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


Bipolar and Related Disorders: Specified With Anxious Distress

The DSM-5-TR outlines a few specifiers to help specify the condition of cyclothymic disorder according to the different states and condition of the individual.These specifiers are as followed:

Specify if:
- With anxious distress


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A. The hypomanic symptoms and depressive symptoms have persisted for at least 2 years (at least a year in children and adolescents) without meeting the criteria for hypomanic episodes and major depressive episodes.

B. Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

C. Criteria for a major depressive, manic, or hypomanic episode have never been found.

D. Schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders cannot be used to explain the symptoms in Criterion A.

E. The symptoms are not ascribed to the physiological effects of a substance or another medical condition.  

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 


[DSM-5-TR] Diagnostic Criteria of Cyclothymic Disorder

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

DSM-5-TR

[DSM-5-TR] Specifiers of Cyclothymic Disorder

- The major feature of cyclothymic disorder is a chronic, fluctuating mood disturbance including plentiful periods of hypomanic symptoms and periods of depressive symptoms (Criterion A). 

- During the initial 2-year period (1 year for children or adolescents), the symptoms must be persistent and any symptom-free intervals last no longer than 2 months (Criterion B). 

- The diagnosis of cyclothymic disorder is made only if the criteria for a major depressive, manic, or hypomanic episode have never been met (Criterion C).

- The cyclothymic disorder diagnosis is not made if the pattern of mood swings is better explained by other specified and unspecified schizophrenia spectrum and other psychotic disorders (Criterion D). 

- The mood disturbance must also not be ascribed to the physiological effects of a substance or another medical condition (Criterion E). 

- Although some individuals may function particularly well during some of the periods of hypomania, over the prolonged course of the disorder, there must be clinically significant distress or impairment in some important areas of functioning as a result of the mood disturbance (Criterion F). 


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