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

MDQ: Mood Disorder Questionnaire Overview

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 and Availability

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