A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day, and including at least three of the following symptoms:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience of racing thoughts
5. Distractibility
6. Increase in goal-directed activity (socially, at work or school, or sexually) or physical agitation. Excessive involvement in activities with high potential for painful consequences (e.g., buying sprees, foolish investments, sexual indiscretions)

Five or more of the following symptoms present during the same two-week period:

1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all or almost all activities
3. Significant unintended weight loss or change in appetite
4. Insomnia or hypersomnia
5. Being physically agitated or listless
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive/inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, or a plan for suicide

At least one of the symptoms is either depressed mood or loss of interest or pleasure.

1. Excessive anxiety or worry, occurring more days than not for at least six months, about a number of events or activities
2. Difficulty controlling the worry
3. The anxiety or worry is associated with at least three of the following symptoms:
   1. Restlessness or feeling on edge
   2. Being easily fatigued
   3. Difficulty concentrating or mind going blank
   4. Irritability
   5. Muscle tension
   6. Sleep disturbance

Obsessions:

1. Recurrent and persistent thoughts, urges, or images that are experienced  as intrusive and unwanted and, in most individuals, cause marked anxiety or distress
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions:

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, silently repeating words) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, they are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

BPD is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following symptoms:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms