Difficulty: Intermediate | Prerequisites: Familiarity with mood disorders, DSM-5 basics
The Altman Self-Rating Mania Scale (ASRM) is one of the APA's "emerging measures" adopted into the DSM-5 cross-cutting assessment framework. It sits at Level 2, meaning a patient only encounters it after flagging possible manic symptoms on the broader Level 1 screening. Understanding the ASRM matters for clinical psychology because it is one of very few validated self-report tools for mania, a symptom domain where patient insight is often limited. You should already be comfortable with the basics of bipolar spectrum disorders and the general structure of DSM-5 diagnostic assessment before diving in.
The ASRM is a brief, 5-item self-report questionnaire that measures the presence and severity of manic symptoms over the past week. Each item is scored 1 to 5, giving a total range of 5 to 25. A total score of 6 or higher suggests a high probability of a manic or hypomanic condition and may indicate a need for further clinical workup.
ASRM (Altman Self-Rating Mania Scale)
A 5-item self-report instrument designed to assess the presence and severity of manic symptoms over the past 7 days. Developed by Altman, Hedeker, Peterson and Davis (1997) and published in Biological Psychiatry.
In simple terms, it is a short checklist a patient fills out before seeing their clinician, rating how elevated their mood, confidence, energy, talkativeness and activity levels have been that week.
DSM-5 Cross-Cutting Symptom Measures
A two-level assessment framework built into the DSM-5. Level 1 is a broad screening across multiple psychiatric domains. Level 2 measures drill deeper into a specific domain flagged at Level 1.
Think of it as triage: Level 1 casts a wide net, Level 2 zooms in on whatever the net caught.
Mania
A state of abnormally elevated, expansive or irritable mood accompanied by increased energy or activity, lasting at least one week (or any duration if hospitalisation is required). A defining feature of Bipolar I Disorder.
In simple terms, a period where someone's mood, energy and behaviour go well beyond their normal baseline, often with impaired judgement.
Hypomania
A milder form of mania lasting at least four consecutive days. Symptoms are observable by others but do not cause severe functional impairment or require hospitalisation. A defining feature of Bipolar II Disorder.
Think of it as mania's quieter cousin: noticeable but not disabling.
Prorated Score
A scoring adjustment used when exactly one item on the ASRM is left unanswered. Calculated by summing the answered items, multiplying by 5 (the total number of items), and dividing by 4 (the number actually answered). The result is rounded to the nearest whole number.
In simple terms, an estimated total that fills in for one missing answer so the scale can still be interpreted.
Self-Report Measure
Any standardised instrument completed by the patient (or a knowledgeable informant) rather than by the clinician through direct observation or structured interview.
Think of it as the patient's own account, captured in a consistent, scorable format.
The ASRM functions as a Level 2 measure in the DSM-5 cross-cutting framework.
A patient reaches it only after endorsing mania-related items on the Level 1 cross-cutting questionnaire, specifically: "sleeping less than usual, but still having a lot of energy" and/or "starting lots more projects than usual or doing more risky things than usual" at mild or greater severity.
It is classified as an "emerging measure" by the APA, intended for research and clinical enhancement rather than as a standalone diagnostic tool.
5 items (called "statement groups" or "question groups"), each addressing one symptom domain.
Each item offers 5 response options scored 1 through 5.
The patient selects the single statement that best describes their experience over the past 7 days.
Question 1: Elevated mood. Ranges from "I do not feel happier or more cheerful than usual" (1) to "I feel happier or more cheerful than usual all of the time" (5).
Question 2: Self-confidence. Ranges from "I do not feel more self-confident than usual" (1) to "I feel extremely self-confident all of the time" (5).
Question 3: Sleep need. Ranges from "I do not need less sleep than usual" (1) to "I can go all day and all night without any sleep and still not feel tired" (5).
Question 4: Talkativeness (pressured speech). Ranges from "I do not talk more than usual" (1) to "I talk constantly and cannot be interrupted" (5).
Question 5: Activity level. Ranges from "I have not been more active (either socially, sexually, at work, home, or school) than usual" (1) to "I am constantly more active or on the go all the time" (5).
The ASRM defines its frequency words precisely, which matters for accurate scoring:
"Occasionally" = once or twice
"Often" = several times or more
"Frequently" = most of the time
Completed by the patient before their clinical appointment.
If the patient has impaired capacity (e.g. dementia), a knowledgeable informant may complete it instead.
The informant version asks the same questions but includes fields to record the informant's relationship to the patient and the number of hours per week they spend together.
The measure can be re-administered at regular intervals to track symptom change over time. For patients with impaired capacity, the same informant should complete follow-up administrations for consistency.
Each of the 5 items is scored 1 to 5.
Sum all 5 item scores to get the total raw score.
Score range: 5 to 25. Higher scores indicate greater severity of manic symptoms.
Score of 6 or higher: High probability of a manic or hypomanic condition. May indicate a need for treatment and/or further diagnostic workup.
Score of 5 or lower: Less likely to be associated with significant symptoms of mania.
Note that the cut-off of 6 is quite low on a 5-to-25 scale. A score of 6 means the patient endorsed even slightly elevated responses on just one or two items. This reflects the scale's design as a sensitive screening tool rather than a diagnostic instrument.
The rules here are strict and are commonly tested:
2 or more items unanswered (more than 25% missing): the scores should not be used at all. Encourage the patient to complete every item.
Exactly 1 item unanswered (4 of 5 answered): calculate a prorated score.
Prorated Score = (Partial Raw Score x 5) / 4
Where:
Partial Raw Score = sum of the 4 answered items
5 = total number of items on the ASRM
4 = number of items actually answered
Round the result to the nearest whole number, then interpret it using the same interpretation table above.
Suppose a patient answers 4 items with scores of 2, 3, 1 and 2 (one item left blank).
Partial raw score = 2 + 3 + 1 + 2 = 8
Prorated score = (8 x 5) / 4 = 40 / 4 = 10
Interpretation: 10 is well above 6, indicating a high probability of a manic or hypomanic condition.
"The ASRM can diagnose bipolar disorder." It cannot. It is a screening and severity-tracking tool, not a diagnostic instrument. The APA is explicit: these measures should enhance clinical decision-making, not replace it.
"A low score rules out mania." A score of 5 or lower is described as "less likely" to be associated with significant mania. That is a probabilistic statement, not a rule-out. Self-report scales are inherently limited by the patient's insight, which is often impaired during manic episodes.
"The scale measures symptoms over the past two weeks." The Level 1 cross-cutting questionnaire uses a two-week window. The ASRM itself asks about the past 7 days. Students frequently confuse these two timeframes.
"If any items are missing, you can still calculate a total." Only if exactly 1 item is missing. With 2 or more items unanswered, the score is invalid and should not be used.
⚠️ Know the cut-off: a total raw score of 6 or higher = high probability of mania/hypomania. This is the single most testable number from the ASRM.
⚠️ The recall window is 7 days, not 14. The 14-day window belongs to the Level 1 cross-cutting measure, not the ASRM.
⚠️ The prorated scoring formula is a common calculation question. Remember: multiply the partial raw score by 5, divide by 4, round to the nearest whole number.
⚠️ The ASRM is a self-report tool, completed by the patient (or informant), not the clinician. The clinician reviews and records scores during the interview but does not administer the questions.
⚠️ The scale tracks five specific domains: elevated mood, self-confidence, reduced sleep need, talkativeness, and increased activity. These map closely to DSM-5 criteria for a manic episode.
In clinical practice, the ASRM is typically handed to a patient in the waiting room before their appointment. The clinician reviews it during the session, using item-level responses to guide the clinical interview. For patients on mood stabilisers or other treatments for bipolar disorder, repeated ASRM administrations over time provide a simple, quantifiable way to track whether manic symptoms are improving, stable or worsening. This is the kind of measure a community mental health clinic would use for routine outcome monitoring.
Answer true or false (answers below):
The ASRM contains 10 items. (False. It has 5 items.)
Each item is scored on a scale of 1 to 5. (True.)
A total score of 6 or higher suggests a high probability of mania or hypomania. (True.)
The ASRM asks patients to rate their symptoms over the past 14 days. (False. The recall window is 7 days.)
If 3 out of 5 items are left unanswered, you should calculate a prorated score. (False. With 2 or more items missing, the score is invalid and should not be used.)
Q: What is the score range of the ASRM, and what does a higher score indicate?
A: The range is 5 to 25. Higher scores indicate greater severity of manic symptoms.
Q: A patient completes the ASRM and scores 2, 1, 3, 1, 2 on the five items. What is their total raw score, and how should it be interpreted?
A: Total raw score = 2 + 1 + 3 + 1 + 2 = 9. A score of 6 or higher indicates a high probability of a manic or hypomanic condition, so this patient's score warrants further clinical evaluation.
Q: A patient answers only 4 of the 5 ASRM items, with scores of 3, 2, 4, and 3. Calculate the prorated score.
A: Partial raw score = 3 + 2 + 4 + 3 = 12. Prorated score = (12 x 5) / 4 = 60 / 4 = 15. The prorated total raw score is 15, well above the cut-off of 6.
Q: Under what circumstance should ASRM scores not be used at all?
A: When 2 or more items are left unanswered (more than 25% of total items missing), the scores are invalid and should not be used.
Q: The ASRM is classified as a Level 2 measure. What does this mean in the DSM-5 cross-cutting framework?
A: It means the ASRM is a domain-specific follow-up measure administered only after a patient flags possible symptoms on the broader Level 1 cross-cutting screening questionnaire. Level 2 measures provide more detailed assessment of a specific symptom domain.
Q: Name the five symptom domains assessed by the ASRM.
A: Elevated mood (cheerfulness), self-confidence, reduced need for sleep, talkativeness (pressured speech), and increased activity level.
The ASRM connects directly to your study of bipolar spectrum disorders (Bipolar I and Bipolar II), since the symptoms it measures are the hallmark features of manic and hypomanic episodes. Understanding how mania is assessed gives you a practical grounding in what the DSM-5 criteria look like when translated into a clinical tool.
It also ties into psychometrics and clinical assessment more broadly. The ASRM is an example of a brief, validated self-report screening instrument, and the concepts of sensitivity, cut-off scores and prorated scoring apply across many clinical measures you will encounter.
Finally, the two-level cross-cutting framework illustrates a broader trend in modern psychiatry: dimensional assessment alongside categorical diagnosis. Rather than simply assigning a diagnosis, the DSM-5 encourages tracking symptom severity across domains over time, and the ASRM is one piece of that system.
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