Everyone has good days and bad days, and normal ups and downs in their life.  How high do the "ups" have to be to be considered mania, and how low do the "downs" have to be before they are considered part of your loved one's bipolar disorder?

The Diagnostic and Statistical Manual on Mental Disorders (DSM-IV), published by the American Psychiatric Association, states that the mood disturbance must be "sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with other people." 

But who decides what "marked impairment" is?  Although the above is the official definition according to the American Psychiatric Association, the term "marked" can be more subjective than objective. 

You know your loved one best, and you can tell when they are not quite themselves.  If their bipolar symptoms continue for more than a few days, you might consider that "marked impairment," and execute your plan for when your loved one goes into a bipolar episode.

The idea of minor degrees of mania or depression is as old as the concept of temperaments in ancient Greece.  The belief is that some individuals are born happy, with much energy (hyperthymic); others are born sad, with little energy (dysthymic); and a few cycle between these two temperaments (cyclothymic).[1]

In recent years, interest in temperaments has been revived by psychiatrists such as Hagop Akiskal in San Diego and Athanasio Koukopoulos in Rome.  Akiskal, in particular, argues for official recognition of what he calls "bipolar III disorder," which is recurrent depression alternating with a hyperthymic temperament.[2]

Both psychiatrists also talk about "subsyndromal depression" and "mini-depressions" as part of the bipolar spectrum.  Akiskal estimates that "3 to 6 percent of the general population, possibly worldwide, seem to exhibit temperamental instability along hypomanic or cyclothymic lines."[3]

This debate points out the importance of defining the outer boundaries of bipolar disorder itself.  Chronic laziness with no energy is not the same as bipolar depression.  On the other hand, workaholism with high energy is not the same thing as bipolar mania.

As I stated earlier, you know your loved one best, and should be able to tell what is just a "bad bipolar day" and what is symptomatic of a bipolar depressive episode and what is just a "good mood" and what is symptomatic of a bipolar manic episode.  Use your own judgment or, if you are not sure, check with your loved one's doctor, psychiatrist, or therapist.

[1] Torry, M.D., E. Fuller and Michael B. Knable, D.O., Surviving Manic Depression, Basic Books, 2005

[2] H.S. akiskal, "The prevalent clinical spectrum of bipolar disorders: Beyond DSM-IV,"Journal of Clinical Pharmacology; 06

[3] Ibid