Mood Disorder Questionnaire (MDQ)

Bipolar Disorder Screening — Validated Self-Report Assessment

✓ Clinically Validated ⚗ 3-Part Assessment 🔒 100% Private
13+2 Items 3 Sections
2.8% Adults / Bipolar Disorder
Used by 1000s of Clinicians
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Section 1: Symptom Checklist (Questions 1–13)

Has there ever been a period of time when you were not your usual self and...

1 ...you felt so good or so hyper that other people thought you were not your normal self, or you were so hyper that you got into trouble?

2 ...you were so irritable that you shouted at people or started fights or arguments?

3 ...you felt much more self-confident than usual?

4 ...you got much less sleep than usual and found you didn’t really miss it?

5 ...you were much more talkative or spoke much faster than usual?

6 ...thoughts raced through your head or you couldn’t slow your mind down?

7 ...you were so easily distracted by things around you that you had trouble concentrating or staying on track?

8 ...you had much more energy than usual?

9 ...you were much more active or did many more things than usual?

10 ...you were much more social or outgoing than usual; for example, you telephoned friends in the middle of the night?

11 ...you were much more interested in sex than usual?

12 ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?

13 ...spending money got you or your family into trouble?

Section 2: Co-occurrence

If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

Section 3: Functional Impairment

How much of a problem did any of these cause you — like being unable to work; having family, money, or legal troubles; getting into arguments or fights?

Understanding Bipolar Disorder

Bipolar disorder is a chronic mental health condition characterized by extreme shifts in mood, energy, and activity levels. These mood episodes go far beyond the normal ups and downs that everyone experiences. The condition affects approximately 2.8% of adults in the United States and typically emerges in late adolescence or early adulthood.

Types of Bipolar Disorder:

  • Bipolar I Disorder: Defined by manic episodes lasting at least 7 days (or requiring hospitalization). Manic episodes involve extremely elevated or irritable mood, increased energy, decreased need for sleep, racing thoughts, grandiosity, and risky behavior. Depressive episodes typically occur as well, lasting at least 2 weeks.
  • Bipolar II Disorder: Characterized by a pattern of hypomanic episodes (a less severe form of mania lasting at least 4 days) and major depressive episodes. People with Bipolar II never experience full-blown mania, but the depressive episodes can be severe and debilitating.
  • Cyclothymic Disorder (Cyclothymia): Defined by periods of hypomanic symptoms and depressive symptoms lasting for at least 2 years (1 year in children and adolescents), but the symptoms do not meet the full diagnostic criteria for a hypomanic episode or a depressive episode.

Mania vs. Hypomania: Mania is a severe episode involving markedly elevated mood, extreme energy, and significant impairment in daily functioning. It may include psychotic features such as delusions or hallucinations. Hypomania involves similar but milder symptoms that are noticeable to others but do not cause severe impairment or require hospitalization.

Depressive Episodes: Bipolar depression shares many features with major depressive disorder, including persistent sadness, loss of interest, fatigue, sleep disturbances, difficulty concentrating, and feelings of worthlessness. However, bipolar depression often includes features like hypersomnia (excessive sleep), increased appetite, and psychomotor retardation (slowed physical movements).

How the MDQ Screening Works

The Mood Disorder Questionnaire (MDQ) was developed by Dr. Robert M.A. Hirschfeld and colleagues in 2000 as a brief, self-report screening instrument for bipolar spectrum disorders. It is one of the most widely used screening tools for bipolar disorder in both clinical and community settings.

The 3-Part Structure:

  • Section 1 (13 Yes/No items): Screens for lifetime history of manic or hypomanic symptoms derived from DSM-IV criteria and clinical experience. These symptoms include elevated mood, irritability, increased self-confidence, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased energy, increased activity, increased sociability, hypersexuality, risky behavior, and excessive spending.
  • Section 2 (Co-occurrence): Asks whether several of the endorsed symptoms occurred during the same time period, which is a key feature distinguishing bipolar episodes from isolated symptoms.
  • Section 3 (Functional Impairment): Assesses the degree to which these symptoms caused problems in daily life, from no problem to serious problem.

Scoring: A positive screen requires all three criteria to be met: (1) 7 or more “Yes” responses in Section 1, (2) “Yes” to co-occurrence in Section 2, and (3) at least “Moderate” functional impairment in Section 3.

Sensitivity and Specificity: In the original validation study (Hirschfeld et al., 2000), the MDQ demonstrated a sensitivity of 0.73 and specificity of 0.90 in a psychiatric outpatient population. In community (general population) settings, sensitivity tends to be lower (approximately 0.28), while specificity remains high (approximately 0.97). This means the MDQ is better at ruling out bipolar disorder (few false positives) than at detecting all cases (some false negatives).

Clinical Use: The MDQ is intended as a screening tool, not a diagnostic instrument. A positive screen suggests the need for a comprehensive diagnostic evaluation by a qualified mental health professional. A negative screen does not definitively rule out bipolar disorder.

Treatment Options for Bipolar Disorder

Bipolar disorder is a treatable condition. Most people with bipolar disorder require a combination of medication and psychotherapy for optimal management. Treatment is typically lifelong and aims to stabilize mood, prevent episodes, and improve quality of life.

Mood Stabilizers:

  • Lithium: The oldest and most well-studied mood stabilizer. It is effective for treating acute mania and preventing both manic and depressive episodes. Requires regular blood monitoring to maintain therapeutic levels and avoid toxicity.
  • Valproate (Depakote): An anticonvulsant commonly used as a mood stabilizer. Effective for acute mania and mixed episodes. Also requires blood monitoring.
  • Lamotrigine (Lamictal): Particularly effective for preventing bipolar depressive episodes. Generally well-tolerated with fewer side effects than lithium or valproate.
  • Carbamazepine (Tegretol): Another anticonvulsant used when other mood stabilizers are not effective or tolerated.

Atypical Antipsychotics:

  • Quetiapine (Seroquel): FDA-approved for bipolar mania, bipolar depression, and maintenance treatment.
  • Olanzapine (Zyprexa): Used for acute mania and maintenance treatment. Often combined with fluoxetine for bipolar depression.
  • Aripiprazole (Abilify): Approved for acute mania and maintenance treatment.
  • Lurasidone (Latuda): Approved specifically for bipolar depression.

Psychotherapy:

  • Cognitive Behavioral Therapy (CBT): Helps identify and change negative thought patterns, develop coping strategies, and improve medication adherence.
  • Interpersonal and Social Rhythm Therapy (IPSRT): Focuses on stabilizing daily routines, sleep-wake cycles, and interpersonal relationships — all of which can trigger mood episodes when disrupted.
  • Family-Focused Therapy: Involves family members in treatment to improve communication, reduce conflict, and increase support.
  • Psychoeducation: Teaching patients and families about bipolar disorder, treatment options, early warning signs of episodes, and self-management strategies.

Living with Bipolar Disorder

With proper treatment and self-management, many people with bipolar disorder lead full, productive lives. The following strategies are supported by research and clinical experience:

Mood Tracking:

  • Keep a daily mood chart or use a mood tracking app to identify patterns, triggers, and early warning signs of episodes
  • Track sleep, medication, exercise, stress levels, and life events alongside mood
  • Share mood records with your treatment team to help guide decisions

Sleep Importance:

  • Sleep disruption is one of the most powerful triggers for manic and hypomanic episodes
  • Maintain a consistent sleep schedule — go to bed and wake up at the same time every day, including weekends
  • Aim for 7–9 hours of sleep per night
  • Avoid all-nighters, jet lag, and shift work when possible

Identifying and Managing Triggers:

  • Common triggers include sleep loss, substance use, major life changes, interpersonal conflict, seasonal changes, and medication non-adherence
  • Develop a personalized “wellness plan” that lists your triggers, early warning signs, and coping strategies
  • Reduce or eliminate alcohol and recreational drug use, as these can destabilize mood and interfere with medications

Building Support Systems:

  • Identify trusted friends, family members, or peers who can provide support and notice early warning signs
  • Consider joining a bipolar disorder support group (in-person or online) such as those offered by the Depression and Bipolar Support Alliance (DBSA) or the National Alliance on Mental Illness (NAMI)
  • Maintain regular appointments with your psychiatrist and therapist, even when you feel well
  • Create an advance directive or crisis plan outlining your treatment preferences in case of a severe episode

Frequently Asked Questions

The Mood Disorder Questionnaire (MDQ) is a brief, validated self-report screening instrument for bipolar spectrum disorders. It was developed by Dr. Robert M.A. Hirschfeld and colleagues in 2000 and published in the American Journal of Psychiatry. The MDQ consists of 13 yes/no questions about manic or hypomanic symptoms, one question about whether these symptoms co-occurred, and one question about the level of functional impairment caused. It is designed to be completed in approximately 5 minutes and is one of the most widely used bipolar disorder screening tools in clinical practice.

A positive screen on the MDQ means that you endorsed 7 or more manic/hypomanic symptoms in Section 1, indicated that several of these symptoms occurred during the same time period (Section 2), and reported that these symptoms caused at least moderate functional impairment (Section 3). A positive screen does not mean you have bipolar disorder — it means that further evaluation by a psychiatrist or other qualified mental health professional is recommended. The MDQ has a specificity of approximately 90%, meaning that most people who screen negative truly do not have bipolar disorder, but some who screen positive may not have the condition after a comprehensive evaluation.

The primary difference lies in the severity of the manic episodes. Bipolar I involves full manic episodes — periods of abnormally and persistently elevated, expansive, or irritable mood lasting at least 7 days (or any duration if hospitalization is required), accompanied by markedly increased energy and at least three additional manic symptoms. Manic episodes may include psychotic features. Bipolar II involves hypomanic episodes — similar to mania but less severe, lasting at least 4 days, and not causing marked impairment or requiring hospitalization. People with Bipolar II also experience major depressive episodes, which are often the predominant and most distressing aspect of the illness. Both types are serious mental health conditions that benefit from treatment.

Bipolar disorder is a chronic (lifelong) condition that currently cannot be cured. However, it is highly treatable. With appropriate medication (such as mood stabilizers, atypical antipsychotics, or a combination), psychotherapy (such as CBT or Interpersonal and Social Rhythm Therapy), and lifestyle management (regular sleep, mood monitoring, trigger avoidance), most people with bipolar disorder can achieve significant symptom control and lead productive, fulfilling lives. Early diagnosis and consistent treatment are key to better long-term outcomes. Many people with bipolar disorder are able to work, maintain relationships, and achieve their personal goals with proper management.

Bipolar disorder is diagnosed through a comprehensive clinical evaluation by a psychiatrist or other qualified mental health professional. The evaluation typically includes a thorough psychiatric history (including mood episodes, duration, severity, and impact on functioning), family history (bipolar disorder has a strong genetic component), medical history, and sometimes psychological testing. The diagnosis is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Screening tools like the MDQ can help identify individuals who may benefit from a full evaluation, but they do not replace a clinical diagnosis. On average, it takes approximately 5–10 years from the onset of symptoms to receive a correct diagnosis of bipolar disorder, highlighting the importance of screening.

No. This tool is a screening instrument only. The MDQ is designed to identify individuals who may be at risk for bipolar disorder and who should seek a comprehensive evaluation from a qualified mental health professional. A positive screen on the MDQ is not equivalent to a diagnosis of bipolar disorder. Similarly, a negative screen does not definitively rule out bipolar disorder. Only a licensed clinician — typically a psychiatrist — can make a formal diagnosis based on a thorough clinical evaluation, including a detailed psychiatric history, symptom assessment, rule-out of other conditions, and consideration of the full clinical picture.

Medical Disclaimer

This Mood Disorder Questionnaire (MDQ) is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The MDQ is a screening tool, not a clinical diagnostic instrument. Your results should be interpreted in the context of a comprehensive evaluation by a qualified healthcare professional, ideally a psychiatrist. If you are experiencing a mental health crisis, please contact the 988 Suicide & Crisis Lifeline (call or text 988) or go to your nearest emergency department. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.

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References

  1. Hirschfeld RMA, Williams JBW, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873-1875.
  2. Hirschfeld RMA, Holzer C, Calabrese JR, et al. Validity of the Mood Disorder Questionnaire: a general population study. Am J Psychiatry. 2003;160(1):178-180.
  3. Miller CJ, Klugman J, Berv DA, Rosenquist KJ, Ghaemi SN. Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. J Affect Disord. 2004;81(2):167-171.
  4. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007;64(5):543-552.

MDQ: Hirschfeld, R.M.A., Williams, J.B.W., Spitzer, R.L., et al. (2000). Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873–1875.