MDQ: Mood Disorder Questionnaire

Foundational Context

The Mood Disorder Questionnaire was developed by Robert Hirschfeld and colleagues (2000) to address the persistent underdiagnosis and misdiagnosis of bipolar disorder in clinical settings. Prior to the MDQ, no brief validated self-report instrument existed specifically for bipolar spectrum screening. Studies at the time documented that many patients with bipolar disorder were initially misdiagnosed with unipolar depression and received inadequate or potentially harmful treatment as a result.

The MDQ maps directly onto DSM criteria for a manic or hypomanic episode and applies a three-criterion algorithm designed to balance sensitivity and specificity. Its development involved systematic extraction of bipolar-associated symptoms from the Structured Clinical Interview for DSM (SCID), translated into accessible lay language for self-completion. The MDQ can typically be completed in 5 minutes and is appropriate for use in primary care, outpatient psychiatry, and research contexts.

What the Assessment Measures

The MDQ assesses manic and hypomanic symptom history across three criteria:

Criterion 1, Symptom checklist (13 items): Respondents indicate whether they have ever experienced each of the following during the same period of time:

• Feeling so good or hyper that others thought you were not your normal self, or were so hyper you got into trouble
• Being so irritable that you shouted at people or started fights
• Feeling much more self-confident than usual
• Getting much less sleep than usual but still feeling full of energy
• Being much more talkative or speaking faster than usual
• Thoughts racing through your head, unable to slow down
• Being easily distracted by things around you, trouble concentrating
• Having much more energy than usual
• Being much more active or doing many more things than usual
• Being much more social or outgoing than usual
• Being much more interested in sex than usual
• Doing things that are unusual or risky
• Spending money in ways that got you into trouble

Criterion 2, Symptom clustering: Whether several endorsed symptoms occurred during the same time period.

Criterion 3, Functional impact: Whether the symptoms caused moderate or serious problems.

Interpretation Guidelines

A positive screen requires meeting all three criteria simultaneously:

• Criterion 1: ≥7 of 13 symptoms endorsed
• Criterion 2: Multiple symptoms co-occurred during the same period (answer: Yes)
• Criterion 3: Symptoms caused moderate or serious problems (not "no problem" or "minor problem")

Interpretation Notes:

• Sensitivity for bipolar I disorder: approximately 73%; specificity: approximately 90% (Hirschfeld et al., 2000).
• The MDQ shows lower sensitivity for bipolar II disorder (~58%), a positive screen increases likelihood of a bipolar spectrum condition, but a negative screen does not rule out bipolar II or cyclothymia.
• A positive MDQ indicates the need for a structured clinical interview, not a diagnosis.
• Comorbid conditions (e.g., ADHD, borderline personality disorder, substance use) can produce false-positive screens; clinical context is essential.
• Some researchers use a more relaxed Criterion 3 threshold (any problem vs. moderate/serious) to improve sensitivity.

Psychometric Properties

Reliability

• Good internal consistency for the 13-item checklist (α ≈ 0.90)
• Adequate test-retest reliability in outpatient samples

Validity

• Sensitivity 73%, specificity 90% for bipolar I in psychiatric outpatient settings
• Well-validated in primary care, specialty mental health, and community samples
• Positive predictive value varies by setting and base rate of bipolar disorder in the sample
• Consistently distinguishes bipolar spectrum disorders from unipolar depression in screening contexts

Administration Considerations

• Self-administered; requires approximately 5 minutes
• Available in multiple languages; widely used internationally
• Appropriate for adults; adolescent validation is less robust, use validated pediatric measures (e.g., Y-MRS, PGBI) for youth
• Should be followed by structured diagnostic assessment when screen is positive
• Most useful in populations where bipolar disorder has a meaningful base rate (e.g., patients presenting with treatment-resistant depression, recurrent mood episodes, or family history of bipolar disorder)

Limitations

• Substantially lower sensitivity for bipolar II disorder and cyclothymia than for bipolar I
• Does not assess current severity or phase of illness, only lifetime manic/hypomanic symptom history
• False positives can arise from ADHD, borderline personality disorder, substance intoxication, or anxiety disorders
• Not designed for monitoring treatment response or tracking symptom change over time
• A negative screen should not be used to exclude bipolar disorder in clinically suspicious presentations

References

Additional Context

HiBoop automates MDQ delivery, scoring, and longitudinal mood tracking. Screen for bipolar spectrum disorders alongside PHQ-9 and GAD-7 in a single session.

The MDQ (Mood Disorder Questionnaire) is a validated 13-item self-report screening tool Each item asks about lifetime history of elevated/expansive mood symptoms ("Has there ever been a period of time when you were not your usual self and..."). A positive MDQ screen requires: (1) ≥7 of 13 "yes" answers, (2) several symptoms occurring during the same time period, and (3) moderate or serious functional impairment.

This interactive MDQ online test calculates your symptom count and determines screen status based on the three-criterion algorithm. The MDQ has sensitivity of 73% and specificity of 90% in primary care and outpatient settings. It screens for bipolar I, bipolar II, and bipolar NOS. A positive screen requires follow-up clinical evaluation – it does not constitute a diagnosis. For related tools, see our assessment library and learn about measurement-based care.

HiBoop supports automated MDQ delivery with integrated scoring and longitudinal mood tracking for bipolar spectrum monitoring in mental health practices.

The Mood Disorder Questionnaire (MDQ) is the most widely validated self-report screening tool for bipolar spectrum disorders. It assesses lifetime history of manic and hypomanic symptoms associated with bipolar I and II disorder. Developed by Hirschfeld et al. (2000), it is designed for use in primary care and mental health settings.

For each item, answer Yes or No based on your lifetime experience. Then answer the two follow-up questions about timing and functional impact.

All 13 items use a Yes / No format. After completing the items, answer the two follow-up questions.

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

Symptom Clustering

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

Functional Impairment

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

A positive MDQ screen suggests elevated likelihood of a bipolar spectrum disorder. This is not a diagnosis. Clinical evaluation is required.

A negative MDQ screen does not rule out bipolar disorder. Clinical judgment is always required.

MDQ Scoring and Interpretation

MDQ Psychometric Properties

Among individuals with confirmed bipolar disorder, 73% will screen positive on the MDQ (Hirschfeld et al., 2000)

Among individuals without bipolar disorder, 90% will screen negative, false positive rate is ~10%

Varies with base rate. In mental health settings (higher prevalence), PPV is higher than in primary care

Validated in psychiatric outpatients, primary care, and community samples; not validated in inpatient or adolescent settings

Documenting MDQ results in clinical notes?

MDQ screen status (positive/negative) and criterion breakdown belong in the Objective section of your clinical note. See our SOAP notes guide for templates and examples.

Copyright: The MDQ is in the public domain and free for clinical and research use.