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 might lose control of himself or herself