manic episode::
- Mild
- Moderate
- Severe

Specify current severity of major depressive episode:
- Mild
- Moderate
- Severe


[DSM-5-TR] Specifiers for Bipolar and Related Disorders

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

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